Test and, when necessary, vaccinate women
The key point for clinicians to recognize is that varicella now can be almost completely prevented through universal vaccination.9
Although the principal target group for vaccination is young children, ObGyns should question all women of reproductive age about susceptibility to varicella. Women who do not have a convincing history of natural infection should have a serologic test for varicella-zoster IgG. If immunity is not evident, they should be vaccinated prior to attempting pregnancy.
- The present varicella vaccine (Varivax) is a live-virus vaccine, which should be administered in 2 subcutaneous injections (0.5 mL) 4 to 8 weeks apart.
- The vaccine should not be administered to infants younger than 12 months of age, to pregnant or lactating women, or to patients who have received systemic steroids within the last month.
- The vaccine also should not be given to persons who are immunosuppressed, except as part of a carefully supervised research protocol.
The vaccine is highly immuno-genic and produces immunity in approximately 90% of healthy children. The rate of seroconversion is lower in adults and immunosuppressed patients. Vaccinated patients have a significantly lower rate of natural infection after exposure.
The author reports no financial relationships relevant to this article.