Recommendations for use of vaccine

Recommendations for the use of vaccine are summarised (1).

Specific individuals may benefit from pre-exposure vaccine (those without VZ antibody):

• healthcare workers - those working in general practice and hospitals who have patient contact, e.g. cleaners on wards, catering staff, ambulance staff, receptionists in general practice, as well as medical and nursing staff
  • those with a definite history of chickenpox or herpes zoster can be considered protected. Healthcare workers with a negative or uncertain history of chickenpox or herpes zoster should be serologically tested and vaccine offered only to those without VZ antibody
  • healthcare workers should be told at the time of vaccination that they may experience a local rash around the site of injection or a more generalised
    rash in the month after vaccination
    • in either case, they should report to their occupational health department for assessment before commencing work
    • if the rash is generalised and consistent with a vaccine-associated rash (papular or vesicular), the healthcare worker should avoid patient contact
      until all the lesions have crusted
    • healthcare workers with localised vaccine rashes that can be covered with a bandage and/or clothing should be allowed to continue working unless in contact with immunocompromised or pregnant patients
      • in the latter situation, an individual risk assessment should be made
• laboratory staff - people who might be exposed to the virus during their work e.g. - in virology laboratories and clinical infectious disease units
• contacts of immunocompromised patients - VZ vaccine is recommended for healthy susceptible contacts of immunocompromised patients with continuing close contact e.g. - siblings of a leukaemic child, or a child whose parent is undergoing chemotherapy

The vaccine should not be given to:

• immunosuppressed patients
• for patients who require protection against chickenpox, seek advice from a specialist
• women who are pregnant. Pregnancy should be avoided for one month following the last dose of varicella vaccine
• or to those who have had:
  • a confirmed anaphylactic reaction to a previous dose of the vaccine
  • a confirmed anaphylactic reaction to any component of the vaccine, including neomycin or gelatin

Check uptodate guidance before prescribing VZG

Reference

• 1.UK Department of Health 2023. The Green Book - Varicella