Contraindications and Precautions for Varicella Vaccination

Contraindications

People with contraindications for varicella vaccine should not receive varicella vaccine, including anyone who—

• has a history of anaphylactic/anaphylactoid reaction to gelatin, neomycin, or any other component of the vaccine
• has blood dyscrasias, leukemia, lymphomas, or malignant neoplasms affecting bone marrow or lymphatic system
• is receiving prolonged, high-dose systemic immunosuppressive therapy (≥2 weeks), including large doses of oral steroids (≥2mg/kg of body weight or a total of 20mg/day of prednisone or its equivalent for people who weigh >10kg)
• has a moderate or severe concurrent illness
• has received blood products (such as whole blood, plasma, or immune globulin) during the previous 3 to 11 months, depending on dosage
• has a family history (first degree relatives) of congenital hereditary immunodeficiency, unless the person is immunocompetent
• is or may be pregnant. For more information, see Guidelines for Vaccinating Pregnant Women: Varicella and Vaccination Recommendations for Specific Groups.

Some people with contraindications for varicella vaccine may receive varicella zoster immune globulin after being exposed to varicella. For more information, see Managing People at Risk for Severe Varicella.

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Precautions

People with Acute Illness

• People with acute severe illness, including untreated, active tuberculosis, should postpone vaccination until they recover. The decision to delay vaccination depends on the severity of symptoms and the etiology of disease.

People with Thrombocytopenia

• Thrombocytopenia is not a contraindication for vaccination with single-antigen varicella vaccine (Varivax®).
• For vaccination of thrombocytopenic children with combination MMRV vaccine (ProQuad®), healthcare providers should refer to the Advisory Committee on Immunization Practices recommendation on MMR vaccination.

Recipients of Blood Products

• People who have recently received (within 3 to 11 months depending on dosage) blood, plasma, or immune globulin products should not be vaccinated.
  • Blood, including whole blood, packed red blood cells, and plasma, and other antibody-containing blood products may interfere with the effectiveness of the vaccine.
• People who have received varicella vaccine should not receive blood products for 14 days after being vaccinated unless the benefits of blood product outweigh the need for protection from vaccination.

People Receiving Salicylates

• People should avoid using salicylates for 6 weeks after getting varicella vaccine. This is because of the association between aspirin use and Reye syndrome following varicella, and also the potential risk of Reye syndrome if a person is given aspirin after varicella vaccination.
• Take caution when vaccinating children who are receiving salicylates. However, no adverse events have been reported.
• Children with rheumatoid arthritis or other conditions that require therapeutic aspirin should be monitored closely after they get vaccinated.

For more information, see Chart of Contraindications and Precautions for varicella vaccination.

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