Varicella Vaccine Should Be Withheld in Children with Documented Prior Chickenpox Infection
A child with documented prior varicella infection verified by a healthcare professional does not require varicella vaccination, as natural infection provides lifelong immunity. 1, 2
Evidence of Immunity
The American Academy of Pediatrics and CDC clearly establish that documented history of varicella disease verified by a healthcare professional constitutes valid evidence of immunity to varicella-zoster virus. 3, 1 In this case, the pediatric clinic confirmed the diagnosis and the provider was shown a picture of typical varicella rash, which meets the criteria for healthcare professional verification. 1
Why Vaccination Is Not Needed
- Natural immunity is lifelong: Once a child fully recovers from varicella, no additional varicella vaccination is needed, as natural infection provides lifelong immunity. 1
- Prior infection eliminates the need: Children with documented history of varicella disease verified by a healthcare professional do not require vaccination. 2
- Healthcare verification is sufficient: For patients with typical disease presentation, any healthcare professional can verify immunity, and this verification is considered valid evidence. 1
Important Clinical Considerations
Reliability of Disease History
In the prevaccine era, 97-99% of adults with a positive history of varicella were seropositive. 3 However, the reliability of varicella history has decreased in the vaccine era, with only 75% of unvaccinated children aged 1-4 years who report a positive history actually being seropositive. 3 This is why healthcare professional verification (not just parental report) is critical. 3
Common Pitfall to Avoid
The main concern is misdiagnosis of prior "chickenpox-like" rashes that were actually other conditions, which could lead to incorrect assumptions about immunity. 1 However, in this scenario, a pediatric clinic confirmed the diagnosis with visual documentation of typical varicella rash, making misdiagnosis unlikely.
Alternative Verification if Needed
If there were any doubt about the prior diagnosis (which does not appear to be the case here), serologic testing could be performed to confirm immunity, though this is generally not necessary with clear healthcare professional documentation. 1
Answer to the Question
The correct answer is A: Varicella vaccine withheld. 1, 2
The other options are incorrect:
- Option B (postpone until age 2) is inappropriate because age is irrelevant when natural immunity already exists. 2
- Option C (give the vaccine) would be unnecessary and wasteful, as the child already has natural immunity. 1
- Option D (give vaccine and immunoglobulins) is completely inappropriate; immunoglobulins are only indicated for post-exposure prophylaxis in high-risk individuals without immunity, not for those with documented prior infection. 2