Who should not get Chickenpox vaccine?
Contraindications to receiving Varivax chickenpox vaccine as documented by Merck in their vaccine package insert include:1
- Persons who have experienced a severe allergic reaction or anaphylaxis to any Varivax vaccine component, including gelatin and neomycin;
- Persons who are immunodeficient or immunosuppressed. This includes individuals with AIDS or clinical symptoms of infection with HIV, lymphoma, leukemia, primary or acquired immunodeficiency states or other malignant neoplasms that affect the lymphatic system or bone marrow;
- Persons receiving corticosteroid or other immunosuppressive therapies;
- Febrile illness or active untreated tuberculosis;
- Pregnant women. Women who receive Varivax should wait at least 3 months following vaccination before getting pregnant;
- Persons with a family history of hereditary or congenital immunodeficiency should not be vaccinated with Varivax until the immune competence of the recipient has been determined.
Transmission of the vaccine virus has been documented between healthy persons who have received the vaccine and developed a chickenpox-like rash and healthy susceptible contacts. The vaccine virus has also been transmitted between a mother who did not develop a chickenpox-like rash, and her newborn child. As a result, persons who receive Varivax should avoid close contact with susceptible high-risk individuals for up to six weeks post-vaccination, to reduce the risk of transmission. These susceptible individuals include:
- Persons who are immunocompromised;
- Pregnant women without lab evidence or documented history of chickenpox;
- Newborn infants whose mothers have no lab evidence or documented history of chickenpox;
- All premature infants born at less than 28 weeks gestation.
The chickenpox vaccine should not be given until at least 5 months have passed since the administration of plasma, blood transfusions or immunoglobulins. Further, immunoglobulins should not be given for at least 2 months following Varivax vaccine unless the use of immunoglobulins outweighs the benefits of vaccination.
Aspirin and aspirin-containing products should not be given to infants and children between 12 months and 17 years of age for at least 6 weeks following Varivax due to an association between aspirin therapy and Reye syndrome.
Varivax is approved for use in individuals 12 months of age and older. Varivax is not approved for use in children under the age of 12 months.
Contraindications to receiving ProQuad (MMRV) vaccine as documented by Merck in their vaccine package insert include:2
- A severe allergic reaction or anaphylaxis to any MMRV vaccine component, including gelatin and neomycin;
- Febrile illness or active untreated tuberculosis;
- Acquired or primary immunodeficiency status or use of immunosuppressive therapies. Vaccination with MMRV should be delayed for 3 months following the administration of human immune globulin, blood, or plasma;
- A family history of hereditary or congenital immunodeficiency;
- Leukemia, lymphoma, blood dyscrasias and other malignant neoplasms affecting the lymphatic systems or bone marrow.
Merck’s ProQuad product insert warns of a higher incidence of fever and febrile seizures in children between the ages of 12 and 23 months following administration of MMRV in comparison to children who receive separate doses of MMR and varicella vaccines. Caution is advised when administering MMRV vaccine in children with a history of seizures, cerebral injury, or any other medical condition where stress from fever should be avoided.
Both live measles and mumps vaccine are manufactured in chick embryo cell culture. Extreme caution should be taken when vaccinating individuals with a history of anaphylaxis or immediate hypersensitivity to eggs. Merck advises that a careful evaluation of the risks and benefits should be completed when vaccination is being considered in this population.
Merck’s MMRV vaccine package insert reports that transmission of varicella vaccine virus may occur between vaccine recipients and susceptible contacts, including high risk individuals, resulting in both the development or non-development of varicella-like rash. As a result, Merck cautions that vaccine recipients should attempt to avoid close contact with high-risk individuals. This population includes pregnant women who lack a positive history of illness or vaccination and their newborn infants, any infants born prior to 28 weeks gestation, and any immunocompromised individuals.
Merck also advises that a careful evaluation of the risk and benefits of vaccination with MMRV be completed in children with thrombocytopenia or history of the blood disorder, as no clinical data on the development or exacerbation of this condition exists. Thrombocytopenia has been reported following vaccination with MMRII, measles vaccine, varicella vaccine and again following an additional dose of both measles and MMRII vaccines.
The safety or efficacy of MMRV vaccine in HIV-positive children is unknown.
Children who receive MMRV vaccine should avoid the use of salicylate (aspirin) or salicylate-containing products for 6 weeks following vaccination due to the association of Reye Syndrome with aspirin use and wild-type varicella disease.
MMRV vaccine is approved for use in children 12 months to 12 years of age. Children under the age of 12 months or older than 12 years of age should not receive MMRV vaccine.
IMPORTANT NOTE: NVIC encourages you to become fully informed about Chickenpox and the Chickenpox vaccine by reading all sections in the Table of Contents , which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.
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1 FDA Varivax Package Insert Jan. 23, 2019
2 FDA PROQUAD Package Insert. Jan. 22, 2019