Varicella vaccine

Varicella vaccine recommended for persons 12 months of age or older who are susceptible to chickenpox.

Use of 2 dose vaccine for children younger than 13 years.

First dose recommended between ages 12-15 months and the second dose should be given between ages 4-6 years.

All individuals over than 13 years who have no evidence of immunity against varicella-zoster virus should be given the vaccine.

Has had a profound effect on the epidemiology of varicella and its effects in herpes zoster is yet to be seen.

In patients that have received HZ vaccine the incidence of shingles has decreased by 51.3% and there has been a 39% decrease in postherpetic neuralgia(Oxman MN et al).

On rare occasions varicella virus may disseminate without other organ involvement, and in patients with demonstrated immunodeficiencies the vaccine can disseminate to other organs such as lung, liver and CNS.

For patients with immune mediated diseases it is recommended to initiate immunosuppressant drug therapy after vaccination.

Compared to the general population patients with rheumatoid arthritis, inflammatory bowel disease, and systemic lupus are increased risk for herpes zoster.

Currently recommendations for patients taking corticosteroids is that the zoster vaccine is safe when taking low-dose or short-term therapy of less than 20 mg a day for less than 14 days.

Patients receiving high-dose steroids greater than 20 mg a day of prednisone for greater than 14 days should not receive zoster vaccination until corticosteroid therapy has been stopped for at least one month.

There is a modest increase risk of herpes zoster in the 42 days after vaccination when comparing those with current versus remote immunosuppressant drug use (Cheetham TC et al.).

The development of herpes zoster in the 42 days after vaccination suggests this is likely due to reactivation of latent zoster virus rather than to dissemination by the vaccine.

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