Varicella Vaccination and Management

Primary Prevention

The American Academy of Pediatrics recommends that all children receive two doses of varicella vaccine, with the first dose at 12-15 months of age and the second dose at 4-6 years of age, providing 98% efficacy against any varicella disease and 100% efficacy against severe disease 1, 2
Children 12 months through 12 years should receive two 0.5-mL doses of varicella vaccine administered subcutaneously, separated by at least 3 months, as recommended by the American Academy of Pediatrics 1, 2, 3
Adolescents ≥13 years should receive two 0.5-mL doses of varicella vaccine separated by at least 28 days, as recommended by the American Academy of Pediatrics 1, 2, 3

For susceptible children exposed to varicella, the Centers for Disease Control and Prevention recommends administering varicella vaccine within 3 days of exposure for >90% effectiveness in preventing disease, or within 5 days for 70% effectiveness in preventing disease and 100% effectiveness in modifying severe disease 4
Household contacts have the highest risk of infection, with approximately 85% of susceptible contacts developing varicella, and should receive immediate vaccination if they lack immunity, as recommended by the Centers for Disease Control and Prevention 4

The American Academy of Pediatrics states that children with documented history of varicella disease verified by a healthcare professional do not require vaccination, as prior infection provides natural immunity 7
Acceptable documentation of immunity includes documentation of 2 appropriately timed vaccine doses, laboratory evidence of immunity or laboratory-confirmed disease, varicella diagnosed by a healthcare professional or verified history, and history of herpes zoster diagnosed by a healthcare professional, as recommended by the American Academy of Pediatrics 8

The American Academy of Pediatrics recommends that immunocompromised children do not routinely receive varicella vaccine, except for certain HIV-infected children who may be vaccinated with expert guidance 8
Pregnant women should not receive varicella vaccine, but postpartum women without immunity should receive monovalent vaccine before hospital discharge, with second dose ≥28 days later, as recommended by the American Academy of Pediatrics 8