Varicella Vaccine Should Be Withheld in This Child
A child with documented, healthcare provider-verified varicella infection 2 months ago does not need varicella vaccination, as natural infection provides lifelong immunity that is superior to vaccine-induced immunity. 1
Evidence of Immunity Eliminates Need for Vaccination
The Advisory Committee on Immunization Practices (ACIP) explicitly recognizes a diagnosis of varicella by a healthcare provider or healthcare provider verification of a history of disease as evidence of immunity, which is a valid reason to withhold varicella vaccination. 1
A documented history of varicella disease verified by a healthcare provider constitutes evidence of immunity and vaccination provides no additional benefit while wasting resources. 1
Once a child fully recovers from varicella, no additional varicella vaccination is needed, as natural infection provides lifelong immunity. 2
Why Other Options Are Incorrect
Postponing Until Age 2 Years Makes No Sense
There is no immunological rationale for waiting until age 2 years to vaccinate a child who already has documented natural immunity. 1
The standard vaccination schedule calls for the first dose at 12-15 months and second dose at 4-6 years in susceptible children, but this 18-month-old is no longer susceptible. 3, 1
Giving the Vaccine Now Is Contraindicated
Administering varicella vaccine to a child with confirmed prior varicella infection provides no immunological benefit because natural infection already induces immunity, and the vaccine does not augment the immune response. 1
The ACIP recommends against vaccinating individuals with documented immunity, as it provides no additional benefit and wastes resources. 1
Varicella Immunoglobulin Is Not Indicated
Varicella-zoster immune globulin (VZIG or VariZIG) is only indicated for post-exposure prophylaxis in susceptible individuals within 10 days of exposure to prevent or attenuate disease. 4, 5
This child is not susceptible (having recovered from natural infection 2 months ago) and is not currently exposed, making immunoglobulin completely inappropriate. 3
Critical Documentation Point
Ensure documentation of the verified varicella history is placed in the medical record to prevent future unnecessary vaccination attempts. 1
Written documentation of healthcare provider verification of varicella history should be considered valid evidence, as this is more reliable than parental reporting alone. 1
Common Pitfall to Avoid
- Do not confuse this scenario with catch-up vaccination schedules for unvaccinated children—a child with documented natural disease is fundamentally different from being unvaccinated but susceptible. 1