Good, Better, Best

1
Good, Better,
Best!

• Increasing Varicella Coverage ages 4-12

Carole Watson, RN, BSN Immunization Program
Manager Forsyth County Department of Public
Health 10/2/03
2
Varicella Age-Specific Incidence
Rate per 100,000 population. National Health
Interview Survey data, 1990-1994.
3
History of Varicella Vaccine

• Live, attentuated viral vaccine, derived from
  Oka strain of varicella zoster virus (herpes
• virus family)
• Licensed in Japan Korea in 1988
• Licensed in US in 1995 (Varivax)

4
Effectiveness of Varivax

• Efficacy against infection 80-90
• Efficacy against severe disease 95
• Secondary bacterial (Staph or Strep) infections
  of skin lesions
• CNS manifestations (aseptic meningitis,
  encephalitis, etc.)

5
9-yr-old with Staphylococcus aureus of varicella
lesions
6
Child with scleral lesions and bulbar
conjunctivitis
7
Use of Varivax

• Routinely given at 12-18 mos. of age
• Required for children born on or after
• April 1, 2001 (given between 12 and 18 months of
  age)
• Recommended for all susceptible children before
  their 13th birthday
• (Susceptible no reliable history of disease
  and no history of vaccine)

8
SHOULD YOU GIVE VARIVAX IF

• The parent is not sure if the child has had
  chickenpox disease?
• There is an immunosuppressed person living in
  the home with the child?
• The child is receiving an MMR today?
• The child received an MMR 2 weeks ago?
• There is a pregnant woman in the home?

9
Adverse Varivax Reactions

• Injection site soreness, redness, swelling
• Fever (usually from other illness)
• Generalized varicella-like rash
• 4-6 of recipients
• Average of 5 lesions
• Occurs within 3 wks. usually maculopapular
  (rather than vesicular)

10
Zoster (Shingles) After Vaccination

• Most occur among children
• Not all are confirmed from virus
• All have been mild not associated with
  complications
• Risk from wild virus 4-5 times higher than from
  vaccine virus

11
Total Varicella Doses Given at FCDPH (1999-2002)
12
Varicella Doses, ages 4-12, FCDPH (1999)
GOOD
13
Varicella Doses, ages 4-12, FCDPH (2000-2002)
BETTER
14
Varicella Doses, ages 4-12, FCDPH (1999-2002)
BEST?