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Varilrix

Common name:

Chickenpox vaccine, varicella vaccine

Protects against varicella (chickenpox).

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Overview

In New Zealand, chickenpox is a common illness in childhood and most adults will have had the disease as a child. Adults who grew up in tropical countries are less likely to have had chickenpox in childhood. Adolescents and adults are at higher risk than children of severe disease and complications.

Varilrix® is a live vaccine containing a weakened form of the varicella-zoster virus to protect children and adults from chickenpox.

In children aged from 9 months to under 13 years, a single dose of vaccine will protect around eight in 10 children. Up to two in 10 may still get chickenpox, but are usually protected against moderate to severe disease. Children aged 13 years and older, and adult up to 50 years who are not immune, require two doses of the vaccine for protection against moderate to severe disease. The vaccine may also prevent or reduce the severity of chickenpox in someone who has not previously had chickenpox or been vaccinated, if it is given within 3–5 days of exposure to the disease.

On 1 July 2017, Varilrix was added to the National Immunisation Schedule for some healthy children at the 15 months of age immunisation visit or at 11 years of age. Varilrix will continue to be free for children and adults with a medical condition that meets the eligibility criteria for one of the ‘special groups’ described in the Pharmaceutical Schedule. Varilrix is also available for purchase through your family doctor.

Extremely rarely a vaccine recipient with a vaccine-related rash could transfer the vaccine virus to another person. With more than 60 million vaccine doses given, 10 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.

Responses to vaccine

Varilrix (VV)

Common Responses

  • Headache and/or tiredness
  • Mild rash 6–43 days after immunisation

Rare Responses

  • High fever
  • Transfer of vaccine virus from a vaccine rash to another person

As with any medicine, very rarely a severe allergic reaction (anaphylaxis) can occur following immunisation.

References

  • Ampofo K, Saiman L, LaRussa P, Steinberg S, Annunziato P, Gershon A. Persistence of immunity to live attenuated varicella vaccine in healthy adults. Clin Infect Dis. 2002;34(6):774-9.
  • Baxter R, Ray P, Tran TN, Black S, Shinefield HR, Coplan PM, et al. Long-term effectiveness of varicella Vaccine: A 14-year, prospective cohort study. Pediatrics. 2013;131(5):138-1396.
  • 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
  • Centers for Disease Control and Prevention. Prevention of varicella recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2007;56(RR-04):1-40.
  • Chaves SS, Haber P, Walton K, Wise RP, Izurieta HS, Schmid DS, et al. Safety of varicella vaccine after licensure in the United States: Experience from reports to the Vaccine Adverse Event Reporting System, 1995–2005. J Infect Dis. 2008;197(Suppl 2):S170-7.
  • Civen R, Chaves SS, Jumaan A, Wu H, Mascola L, Gargiullo P, et al. The incidence and clinical characteristics of herpes zoster among children and adolescents after implementation of varicella vaccination. Pediatr Infect Dis J. 2009;28(11):954-9.
  • Levin MJ, Murray M, Zerbe GO, White CJ, Hayward AR. Immune responses of elderly persons 4 years after receiving a live attenuated varicella vaccine. J Infect Dis. 1994;170(3):522-6.
  • Macartney K, McIntyre P. Vaccines for post-exposure prophylaxis against varicella (chickenpox) in children and adults. Cochrane Database Syst Rev. 2008;(3):Art. No.: CD001833.
  • Marin M, Marti M, Kambhampati A, et al. Global Varicella Vaccine Effectiveness: A Meta-analysis. Pediatrics. 2016;137(3):1-10.
  • Ministry of Health. Immunisation Handbook 2017 2nd Edition. Ministry of Health: Wellington. Available from http://www.health.govt.nz/publication/immunisation-handbook-2017
  • Schmid DS, Jumaan AO. Impact of varicella vaccine on varicella-zoster virus dynamics. Clin Microbiol Rev. 2010;23(1):202-17.
  • Strategic Advisory Group of Experts on Immunization. Systematic review of available evidence on effectiveness and duration of protection of varicella vaccines: WHO; 2014 [cited 2016 March 14]. Available from: http://www.who.int/immunization/sage/meetings/2014/april/presentations_background_docs/en/
  • World Health Organization. Varicella and herpes zoster vaccines: WHO position paper, June 2014. Wkly Epidemiol Rec. 2014;89(25):265-87.
  • Wutzler P, Knuf M, Liese J. Varicella: Efficacy of two-dose vaccination in childhood. Dtsch Arztebl Int. 2008;105(33):567-72.
In Depth

