A 5-month-old child who received VariZIG after varicella exposure during chemotherapy is 5 months post-therapy. Which vaccines should be ordered?

A 5-month-old child who received VariZIG after varicella exposure during chemotherapy is 5 months post-therapy. Which vaccines should be ordered?

• A. MMR and Tdap
• B. MMR, Varivax, Tdap
• C. Tdap only
• D. Varivax and Tdap

Answer: (B)

After exposure to varicella, giving VariZIG introduces passive antibodies that can interfere with the immune system’s response to live vaccines if they are given too soon. In particular, varicella vaccine should be delayed for about five months after VariZIG to avoid neutralization of the vaccine virus. Once five months have passed since the immune globulin, and the child has recovered from chemotherapy, the immune system is more capable of mounting a response to vaccines. With that window now passed, it’s appropriate to restart catch-up vaccination to protect against several diseases at once. The measles, mumps, and rubella vaccine is a live vaccine that should be given as part of catch-up when the patient is immunocompetent and past the acute immunosuppressed period. The varicella vaccine (Varivax) can now be given since the interfering antibodies from VariZIG have waned. The Tdap vaccine is non-live and safe to administer for broader protection, and it’s important to include it in catch-up schedules as well. So the best approach is to order the measles-mumps-rubella vaccine, the varicella vaccine, and the Tdap vaccine.

After exposure to varicella, giving VariZIG introduces passive antibodies that can interfere with the immune system’s response to live vaccines if they are given too soon. In particular, varicella vaccine should be delayed for about five months after VariZIG to avoid neutralization of the vaccine virus. Once five months have passed since the immune globulin, and the child has recovered from chemotherapy, the immune system is more capable of mounting a response to vaccines.

With that window now passed, it’s appropriate to restart catch-up vaccination to protect against several diseases at once. The measles, mumps, and rubella vaccine is a live vaccine that should be given as part of catch-up when the patient is immunocompetent and past the acute immunosuppressed period. The varicella vaccine (Varivax) can now be given since the interfering antibodies from VariZIG have waned. The Tdap vaccine is non-live and safe to administer for broader protection, and it’s important to include it in catch-up schedules as well.

So the best approach is to order the measles-mumps-rubella vaccine, the varicella vaccine, and the Tdap vaccine.