Formulary
Varicella-zoster vaccine: Indications, Dosing, Side Effects and Interactions
For varicella-zoster vaccine Varicella-zoster vaccines are live attenuated vaccines that protect against varicella (chickenpox) caused by varicella-zoster...
MedNext Academy | 6 min read
Varicella-zoster vaccine: Indications, Dosing, Side Effects and Interactions
For varicella-zoster vaccine Varicella-zoster vaccines are live attenuated vaccines that protect against varicella (chickenpox) caused by varicella-zoster...
Drug action
For varicella-zoster vaccine Varicella-zoster vaccines are live attenuated vaccines that protect against varicella (chickenpox) caused by varicella-zoster virus infection.
Indications and dose
**Immunisation against varicella infection (chickenpox)**
- **Child** (By Subcutaneous Injection, Or By Intramuscular Injection): 13-17 years 0.5 mL for 1 dose, then 0.5 mL for 1 dose, to be given at least 6 weeks after initial dose.
- **Adult** (By Subcutaneous Injection, Or By Intramuscular Injection): 0.5 mL for 1 dose, then 0.5 mL for 1 dose, to be given at least 6 weeks after initial dose.
**Post-exposure prophylaxis against varicella infection (chickenpox) during co-circulating group A streptococcal infection (e.g. scarlet fever)**
- **Child** (By Subcutaneous Injection, Or By Intramuscular Injection): 9 months-17 years 0.5 mL for 1 dose, then 0.5 mL for 1 dose, to be given 4 to 8 weeks after initial dose.
- **Adult** (By Subcutaneous Injection, Or By Intramuscular Injection): 0.5 mL for 1 dose, then 0.5 mL for 1 dose, to be given 4 to 8 weeks after initial dose.
**Immunisation against varicella infection (chickenpox) for varicella-zoster vaccine**
- **Child 9-11 months** (By subcutaneous injection, or by intramuscular injection): 0.5 mL for 1 dose, then 0.5 mL for 1 dose, to be given at least 12 weeks after initial dose.
- **Child 1-12 years** (By subcutaneous injection, or by intramuscular injection): 0.5 mL for 1 dose, then 0.5 mL for 1 dose, to be given at least 4 weeks after initial dose.
- **Child 13-17 years** (By subcutaneous injection, or by intramuscular injection): 0.5 mL for 1 dose, then 0.5 mL for 1 dose, to be given at least 6 weeks after initial dose.
**Post-exposure prophylaxis against varicella infection (chickenpox) during co-circulating group A streptococcal infection (e.g. scarlet fever) for varicella-zoster vaccine**
- **Child 9 months-17 years** (By subcutaneous injection, or by intramuscular injection): 0.5 mL for 1 dose, then 0.5 mL for 1 dose, to be given 4 to 8 weeks after initial dose.
Cautions
For all vaccines, general Acute illness; minor illnesses Cautions, further information Illness UKHSA advises vaccination may be postponed if the individual is suffering from an acute illness; however, it is not necessary to postpone immunisation in patients with minor illnesses without fever or systemic upset. Predisposition to neurological problems UKHSA advises: when there is a personal or family history of febrile convulsions, there is an increased risk of these occurring during fever from any cause including immunisation, but this is not a contra-indication to immunisation. In children who have had a seizure associated with fever without neurological deterioration, immunisation is recommended ; advice on the management of fever should be given before immunisation. When a child has had a convulsion not associated with fever, and the neurological condition is not deteriorating, immunisation is recommended ; children with stable neurological disorders (e.g. spina bifida, congenital brain abnormality, and peri-natal hypoxic-ischaemic encephalopathy) should be immunised according to the recommended schedule; when there is a still evolving neurological problem , including poorly controlled epilepsy, immunisation should be deferred and the child referred to a specialist. Immunisation is recommended if a cause for the neurological disorder is identified. If a cause is not identified, immunisation should be deferred until the condition is stable. Impaired immune response and drugs affecting immune response Immune response to vaccines may be reduced in immunosuppressed patients, UKHSA advises consider seeking specialist advice. Cautions For all vaccines, live Cautions, further information Impaired immune response and drugs affecting immune response There is a risk of generalised infection with live vaccines. UKHSA advises seek specialist advice for immunosuppressed patients, including those who are: taking high doses of corticosteroids (dose equivalents of prednisolone: adults , at least 40 mg daily for more than 1 week or at least 20 mg daily for more than 14 days; children , 2 mg/kg (or more than 40 mg) daily for more than 1 week or 1 mg/ kg (or more than 20 mg) daily for more than 14 days); taking immunosuppressive drugs; receiving treatment for malignant or non-malignant conditions with chemotherapy or generalised radiotherapy. UKHSA advises live vaccines should be postponed until at least 3 months after stopping high-dose systemic corticosteroids, or non-biological oral immune modulating drugs; and at least 6 months after stopping other immunosuppressive drugs, or generalised radiotherapy; and at least 12 months after discontinuing immunosuppressive biological therapy. Cautions For varicella-zoster vaccine Post-vaccination close contact with susceptible individuals Cautions, further information UKHSA advises that the risk of transmission of varicella-zoster vaccine virus from immunocompetent vaccinated individuals to susceptible close contacts is very low. If a localised rash develops, the lesions should be covered to reduce the risk of transmission. The risk of transmission is higher with a disseminated rash. UKHSA advises healthcare workers who develop a generalised papular or vesicular rash on vaccination should avoid contact with patients until the lesions have crusted. Those who develop a localised rash after vaccination should cover the lesions and be allowed to continue working unless in contact with patients at high risk of severe varicella. Administration with MMR vaccine UKHSA advises varicella-zoster and MMR vaccines can be given on the same day or separated by a 4-week minimum interval. When protection is rapidly required, the vaccines can be given at any interval and an additional dose of the vaccine given second may be considered.
Contraindications
For all vaccines, live Contra-indications, further information Impaired immune response UKHSA advises severely immunosuppressed patients should not be given live vaccines (including those with severe primary immunodeficiency).
Side effects
For all vaccines, general Common or very common Abdominal pain; appetite decreased; arthralgia; diarrhoea; dizziness; fatigue; fever; headache; lymphadenopathy; malaise; myalgia; nausea; skin reactions; vomiting Uncommon Hypersensitivity Side-effects For all vaccines, live Common or very common Abdominal pain; arthralgia; diarrhoea; fever; headache; myalgia; nausea; skin reactions; vomiting Uncommon Dizziness Side-effects For varicella-zoster vaccine Uncommon Cough; drowsiness; increased risk of infection; irritability Rare or very rare Conjunctivitis; Kawasaki disease; seizure; thrombocytopenia; vasculitis Frequency not known Encephalitis (including fatal cases); stroke
Pregnancy
For all vaccines, live UKHSA advises live vaccines should not be administered routinely to pregnant women because of the theoretical risk of fetal infection, but where there is a significant risk of exposure to disease the need for vaccination may outweigh any possible risk to the fetus. Termination of pregnancy following inadvertent immunisation is not recommended.
Breast feeding
For all vaccines, live Although there is a theoretical risk of live vaccine being present in breast milk, vaccination is not contra-indicated for women who are breast-feeding when there is significant risk of exposure to disease.
Medicinal forms
Solution,Injection
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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