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Assess adults for varicella immunity.(News)
ATLANTA -- All healthy adolescents and adults born in the United States after 1965 should be assessed for varicella immunity and vaccinated if susceptible, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its summer meeting.
The committee recommended a prenatal assessment of women for varicella immunity. Upon completion or termination of pregnancy, women who do not have evidence of varicella immunity should receive the first dose of varicella vaccine before discharge from the hospital, birthing center, or abortion clinic, and a second dose 4-8 weeks later. Such institutions should adopt standing orders to institute the procedure, ACIP said.
The new recommendations--which are not official until approved by the CDC--expand the previously published list of adults at high risk for varicella exposure and/or transmission by adding healthy people who do not have a history of chickenpox or herpes zoster disease and who have not been vaccinated against varicella. The list already includes health care workers, family contacts of immunocompromised persons, people who live or work in high-risk environments such as day care centers, nonpregnant women of childbearing age, and international travelers (MMWR 1999;48[RR06]:1-5).
"Before, the emphasis was on high risk. Now, [ACIP] is saying screen everyone," Kathleen M. Neuzil, M.D., the American College of Physicians' liaison to ACIP, told this newspaper.
But, she added, the new recommendation may not be as onerous as it sounds, since most adults--even those born after 1965--are already immune to varicella; nearly 100% of individuals aged 40 and older are immune, compared with about 99% of those aged 30-39 and 96% of people in their 20s.
"If they say they had chickenpox, you don't have to do anything else," said Dr. Neuzil of the division of allergy and infectious diseases at the University of Washington, Seattle.
But two doses of live varicella virus vaccine (Varivax) given 4-8 weeks apart are now advised for the small number of individuals aged 13 and older who do not have evidence of prior varicella disease (by self-report of typical disease or diagnosis by a health care provider), herpes zoster, ...
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