Ferson MJ. Varicella vaccine in post-exposure prophylaxis. Commun Dis Intell. 2001 Jan;25(1):13-5.

Abstract: Evidence concerning the effectiveness of Oka-based varicella vaccines when

administered following exposure to varicella zoster virus in domestic and hospital settings is
reviewed. The evidence appears to support post-exposure use of Oka-derived varicella vaccines in
children within 3 days of rash onset in the index case. Despite vaccination, a small proportion will
develop mild, but infectious, chickenpox, especially if they have been exposed in the household
setting. Controlled studies of post-exposure prophylaxis in adults using both Varilrix and Varivax II
are still needed. The applicability of this approach to disease control in health care facilities and in
community settings warrants wider discussion.

Pediatr Infect Dis J. 2010 Jan;29(1):10-3. doi: 10.1097/INF.0b013e3181b36022.

Brotons M, Campins M, Méndez L, Juste C, Rodrigo JA, Martínez X, Hermosilla E, Pinós L, Vaqué J.
Effectiveness of varicella vaccines as postexposure prophylaxis.

BACKGROUND: Although chickenpox is usually a mild disease, it is not always free of complications,
especially in adolescents and adults. Previous studies of postexposure prophylaxis conducted with
experimental vaccines showed the vaccine to be highly effective if administered in the first 3 to 5 days after
exposure. However, studies carried out with commercialized vaccines yielded discordant results. The aim
of the present study was to assess the effectiveness of currently available varicella vaccines as
postexposure prophylaxis.

METHODS:

We conducted a prospective cohort study. Patients susceptible to chickenpox consulting at the Preventive
Medicine Department of the Vall d'Hebron Hospital after household exposure to a case of chickenpox were
included. Postexposure prophylaxis with varicella vaccine was administered within the first 5 days after
contact. Subjects were interviewed by telephone between 4 and 8 weeks after vaccination to ascertain
whether chickenpox had appeared and, if so, its severity. The effectiveness of the vaccine in preventing
and attenuating the disease was calculated with a confidence interval of 95%.

RESULTS:

Sixty-seven subjects were included in the study. Effectiveness of the varicella vaccine in preventing any
type of disease was 62.3% (CI 95%: 47.8-74.9) and 79.4% (CI 95%: 66.4-88.9) in preventing moderate and
severe disease. No statistically significant differences were found when effectiveness was compared
according to sex, age, or days elapsed since exposure.

CONCLUSIONS:

Administration of varicella vaccines within the first 5 days postexposure is effective in preventing
chickenpox and in attenuating the illness.
Tidsskr Nor Laegeforen. 2011 Sep 6;131(17):1645-8. doi: 10.4045/tidsskr.10.0149.

[Post-exposure varicella prophylaxis].[Article in Norwegian] Johansen JS, Westergren T, Lingaas E.

Abstract

BACKGROUND:

Varicella may have a serious and sometimes fatal course, especially in immunocompromised patients.
Some patient groups may need prophylaxis after exposure to the varicella-zoster-virus. In this article we
review the evidence for usefulness of prophylactic measures after such exposure.

MATERIAL AND METHODS:

The article is based on a non-systematic literature search in Medline, the Cochrane Library, UpToDate and
Clinical Evidence.

RESULTS:

The effect of post-exposure varicella prophylaxis on disease rate and severity of varicella is only weakly
documented. There is some evidence that passive immunisation with varicella-zoster immunoglobulin
(VZIG) reduces the risk of serious disease when it is administered within 72-96 hours after exposure.
Several studies of mostly healthy children have shown that prophylactic acyclovir is better than control
treatment, but the studies are small and they are not properly designed. Post-exposure vaccination is
shown to reduce disease rate and severity in otherwise healthy children.

INTERPRETATION:

We believe that acyclovir or valacyclovir can be used as post-exposure varicella prophylaxis in risk patients
for whom the time window for VZIG-use has expired.

Vaccines and Preventable Diseases:

Post-exposure Varicella Vaccination Information for Health Care Providers

The Advisory Committee on Immunization Practices (ACIP) recommends that after being exposed to
varicella or herpes zoster, people who do not have evidence of immunity and are eligible for vaccination
should get varicella vaccine.

