Varilrix is the funded varicella (chickenpox) vaccine on the National Immunisation Schedule and is routinely administered at 15 months of age (or as a catch-up of the 15-month dose). A separate catch-up programme is available for children and adolescents from 11 years of age until they turn 18 years if they have not had previously had varicella infection or vaccine. Funded varicella vaccination may also be available for eligible children and adults through the Special Groups programme.

• Children born on/after 1 April 2016 can have one free varicella vaccine dose when they turn 15 months (or as a catch-up of the 15-month dose). This includes those who have previously had varicella infection or received a non-funded varicella vaccine.
• Children and adolescents 11 years of age can have one funded varicella vaccine (or as a catch-up of the 11-year dose until they turn 18 years of age) if they have not previously had varicella infection or received a varicella vaccine (funded or non-funded over the age of 12 months). Two doses are recommended from 13 years of age; however, only one dose is funded with the second dose being non-funded.
• Adults aged 18 years and over are not eligible for funded varicella vaccine unless they have a medical condition that meets eligibility criteria for one of the special groups listed in the Pharmaceutical Schedule.
• Varilrix can be given from 9 months of age. A two-dose course is recommended if administration is started before 12 months of age. The first dose may be administered between 9 and 11 months of age (non-funded and with a prescription, unless special group eligibility), with a second dose given from 12 months of age.

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Special groups funding

A maximum of two doses of varicella vaccine (Varilrix) are funded for non-immune individuals in the following groups:

• People with chronic liver disease who may be candidates for transplantation in the future
• People with deteriorating renal function before transplantation
• People awaiting a solid organ transplant
• People prior to elective immunosuppression*
• Immunocompetent inpatients requiring post-exposure prophylaxis
• People at least 2 years after bone marrow transplantation, on the advice of their specialist
• People at least 6 months after completing chemotherapy, on the advice of their specialist
• People living with HIV who are non-immune to varicella and have mild to moderate immunosuppression, on the advice of an HIV specialist
• People with inborn errors of metabolism who are at risk of major metabolic decompensation and have no clinical history of varicella
• Household contacts of paediatric patients who are immunocompromised, or undergoing a procedure that will lead to immunocompromise, who have no clinical history of varicella
• Household contacts of severely immunocompromised adult patients, or adult patients undergoing a procedure that will lead to immunocompromise, who have no clinical history of varicella

* immunosuppression due to steroid or other immunosuppressive therapy must be for a treatment period of greater than 28 days

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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 is recommended to be administered a minimum of six weeks after the first dose. If a shorter gap is required then a minimum of four weeks can be considered.
• Infants who receive their 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 six weeks apart for individuals in this age group receiving varicella vaccine for the first time. A minimum of four weeks can be considered if a shorter gap is required.
• Varicella vaccination is not routinely recommended for adults aged 50 years or older.

Catch-up doses

• All children and adults up to 50 years of age, as required.
• Varicella vaccination is not routinely recommended for adults aged 50 years or older.

Vaccine storage and preparation

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

Administration

• The Ministry of Health recommends that varicella vaccine is administered via the IM route. However, administration of varicella vaccine by either the IM or SC injection route delivers a valid dose of vaccine. In the original clinical trials, varicella vaccine was given by SC injection and this became the recommended route of injection. Since then, data has shown that administration of varicella vaccine by IM injection generates an immune response equal to the response when the vaccine is given via the SC route, and the vaccine is also well-tolerated.

For infants likely to require a liver or kidney transplantation who are on an accelerated vaccination schedule (refer to table 4.4 in the current Immunisation Handbook)

• Varilrix can be administered concurrently with other Schedule vaccines, including MMR or hepatitis A. Separate syringes and different injection sites should be used.
• If Varilrix is not given at the same visit as another live injectable vaccine e.g. MMR, a four-week interval between the two live virus vaccines should be observed.

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, see chapter 22.6.1 in the Immunisation Handbook.
• 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 four 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 vaccine-related 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.

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 six 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.

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