Varicella and zoster. Conclusion.

In light of these studies, the ACIP and the American Academy of Pediatrics (AAP) formulated a series of recommendations for the routine use of varicella vaccine. Varicella vaccine may be given simultaneously with measles-mumps- rubella vaccine (MMR), but the vaccines should not be mixed in one syringe or administered in the same site. No data suggest any adverse interaction between varicella and other vaccines administered routinely to children. Postimmunization serologic testing is not recommended for young children or adolescents. For health care workers employed in areas with immunocompromised children, postimmunization serologic testing may be helpful in documenting seroconversion and simplifying management of exposures in high-risk areas.

The vaccines are not licensed for use in immunocompromised children or adults, including those who have congenital immunodeficiency, blood dyscrasias, leukemia, lymphoma, symptomatic HIV infection, or those receiving immunosuppressive agents or corticosteroids (2 mg/kg per day or greater for longer than 1 month). No precautions need to be taken in immunized patients whose families contain immunocompromised members because transmission of vaccine virus has been documented infrequently, and the virus has been shown to retain its attenuated phenotype. However, if a rash develops in the vaccinee, contact with immunosuppressed patients should be avoided for the duration of the rash. Varicella vaccine may be given to patients who have acute lymphocytic leukemia after they have been in remission for 1 year and have a lymphocyte count greater than 700/mcL and a platelet count greater than 100,000/mcL within 24 hours of immunization. Patients who have undergone immunosuppressive therapies may be vaccinated after at least 3 months has passed and evidence of immune suppression is lacking. Patients receiving greater than 2 mg/kg of systemic cortico-steroid therapy must be off steroids for at least 1 month prior to receiving the vaccine. Inhaled or intranasal corticosteroids are not a contraindication to varicella vaccination.

With routine administration of varicella vaccine to all young children and to those individuals not previously infected, there is reason to believe that chickenpox can be eliminated.

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