Varicella Vaccination in Adults

Primary Recommendation

• The Centers for Disease Control and Prevention recommends that all adults without evidence of immunity to varicella should receive two 0.5-mL doses of single-antigen varicella vaccine administered subcutaneously, 4-8 weeks apart 1, 2, 3, 4

Assessing Evidence of Immunity

• The American College of Physicians suggests that evidence of immunity to varicella includes documentation of 2 doses of varicella vaccine at least 4 weeks apart, being U.S.-born before 1980, healthcare provider-verified history of varicella or herpes zoster, or laboratory evidence of immunity or laboratory-confirmed disease 5, 6

Vaccination Schedule and Administration

• The Centers for Disease Control and Prevention recommends a two-dose series of single-antigen varicella vaccine, with a minimum interval of 4 weeks between doses for adults ≥13 years 1, 2, 3, 4
• The vaccine should be administered subcutaneously 1

Priority Populations Requiring Special Consideration

• The Centers for Disease Control and Prevention recommends priority vaccination for adults at increased risk for exposure or transmission who lack evidence of immunity, including healthcare personnel, household contacts of immunocompromised persons, teachers and daycare employees, college students, military personnel, and correctional facility inmates/staff 1, 2, 7

Contraindications and Special Situations

• The American College of Obstetricians and Gynecologists states that pregnancy is a contraindication to varicella vaccination, and the vaccine should be given postpartum before discharge 2, 4, 7
• The Infectious Diseases Society of America recommends that varicella vaccine is contraindicated in adults with severe immunocompromising conditions, such as HIV with CD4 <200 cells/μL, active malignancy, or immunosuppressive therapy 3, 4, 7

Post-Exposure Prophylaxis

• The Centers for Disease Control and Prevention recommends that unvaccinated adults without evidence of immunity who are exposed to varicella should receive varicella vaccine within 3 days of exposure for >90% efficacy in preventing disease, or varicella-zoster immune globulin within 96 hours of exposure if contraindicated to vaccination 8, 9

Clinical Efficacy and Rationale

• The two-dose regimen of varicella vaccine provides superior protection compared to single-dose vaccination, with 98% efficacy against any varicella disease and 100% efficacy against severe disease 10

Varicella Vaccination Recommendations for Healthy Adults

Dosing Schedule and Efficacy

Immunity Evidence and Exemptions

Priority Populations

Contraindications to Screen For

Implementation Pitfalls