Two-dose varicella vaccination for persons ages 13 years and older without evidence of immunity is recommended by the Centers for Disease Control & Prevention Advisory Committee on Immunization Practices.

ACIP voted unanimously, with two abstentions, to recommend vaccination with two doses of varicella at least four weeks apart for all susceptible persons over age 13 without evidence of immunity during its June 29 meeting in Atlanta.

CDC currently recommends routine single-dose varicella vaccination for children 12-18 months old. Merck markets the varicella vaccine Varivax ; labeling for the vaccine was revised to include information on two-dose vaccination.

ACIP further recommended a second dose of varicella vaccine be administered to children ages two to 12 years with three months between first and second doses for outbreak control in specific geographical areas.

In addition, the panel recommended two-dose varicella vaccination for pregnant women without evidence of immunity and HIV-positive children. ACIP also recommended school entry requirements for varicella vaccination at all school entry levels.

However, ACIP declined to make a recommendation for routine or permissive second-dose varicella vaccination on children ages two to 12 years. Committee members cited the lack of clear benefit, the cost and the pending application for Merck's measles, mumps, rubella and varicella combination vaccine ProQuad .

Committee Chair Jon Abramson questioned whether the remaining varicella disease burden would warrant the cost of adding a second dose.

CDC estimated a two-dose program would have $549 mil. in direct costs and $585 mil. in societal costs versus $293 mil. and $330 mil. for a single-dose program. CDC's least conservative cost/benefit estimate found the direct cost per life-year saved to be $1.2 mil. ($693,000 C/LYS from a societal perspective).

Committee members expressed concern about making recommendations for a two-dose vaccination program without pricing data on ProQuad. Merck said it will not set a price for ProQuad until the vaccine is approved, but that the company is sensitive to pricing concerns and will take a rational approach in establishing a price. The company filed a BLA for ProQuad in August 2004.

Varicella Two-Dose Vaccination Recommended For Teens And Older Cohorts

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