Varicella Vaccine Should Be Withheld in a Child with Active Chickenpox
The varicella vaccine must be withheld (Answer A) when a child has confirmed active varicella infection, as administering live-attenuated vaccine during active disease provides no immunological benefit and is contraindicated. 1
Rationale for Withholding Vaccination
Natural Immunity Supersedes Vaccination
- Once a child has confirmed chickenpox, natural infection provides lifelong immunity that is superior to vaccine-induced immunity, making vaccination unnecessary. 1
- A documented history of varicella disease verified by a healthcare provider constitutes evidence of immunity and is a valid reason to permanently withhold varicella vaccination. 1
- The vaccine does not augment the immune response in someone already infected with wild-type varicella-zoster virus. 1
Clinical Management During Active Infection
Supportive care is the primary treatment for otherwise healthy children with uncomplicated varicella infection. 2
Key management points include:
- Isolate the child until all lesions have crusted over (typically 5-7 days) to prevent spread. 2
- Relieve itching with lukewarm baths containing colloidal oatmeal. 2
- Monitor for bacterial superinfection, particularly invasive group A streptococcal infections, which are the most frequent complications requiring hospitalization. 2
- Watch for signs of complications including pneumonia, dehydration, and encephalitis. 2
Why Other Options Are Incorrect
Option B (postpone until age 2) is incorrect because:
- The standard first dose of varicella vaccine is recommended at 12-15 months of age, not at 2 years. 3, 1
- More importantly, this child now has natural immunity from confirmed infection and requires no vaccination at any age. 1
Option C (give the vaccine now) is contraindicated because:
- Administering live-attenuated vaccine during active infection provides no benefit and unnecessarily consumes healthcare resources. 1
- The vaccine cannot prevent disease that is already occurring.
Option D (vaccine plus immunoglobulin) is incorrect because:
- Varicella-zoster immune globulin (VZIG) is indicated for post-exposure prophylaxis in susceptible high-risk individuals within 96 hours of exposure, not for children with established disease. 3
- VZIG does not treat active infection; it only prevents or attenuates disease when given before symptom onset. 4
- Combining vaccine with immunoglobulin during active infection serves no therapeutic purpose.
Post-Recovery Considerations
No varicella vaccination is needed after recovery from confirmed chickenpox. 2, 1
- Ensure documentation of the verified varicella history is placed in the medical record to prevent future unnecessary vaccination attempts. 1
- Most cases resolve without complications within 5-7 days, and follow-up is typically not necessary unless complications develop. 2
Protection of Household Contacts
For susceptible family members who have been exposed:
- Varicella vaccine may benefit exposed susceptible individuals if administered within 3-5 days of exposure (>90% effective within 3 days, ~70% effective within 5 days). 3, 2, 1
- VZIG may be indicated for high-risk exposed individuals without immunity, including immunocompromised contacts and pregnant women without evidence of immunity. 3, 2