Recommendations from the National Varicella Consensus Conference: VARICELLA VACCINE USE IN SPECIAL POPULATIONS


Recommendation 3.1: All healthy, susceptible non-pregnant adults should be targeted for vaccination. However, priority for active targeting should be given to health care workers; house­hold contacts of immunocompromised individuals; child care workers; and primary and secondary school teachers. Recommendation 3.2: Active targeting plan: All jurisdictions and employers with an existing responsibility (such as Occu­pational Health/Public Health/obstetric care workers/primary care physicians, etc) are to direct campaigns of screening (his­tory of varicella with or without serology) and offer vaccine to the active targets.

Health care workers

Recommendation 3.3: Susceptible health care workers should be immune prior to employment or should be immu­nized according to a two-dose schedule to be completed within two months, to minimize outbreaks and loss of time due to varicella in health care settings. All susceptible health care workers currently in the system should be immunized. Initial priority should be given to immunizing health care workers on wards or in patient care settings that contain susceptible high-risk patients (eg, settings with immunocompromised pa­tients, intensive care units, and emergency rooms). Recommendation 3.4: Identifying susceptibles: Before an employee begins employment, a varicella history should be obtained. If there is any doubt about previous disease or vaccination, or the history is negative or unknown, sero- logical testing should be performed. If the result is negative, the employee should be immunized. If the individual re­ceives the vaccine, (s)he should be furloughed or reassigned only if there is a varicella-like rash.

Recommendation 3.5: Postexposure management: Significant exposure for health care workers should be defined as 15 minutes face-to-face or one hour in a patient room. Immunized and ex­posed health care workers whose antibody status is not known should be watched vigilantly for a varicella-like rash, with or without serological testing. If a health care worker has a rash, it should be reported to occupational health. The worker should be granted furlough or reassigned for the du­ration of the rash.

Immunocompromised individuals

Recommendation 3.6: Live attenuated vaccine should not be routinely given for immunocompromising diseases (eg, lymphoma, congenital or acquired immunodeficiency) or treatments associated with T-cell abnormalities (eg, intensive chemotherapy, high dose steroids, cyclosporine, azathioprine, methotrexate, tacrolimus).

Recommendation 3.7: Immunization should be discussed with an infectious disease expert in the following cases:

  • patients with congenital transient hypogammaglobulinemia;
  • HIV-infected persons with normal immune status;
  • solid organ transplant recipients (vaccine should be given a minimum of four to six weeks prior to transplantation).

Recommendation 3.8: The following persons may be safely immunized:

  • if they are not on immunosuppressive medications, patients with nephrotic syndrome or those undergoing hemodialysis and peritoneal dialysis;
  • patients on low dose steroid therapy: less than 2 mg/kg and a maximum of less than 20 mg/day;
  • patients on inhaled steroids.

Screening of susceptible persons

Recommendation 3.9: Prior to vaccination, screening (his­tory with/without serology) is recommended for the following special groups: health care workers, teachers, daycare staff, and persons in institutions of health education (eg, nursing schools, medical schools). A reliable history of varicella is sat­isfactory to establish immunity. If there is no known history or the history is uncertain, serology should be performed. Recommendation 3.10: Obstetric care providers should iden­tify the varicella status of women during pregnancy, and im­munize postpartum those who are susceptible prior to discharge. Varicella screening should be added to obstetric pre­natal chart/laboratory requisitions to be checked separately for potential identification of susceptible women. Primary care providers should identify the varicella status of women of re­productive age and immunize them if necessary. Learn how to save money – cialis professional to enjoy your shopping and your treatment

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