Vaccine type: live attenuated

Vaccine schedule and administration

Funded vaccine from 1 July 2017:

  • Children born on/after 1 April 2016 can have one free varicella vaccine dose when they turn 15 months, including those who have previously had one purchased chickenpox vaccine dose.
  • Children born 1 July 2006 to 31 March 2016 can have one free varicella vaccine dose when they turn 11 years IF they have not already had a chickenpox immunisation or had chickenpox disease.
  • Children born before 1 July 2006 and adults do not get a free varicella vaccine dose unless they have a medical condition that meets the eligibility criteria for one of the ‘special groups’ described in the Pharmaceutical Schedule.

    Special groups

    A two dose course of Varilrix® is funded individuals from nine months of age who have not previously had chickenpox or varicella vaccine, and meet at least one of the following criteria:

    • 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 or immunisation

      Vaccine storage and preparation

      Store vaccine and diluent as per cold chain between 2°C to 8°C.

      Administration

      • Varilrix and the alternate Varivax vaccine (not currently available) are interchangeable within a two dose course of vaccines. 
      • Varilrix should be administered by subcutaneous injection only.
      • Varilrix can be administered concurrently with other vaccines, including MMR, Hib and PCV10 or PCV13. Separate syringes and different injection sites should be used.
        • Giving four injections at the same 15 month immunisation visit is safe and avoids parents and children having to make multiple visits. When receiving just one injection, most children become distressed and settle quickly. Increasing the number of injections won’t always mean more distress, and they can still settle quickly. Delaying immunisation could also leave children unprotected from serious diseases for longer.
      • If Varilrix is not given at the same visit as another live injectable vaccine e.g. MMR, a 4 week interval between the two live virus vaccines should be observed.

      Should children and adults have one or two varicella vaccinations?

      Children aged less than 13 years

      • Parents may choose to purchase a second dose of varicella vaccine, which can be administered a minimum of 4 weeks before or after the first dose.
      • Infants who receive theit first varicella vaccine dose when aged under 12 months of age are recommended to have a second varicella vaccination from age 12 months. Maternal antibodies against chickenpox could be present in infants aged under 12 months and affect the infant's individual response to the vaccination.
      • In all children aged under 13 years, one dose gives good protection, two doses give optimal protection.

      Children aged 13 years or older and adults

      • The standard varicella vaccine schedule is two doses administered a minimum of 4 weeks apart for individuals in this age group receiving varicella vaccine for the first time.

      Special groups aged 9 months or older

      • Two vaccine doses are recommended and funded for infants, children and adults who meet the eligibility criteria for one of the ‘special groups’ described in the Pharmaceutical Schedule.

      Catch-up doses

      All children, and adults up to 50 years of age, as required.

      Vaccine safety

      Varicella vaccine can be given to:

      • A person living with a newborn baby or a pregnant woman or a person who is immune suppressed.

      Immunisation should be postponed in individuals suffering from a fever over 38°C. However, the presence of a minor infection is not a reason to delay immunisation.

      Varicella vaccine should not be given to:

      • Anyone who has a severe weakness of the immune system
      • Anyone who had a severe allergic response (anaphylaxis) to a previous dose of this vaccine or a component of this vaccine.
      • Women who are currently pregnant. Women are advised to delay pregnancy for 4 weeks after receipt of a varicella vaccine dose.
      • People who have received another live injected vaccine within the previous four weeks

      Advice should be sought for the following groups:

      • People known to have a weakened immune system.
      • People receiving high-dose steroid medicine, e.g. prednisone, for more than 14 days. They 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.
      • 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 who have received a blood product in the 11 months 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.

      It is possible but extremely rare for a person with a vaccinerelated rash to transfer the vaccine virus to another person, only 10 cases have been reported from around 60 million vaccine doses in the U.S. There is no risk of the vaccine virus being transferred to another person if there is no vaccine-related rash.

      Vaccine effectiveness

      For optimal protection (99%) against all chickenpox disease in children aged nine months up to and including 12 years of age a vaccine course of two doses of Varilrix separated by at least four weeks is recommended. However, a single dose of vaccine offered from the age of 12 months can provide 70–90% protection against all chickenpox, and more than 95% will be protected from moderate-severe disease but may still get mild chickenpox (often fewer than 50 lesions).

      Available information suggests that chickenpox vaccinations may decrease the risk of developing shingles later in life compared with having the wild-type disease.

      Last updated: Oct 2019