What are the contraindications and precautions to varicella vaccine?

Contraindications:

• History of a serious allergic reaction (e.g., anaphylaxis) after a previous dose of varicella vaccine or to a varicella vaccine component. For information on vaccine components, refer to the manufacturer’s package insert (www.immunize.org/fda) or go to www.cdc.gov/pinkbook/hcp/table-of-contents/appendix-b-vaccines.html.
• Pregnancy
• Severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy [e.g., two weeks or more of daily receipt of 20 mg or more, or 2 mg/kg body weight or more, of prednisone or equivalent] or patients with HIV infection who are severely immunocompromised [a child age 1 through 5 years with CD4+ T-lymphocyte percentage less than 15% or a person age 6 years or older with a CD4+ T-lymphocyte count less than 200 cells per microliter])
• Family history of congenital or hereditary immunodeficiency in first-degree relatives (e.g., parents, siblings) unless the immune competence of the potential vaccine recipient has been clinically substantiated or verified by a laboratory

Precautions:

• Recent receipt (within the previous 11 months) of antibody-containing blood product (specific interval depends on product)
• Moderate or severe acute illness with or without fever (defer until recovery)
• Use of aspirin or aspirin-containing products
• Receipt of specific antiviral drugs (acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination (avoid use of these antiviral drugs for 14 days after vaccination)

Precautions for combination MMRV (ProQuad, Merck) only (approved for children 1 through 12 years of age) also include: history of thrombocytopenia or thrombocytopenic purpura, a personal or family history of seizures of any etiology, and a need for tuberculin skin testing or interferon-gamma release assay (IGRA) testing.

For additional information, see the “General Best Practice Guidelines for Immunization” section on contraindications and precautions, table 4–1 and associated footnotes, at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html.