Contraindications and precautions for varicella vaccine

Contraindications

Severe allergic reaction (eg, anaphylaxis) after a previous dose of varicella vaccine or to a varicella vaccine component (eg, neomycin, gelatin)

Pregnancy or possibility of pregnancy within 4 weeks

Severe immunosuppression due to:

Solid tumors and hematologic malignancies (eg, blood dyscrasia, leukemia, lymphoma, malignant neoplasms affecting the bone marrow or lymphatic system)
Current receipt of chemotherapy
Immunosuppressive agents administered to patients who have undergone solid organ or hematopoietic stem cell transplant
Biologic agents for autoimmune conditions (eg, IL-1 receptor antagonists [eg, anakinra], tumor necrosis factor-alpha inhibitors [eg, etanercept, infliximab, adalimumab], and anti-CD20 agents [eg, rituximab])
Congenital or acquired T-lymphocyte immunodeficiency*
HIV infection (HIV-infected patients without severe immunosuppression may receive varicella vaccine)^¶
Long-term high-dose systemic glucocorticoids (ie, ≥2 weeks of prednisone ≥20 mg per day or prednisone ≥2 mg/kg per day [for children who weigh <10 kg] or equivalent)

Untreated active tuberculosis

Precautions^Δ

Varicella vaccination should be deferred in patients at risk for congenital or hereditary immunodeficiency (ie, parent or sibling with hereditary immunodeficiency) until the immunocompetence of the potential vaccinee is clinically substantiated or verified with laboratory testing

Salicylate therapy

Personal history of seizures or seizures in sibling or parent (this a precaution for MMRV, but not for single-antigen varicella vaccine)

Receipt of antibody-containing blood product within past 3 to 11 months^◊

Concomitant antiviral therapy with acyclovir, valacyclovir, or famciclovir (may interfere with varicella vaccine; antiviral therapy should be discontinued ≥24 hours before administration of varicella vaccine and avoided for 14 days after vaccination)

Moderate or severe illness with or without fever (ie, illness more severe than upper respiratory infection, otitis media, gastroenteritis)

Conditions commonly misperceived as contraindications that are not contraindications to varicella vaccine

HIV infection without severe immunosuppression^¶ (this is not a contraindication to varicella vaccine, but is a contraindication to MMRV, which contains ≥7-fold VZV than single-antigen varicella vaccine)

B-lymphocyte (humoral) immunodeficiency (eg, agammaglobulinemia) or congenital complement deficiencies

Breastfeeding

Pregnant contact^§

Immunocompromised family member or household contact^§

Conditions commonly misperceived as contraindications that are not contraindications to ANY vaccine

Mild acute illness with or without fever (eg, upper respiratory infection, otitis media, gastroenteritis)

Mild-to-moderate local reaction (eg, swelling, redness, soreness) after previous dose

Low-grade or moderate fever after previous dose

Current antibiotic therapy

Convalescent phase of illness

Preterm birth (except for hepatitis B vaccine in infants who weigh <2000 g and whose mother is hepatitis B surface antigen negative at the time of birth)

Recent exposure to infectious disease

History of penicillin allergy, other nonvaccine allergies, relatives with allergies, or receiving allergen extract immunotherapy

HIV: human immunodeficiency virus; MMRV: measles, mumps, rubella, varicella combination vaccine.
* Refer to UpToDate topic on medical management of immunodeficiency for definitions of severe immunodeficiency in specific disorders.
¶ Refer to UpToDate topic on immunizations in HIV-infected patients for definition of severe immunosuppression in HIV infection.
Δ Precautions are conditions that may increase the risk of adverse reactions, diminish the immune response, or make it difficult to differentiate between a clinical manifestation of the condition and a vaccine adverse effect. When precautions are present, the risks and benefits of immunization (versus postponing the immunization) should be considered on a case-by-case basis.
◊ The specific interval depends upon the product. Refer to UpToDate topic on vaccination for the prevention of primary varicella infection for details.
§ If vaccinee develops a presumed vaccine-related rash after vaccination, the vacinee should avoid direct contact with immunocompromised persons and susceptible pregnant women for the duration of the rash.

Data from:

Centers for Disease Control and Prevention. Varicella. In: Epidemiology and Prevention of Vaccine-Preventable Diseases. The Pink Book: Course Textbook, 14th ed, Hall E, Wodi AP, Hamborsky J, et al (Eds), Public Health Foundation, Washington, DC 2021. Available at: www.cdc.gov/vaccines/pubs/pinkbook/index.html (Accessed on February 21, 2022).
Kroger A, Bahta L, Hunter P. General Best Practice Guidelines for Immunization. Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP). Contraindications and precautions. Available at: www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html (Accessed February 19, 2022).
Marin M, Güris D, Chaves SS, et al. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2007; 56:1.
Rubin LG, Levin MJ, Ljungman P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2014; 58:e44.

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Contraindications and precautions for varicella vaccine