CDC revises varicella vaccine recommendations
In February 1999, the Advisory Committee on Immunization Practices (ACIP) expanded its recommendations for varicella vaccinations in an effort to promote wider use of the vaccine for susceptible children and adults.1 The following are excerpts from the updated recommendations that relate to health care facilities:
INTRODUCTION
Varicella (i.e., chickenpox) is a highly contagious disease caused by the varicella zoster virus. Varicella is usually a self-limited disease that lasts four to five days and is characterized by fever, malaise, and a generalized vesicular rash typically consisting of 250 to 500 lesions. Infants, adolescents, adults, and immunocompromised persons are at higher risk for complications. Before the availability of varicella vaccine, varicella disease was responsible for an estimated 4 million cases, 11,000 hospitalizations, and 100 deaths each year in the United States (CDC, unpublished data, 1999). Approximately 90% of cases occurred in children. A vaccine was licensed in the United States in 1995, and the Advisory Committee on Immunization Practices (ACIP) issued recommendations for prevention of varicella in July 1996.2
RECOMMENDATIONS
Postexposure Vaccination and Outbreak Control
Data from the United States and Japan from household, hospital, and community settings indicate that varicella vaccine is effective in preventing illness or modifying varicella severity if used within three days, and possibly up to five days, of exposure. ACIP now recommends the vaccine for use in susceptible persons following exposure to varicella.
If exposure to varicella does not cause infection, postexposure vaccination should induce protection against subsequent exposure. If the exposure results in infection, no evidence indicates that administration of varicella vaccine during the presymptomatic or prodromal stage of illness increases the risk for vaccine-associated adverse events.
Although postexposure use of varicella vaccine has potential applications in hospital settings, vaccination is routinely recommended for all health care workers and is the preferred method for preventing varicella in health care settings.3
References
1. Centers for Disease Control and Prevention. Prevention of varicella: Updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999; 48(No. RR-06).
2. Centers for Disease Control and Prevention. Prevention of varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1996; 45(No. RR-11).
3. Centers for Disease Control and Prevention. Immu nization of health-care workers: Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1997; 46(No. RR-18).
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