Disseminated varicella infection is a serious potential complication of natural infection with varicella virus, particularly among immunodeficient persons. Thus, varicella vaccine prevents disseminated varicella infection by protecting against natural infection. However, varicella vaccines can rarely cause disseminated varicella infection in patients with severe immune deficiency, for whom the vaccine is contraindicated. Other vaccines currently routinely recommended to the general population in the U.S.* do not cause disseminated varicella infection.
The 2012 report by the Institute of Medicine (IOM), now called the National Academy of Medicine (NAM), described one study assessing varicella vaccination with disseminated varicella infection 1; however, it did not provide convincing evidence due to a lack of validity and precision 2.
Proposed Biological Mechanism
Varicella vaccines are live attenuated viral vaccines, and are therefore able to replicate in the body. Generalized rash is reported in 4-6% of recipients. Systemic reactions are uncommon but possible. Mild zoster illness (shingles) resulting from a latent infection with varicella vaccine virus has been reported. Immunodeficiency is a contraindication for most live vaccines, including varicella vaccine. For more information, see the Varicella summary.
The 2012 IOM report described cases of disseminated varicella infection after varicella vaccination 3-22, and concluded that these cases together presented strong mechanistic evidence supporting an association 2. In immunodeficient persons, disseminated varicella infection can also result in pneumonia 3-5,14-16, meningitis 7, or hepatitis 3-5,9,11.
There have been several deaths due to disseminated varicella in children who had undiagnosed severe combined immunodeficiency (SCID) at the time of vaccination. However, it is extremely rare for children with SCID to remain undiagnosed at the age of varicella vaccination 23-26.
* These conclusions do not necessarily consider vaccines recommended only for special populations in the United States such as Yellow Fever vaccine (international travelers) or Smallpox vaccine (military personnel), or vaccines no longer recommended to the public such as the Janssen (J&J) COVID-19 vaccine.
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2. Institute of Medicine. In: Stratton K, Ford A, Rusch E, Clayton EW, eds. Adverse Effects of Vaccines: Evidence and Causality. Washington (DC): National Academies Press (US); 2012.
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