 Ideally, the vaccine should be given within 3 to 5 days after the person is exposed. This may
prevent varicella or make it less severe.
 Even if it has been more than 5 days, the vaccine should still be offered. This will provide
protection against varicella if a person is exposed again in the future.
People who previously got the first dose should get a second dose at the appropriate time interval. For
more information, see Routine Vaccination.

There are no data available on the use of the combination measles, mumps, rubella, and varicella vaccine
(ProQuad®) for post-exposure vaccination.

Varicella vaccination is recommended for controlling outbreaks. People who do not have adequate
evidence of immunity should get a first or second dose as needed. For information about outbreak
surveillance, investigation, and control, see Chickenpox (Varicella) Outbreaks.

Communicable Diseases Intelligence, Volume 25, Issue number 1 - January 2001. Varicella vaccine in
post-exposure prophylaxis

Post-exposure prophylaxis in the hospital setting

In their original report, Takahashi and colleagues described 23 children seronegative by complement
fixation titre who received vaccine with 500 plaque forming units (PFU) of infectious virus 'immediately' (not
otherwise defined) after diagnosis of the index case. Two children developed low-grade fever and a mild
vesicular rash attributed to the vaccine.1

Katsushima and colleagues first reported in 1982 administration of experimental vaccines containing
between 250 and 3,000 PFU to children with no history of chickenpox after hospital exposure and extended
their findings in a later report. None of 149 children receiving 250-3,000 PFU within 3 days of exposure -
and none of 15 who received 1000 PFU at 100 hours (i.e. 4 days, rather than 5) - became ill.5,6

A further Japanese report found that 41 of 46 child contacts given 'emergency vaccination' with 300-2,000
PFU were protected from disease, but gave no details of timing.7

When should adults be vaccinated against chickenpox?

All adults who have never had chickenpox or received the vaccination should be vaccinated
against it. Two doses of the vaccine should be given at least four weeks apart.

If you've never had chickenpox or been vaccinated and you are exposed to chickenpox, being
vaccinated right away will greatly reduce your risk of getting sick. Studies have shown that
vaccination within three days of exposure is 90% effective at preventing illness; vaccination
within five days of exposure is 70% effective. If you do get sick, the symptoms will be milder
and shorter in duration.
Who shouldn’t get the chickenpox vaccine?

You should not be vaccinated against chickenpox if you:

 Are moderately to severely ill at the time of vaccination.

 Are pregnant (women should not become pregnant for one month after receiving the
chickenpox vaccine).
 Have ever had an allergic reaction to gelatin, the antibiotic neomycin, or a previous dose of
chickenpox vaccine.

These people should check with their doctor about getting the chickenpox vaccine:

 Patients undergoing chemotherapy or radiation for cancer.

 People taking steroid drugs.
 People with HIV or another disease that compromises the immune system.
 Patients who recently had a blood transfusion or received other blood products.

What’s in the chickenpox vaccine?

The chickenpox vaccine is made from a live, weakened form of the varicella virus. That means
the virus is able to produce immunity in the body without causing illness.

Are there any risks associated with the chickenpox vaccine?

The most common side effect from the chickenpox vaccine is swelling, soreness, or redness at
the site of the injection. A small number of people may also develop a mild rash or a low-grade
fever after vaccination.

Serious reactions to the chickenpox vaccine are extremely rare, but they may include:

 Seizures, Brain infection, Pneumonia, Loss of balance, Severe allergic reaction (anaphylaxis)

If you think you may be having a serious reaction to the chickenpox vaccine, call your health
care provider right away. Make a note of the symptoms you're experiencing, and report them to
the Vaccine Adverse Event Reporting System (VAERS) at 1-800-822-7967.

Women who receive the chickenpox vaccine during pregnancy should contact their health care
provider right away. Chickenpox during pregnancy can cause birth defects, so there may be a
risk that the chickenpox vaccine could cause the same birth defects.

As with other vaccines, the risks associated with the chickenpox vaccine are much lower than the
risks associated with the disease itself.