Version July 2025
| Contraindications |
| Severe allergic reaction (eg, anaphylaxis) after a previous dose of varicella vaccine or to a varicella vaccine component (eg, neomycin, gelatin) |
| Pregnancy or possibility of pregnancy within 4 weeks |
Severe immunosuppression due to:
|
| Untreated active tuberculosis |
| PrecautionsΔ |
| Varicella vaccination should be deferred in patients at risk for congenital or hereditary immunodeficiency (ie, parent or sibling with hereditary immunodeficiency) until the immunocompetence of the potential vaccinee is clinically substantiated or verified with laboratory testing |
| Salicylate therapy |
| Personal history of seizures or seizures in sibling or parent (this a precaution for MMRV, but not for single-antigen varicella vaccine) |
| Receipt of antibody-containing blood product within past 3 to 11 months◊ |
| Concomitant antiviral therapy with acyclovir, valacyclovir, or famciclovir (may interfere with varicella vaccine; antiviral therapy should be discontinued ≥24 hours before administration of varicella vaccine and avoided for 14 days after vaccination) |
| Moderate or severe illness with or without fever (ie, illness more severe than upper respiratory infection, otitis media, gastroenteritis) |
| Conditions commonly misperceived as contraindications that are not contraindications to varicella vaccine |
| HIV infection without severe immunosuppression¶ (this is not a contraindication to varicella vaccine, but is a contraindication to MMRV, which contains ≥7-fold VZV than single-antigen varicella vaccine) |
| B-lymphocyte (humoral) immunodeficiency (eg, agammaglobulinemia) or congenital complement deficiencies |
| Breastfeeding |
| Pregnant contact§ |
| Immunocompromised family member or household contact§ |
| Conditions commonly misperceived as contraindications that are not contraindications to ANY vaccine |
| Mild acute illness with or without fever (eg, upper respiratory infection, otitis media, gastroenteritis) |
| Mild-to-moderate local reaction (eg, swelling, redness, soreness) after previous dose |
| Low-grade or moderate fever after previous dose |
| Current antibiotic therapy |
| Convalescent phase of illness |
| Preterm birth (except for hepatitis B vaccine in infants who weigh <2000 g and whose mother is hepatitis B surface antigen negative at the time of birth) |
| Recent exposure to infectious disease |
| History of penicillin allergy, other nonvaccine allergies, relatives with allergies, or receiving allergen extract immunotherapy |
HIV: human immunodeficiency virus; MMRV: measles, mumps, rubella, varicella combination vaccine.
* Refer to UpToDate topic on medical management of immunodeficiency for definitions of severe immunodeficiency in specific disorders.
¶ Refer to UpToDate topic on immunizations in HIV-infected patients for definition of severe immunosuppression in HIV infection.
Δ Precautions are conditions that may increase the risk of adverse reactions, diminish the immune response, or make it difficult to differentiate between a clinical manifestation of the condition and a vaccine adverse effect. When precautions are present, the risks and benefits of immunization (versus postponing the immunization) should be considered on a case-by-case basis.
◊ The specific interval depends upon the product. Refer to UpToDate topic on vaccination for the prevention of primary varicella infection for details.
§ If vaccinee develops a presumed vaccine-related rash after vaccination, the vacinee should avoid direct contact with immunocompromised persons and susceptible pregnant women for the duration of the rash.
