Morbidity and Mortality Weekly Report

1 Morbidity and Mortality Weekly ReportRecommendations and ReportsJune 22, 2007 / Vol. 56 / No. RR-4 INSIDE: Continuing Education Examinationdepardepardepardepardepartmen t of health and human sertment of health and human sertment of health and human sertment of health and human sertment of health and human servicesvicesvicesvicesvicesCenters for Disease Control and PreventionCenters for Disease Control and PreventionCenters for Disease Control and PreventionCenters for Disease Control and PreventionCenters for Disease Control and PreventionPrevention of VaricellaRecommendations of the Advisory Committeeon Immunization Practices (ACIP)

2 2 Epidemiology of varicella .. 2 Prenatal and Perinatal 7 Herpes Zoster 7 Use of Acyclovir to Treat and Prevent 8 Vaccines for Prevention of varicella .. 9 Immune Response to 10 Vaccine Efficacy and Vaccine 13 Breakthrough 14 Evidence of 16 Simultaneous Administration of 17 Economic Analysis of 17 Storage, Handling, and Transportation of VaricellaVaccines .. 18 Adverse Events After 19 Transmission of Vaccine 21 Summary of Rationale for varicella 22 Recommendations for the Use of varicella 23 Special Considerations for 24 Health-Care 26 Vaccination for Outbreak Control.

3 27 Contraindications .. 27 Precautions .. 28 Postexposure 29 Acknowledgments .. 38 Continuing Education CE-1 Centers for Disease Control and PreventionJulie L. Gerberding, MD, MPHD irectorTanja Popovic, MD, PhDChief Science OfficerJames W. Stephens, PhD(Acting) Associate Director for ScienceSteven L. Solomon, MDDirector, Coordinating Center for Health Information and ServiceJay M. Bernhardt, PhD, MPHD irector, National Center for Health MarketingB. Kathleen Skipper, MA(Acting) Director, Division of Health Information Dissemination (Proposed)Editorial and Production StaffFrederic E.

4 Shaw, MD, JDEditor, MMWR SeriesSuzanne M. Hewitt, MPAM anaging Editor, MMWR SeriesTeresa F. RutledgeLead Technical Writer-EditorJeffrey D. Sokolow, MAProject EditorBeverly J. HollandLead Visual Information SpecialistLynda G. CupellMalbea A. LaPeteVisual Information SpecialistsQuang M. Doan, MBAE rica R. ShaverInformation Technology SpecialistsEditorial BoardWilliam L. Roper, MD, MPH, Chapel Hill, NC, ChairmanVirginia A. Caine, MD, Indianapolis, INDavid W. Fleming, MD, Seattle, WAWilliam E. Halperin, MD, DrPH, MPH, Newark, NJMargaret A.

5 Hamburg, MD, Washington, DCKing K. Holmes, MD, PhD, Seattle, WADeborah Holtzman, PhD, Atlanta, GAJohn K. Iglehart, Bethesda, MDDennis G. Maki, MD, Madison, WISue Mallonee, MPH, Oklahoma City, OKStanley A. Plotkin, MD, Doylestown, PAPatricia Quinlisk, MD, MPH, Des Moines, IAPatrick L. Remington, MD, MPH, Madison, WIBarbara K. Rimer, DrPH, Chapel Hill, NCJohn V. Rullan, MD, MPH, San Juan, PRAnne Schuchat, MD, Atlanta, GADixie E. Snider, MD, MPH, Atlanta, GAJohn W. Ward, MD, Atlanta, GAThe MMWR series of publications is published by the CoordinatingCenter for Health Information and Service, Centers for DiseaseControl and Prevention (CDC), Department of Health andHuman Services, Atlanta, GA Citation: Centers for Disease Control and Prevention.

6 [Title]. MMWR 2007;56(No. RR-#):[inclusive page numbers].Disclosure of RelationshipCDC, our planners, and our content experts wish to disclose theyhave no financial interests or other relationships with themanufacturers of commercial products, suppliers or commercialservices, or commercial supporters. Presentations will not includeany discussion of the unlabeled use of a product or a product underinvestigational 56 / RR-4 Recommendations and Reports1 Prevention of VaricellaRecommendations of the Advisory Committeeon Immunization Practices (ACIP)Prepared byMona Marin, MD, Dalya G ris, MD,* Sandra S.

7 Chaves, MD, Scott Schmid, PhD, Jane F. Seward, MBBSD ivision of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDCS ummaryTwo live, attenuated varicella zoster virus containing vaccines are available in the United States for prevention of varicella :1) a single-antigen varicella vaccine (VARIVAX, Merck & Co., Inc., Whitehouse Station, New Jersey), which was licensed inthe United States in 1995 for use among healthy children aged >12 months, adolescents, and adults; and 2) a combinationmeasles, mumps, rubella, and varicella vaccine (ProQuad, Merck & Co.

8 , Inc., Whitehouse Station, New Jersey), which waslicensed in the United States in 2005 for use among healthy children aged 12 months 12 years. Initial Advisory Committee onImmunization Practices (ACIP) recommendations for prevention of varicella issued in 1995 (CDC. Prevention of varicella :recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 1996;45[No. RR-11]) includedroutine vaccination of children aged 12 18 months, catch-up vaccination of susceptible children aged 19 months 12 years, andvaccination of susceptible persons who have close contact with persons at high risk for serious complications ( , health-carepersonnel and family contacts of immunocompromised persons).

9 One dose of vaccine was recommended for children aged12 months 12 years and 2 doses, 4 8 weeks apart, for persons aged >13 years. In 1999, ACIP updated the recommendations(CDC. Prevention of varicella : updated recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR1999;48[No. RR-6]) to include establishing child care and school entry requirements, use of the vaccine following exposure andfor outbreak control, use of the vaccine for certain children infected with human immunodeficiency virus, and vaccination ofadolescents and adults at high risk for exposure or June 2005 and June 2006, ACIP adopted new recommendations regarding the use of live, attenuated varicella vaccines forprevention of varicella .

10 This Report revises, updates, and replaces the 1996 and 1999 ACIP statements for prevention of new recommendations include 1) implementation of a routine 2-dose varicella vaccination program for children, with thefirst dose administered at age 12 15 months and the second dose at age 4 6 years; 2) a second dose catch-up varicella vaccinationfor children, adolescents, and adults who previously had received 1 dose; 3) routine vaccination of all healthy persons aged>13 years without evidence of immunity; 4) prenatal assessment and postpartum vaccination; 5) expanding the use of thevaricella vaccine for HIV-infected children with age-specific CD4+T lymphocyte percentages of 15% 24% and adolescentsand adults with CD4+T lymphocyte counts >200 cells/ L; and 6) establishing middle school, high school, and college entryvaccination requirements.