- In Depth
Varilrix® is used for primary vaccination of infants from nine months of age, children and adults to protect against varicella-zoster infection (chickenpox). The vaccine may prevent or reduce the severity of chickenpox disease if it is given within 3-5 days of exposure to someone with the disease.
- Infants, children, adolescents and adultsa up to 50 years of ageb at risk of getting chickenpox, i.e. they have not previously had the disease or vaccine.
- a. Adults who have grown up in tropical countries are much less likely to have had chickenpox.
- b. The herpes zoster vaccine Zostavax® is licensed for adults 50 years of age and over to prevent shingles.
A two dose course of Varilrix® is recommended and funded for individuals aged 9 months or older who have not have the disease or immunisation and who meet at least one of the eligibility criteria below:
- Who are HIV-positive with mild or moderate immunosuppression, on the advice of their specialist
- Prior to elective immunosuppressive therapy that will be longer than 28 days
- With chronic liver disease who may in future be candidates for transplantation
- With deteriorating renal function before transplantation
- Prior to solid organ transplantation
- After a haematopoietic stem cell transplantation, on the advice of their specialist
- After chemotherapy, on the advice of their specialist
- With an inborn error of metabolism at risk of major metabolic decompensation,
- Who are a household contact of a child or adult patient who is immunocompromised or undergoing a procedure leading to immunocompromise, where the household contact has no clinical history of varicella infection of immunisation
People in the following groups should see specialist advice before receiving the vaccine:
- People known to have a weakened immune system.
- Children taking aspirin: Whilst there has been no association between chickenpox immunisation and Reye’s Syndrome, avoidance of aspirin around the time of immunisation and for six weeks afterward is advised as a precaution.
- People receiving high-dose corticosteroid medicine for more than 14 days should wait for at least four weeks after their treatment has finished before receiving the vaccine.
- People taking antiviral medication e.g. tablets for cold sores: These should be stopped for 24 hours prior to immunisation and not restarted for 14 days afterwards.
- People who have received a blood product in the year before immunisation.
- People expecting to receive a blood product in the two months after immunisation: These should not be given for two months after immunisation unless their use outweighs the benefits of the immunisation.
The vaccine is contradicted for:
- Anyone with severe allergy (anaphylaxis) to a previous dose of this vaccine or a component of the vaccine.
- Women who are currently pregnant. Delay pregnancy until one month after having the vaccine.
- People who have received another live injected vaccine within the previous four weeks.
- Immunisation should be postponed in individuals suffering from a fever over 38°C. The presence of a minor infection is not a reason to delay immunisation.
Immunisation against chickenpox pox may not protect every person completely.
- After a single chickenpox vaccine dose, 70-90% of children are expected to be fully protected against all chickenpox and more than 95% protected from moderate to severe chickenpox .
- After two chickenpox vaccine doses, 97-99% of children are protected against all chickenpox and 100% protected from moderate to severe chickenpox.
- After two chickenpox vaccine doses, 79-91% of adults are protected against moderate to severe chickenpox.
For seven in 10 people who have been vaccinated against chickenpox and get the disease, it is less severe than the disease in an unvaccinated person.
Available information suggests that chickenpox immunisation may reduce the risk of developing shingles later in life in comparison to those who had wild-type disease.
In the current New Zealand environment fewer children are vaccinated against chickenpox compared to the number of children who are not. Children are highly likely to be exposed to wild-type chickenpox and have their vaccine protection against chickenpox boosted. A single vaccine dose is expected to provide long lasting protection against the disease.
Analysis of vaccine safety after almost 48 million doses had been administered showed an on-going excellent safety profile. The most common vaccine side effects occur around the site of injection and include redness, swelling and pain. Headache, mild fever and tiredness after immunisation are also common. Around 5 in 100 healthy vaccine recipients may develop a vaccine related chickenpox rash, but with fewer spots in comparison to wild-type chickenpox (acquired from another person). The vaccine rash could appear as soon as six days or as long as 43 days after immunisation.
It is extremely rare for a vaccine recipient with a vaccine related rash to transfer the vaccine virus to another person. With more than 48 million vaccine doses given, six cases have been documented. There is no risk of the vaccine virus being transferred to another person if there is no vaccine related rash.
Vaccine recipients who develop a rash should avoid contact with women who are pregnant and not immune to chickenpox, newborn babies and people known to have weakened immune systems until the rash has gone.
The possible effects of the vaccine on fetal development are unknown at this time. Women should delay pregnancy for one month after having the vaccine.
Immunisation against chickenpox is also recommended for adults with no history of having chickenpox and who work in at-risk occupations such as health care workers, teachers and other early childhood education and/or day-care centre staff; students training for work in these areas; adults who have grown up in tropical countries (they are much less likely to have had chickenpox) and adults who are parents of young children.
Children and adults up to 50 years of age can catch up missed doses at any time. Older adults require a stronger vaccine (Zostavax®) for protection against herpes zoster (shingles).
|Possible vaccine side effects|
|Common side effects||Uncommon side effects||Rare/very rare side effects|
- Centers for Disease Control and Prevention. General Recommendations on Immunization Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011;60(2):1-61.
- Gershon AA, Takahashi M, Seward JF. Varicella vaccine. In: Plotkin S, Orenstein W, Offit P, editors. Vaccines. 5th ed. Philadelphia: Elsevier Inc; 2008
- GlaxoSmithKline NZ Ltd. Varilrix data sheet [Homepage on the Internet]. Wellington: Medsafe; 2010 [cited 2011, May 10]. Available from: http://www.medsafe.govt.nz/profs/Datasheet/v/Varilrixinj.pdf.
- GlaxoSmithKline Biologicals SA. Varilrix consumer medicine information leaflet. [Homepage on the Internet] Woden, A.C.T.: Therapeutic Goods Administration; 2011 [updated 2011, January 21; cited 2011, May 10]; Available from: https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-CMI-05276-3.
- Ministry of Health. Immunisation handbook 2006. Wellington: Ministry of Health; 2006.
- Ministry of Health. Immunisation handbook 2011. Wellington: Ministry of Health; 2011.