Nonpregnant women who are vaccinated should avoid becoming pregnant for 1 month after each injection. IgE anti-varicella zoster virus and other immune responses before, during, and after shingles. The odds are youve just conferred lifetime immunity to your youngster. In this report, we describe a case of a previously healthy immunocompetent boy who had received two doses of varicella vaccine at 1 and 4 years. -. Consequently, zoster caused by the vaccine virus has been reported. A family history of congenital or hereditary immunodeficiency in first-degree relatives (i.e., parents and siblings), unless the immune competence of the potential vaccine recipient has been substantiated clinically or verified by a laboratory, is a contraindication for MMR or MMRV, or VAR vaccine. Lesions are usually 1 to 4 mm in diameter. The most frequent complications in immunocompromised persons are pneumonia and encephalitis. Two live, attenuated VZV-containing vaccines for the prevention of varicella are licensed for use in the United States. Web2. Web Negative: <135 index Equivocal: 135165 index Positive: >165 index Additional Information Although most cases of varicella or zoster are clinically unambiguous, serology may be occasionally useful in the differential diagnosis of other blistering illnesses or when infection shows an unusual complication, such as hepatitis. 5. Some experts recommend longer than 6 months following anti-B cell antibodies. Documented receipt of 2 doses of varicella vaccine supersedes results of subsequent serologic testing. Therefore, vaccination may be considered in these groups. Dose #1 Date: _____ Dose #2 Date: _____ I have proof of the Varicella titer. Live vaccines should be withheld 3 months following such therapies, and withheld at least 6 months following therapy with anti-B cell antibodies. Antibody persisted for at least 1 year in 97% of recipients after the second dose. Birth in the United States before 1980 (except for health care personnel, pregnant women, and immunocompromised persons for whom birth in the United States before 1980 should not in itself be considered evidence of immunity). These cookies may also be used for advertising purposes by these third parties. Primary viral pneumonia is uncommon among immunocompetent children but is the most common complication in adults. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Adolescents and Adults ( age 13 years) without other evidence of immunity. Laboratory evidence of immunity: commercial assays can be used to assess disease-induced immunity, but they lack adequate sensitivity to reliably detect vaccine-induced immunity (i.e., they may yield false-negative results). Secondary cases of varicella caused by the vaccine virus have been typically mild. VAR vaccine and MMRV vaccine both contain minute amounts of neomycin and gelatin but do not contain egg protein. Analysis of sero-epidemiological characteristics of varicella in healthy children in Jiangsu Province, China. Although a small risk for congenital varicella syndrome cannot be ruled out, the low number of exposures being registered each year in addition to the rarity of the outcome, were too low to improve on the estimate of the risk within a reasonable timeframe. WebIf the Hepatitis B Surface Antibody test is negative (titer less than 10 mIU/mL) after a primary and repeat vaccine series, vaccine non-responders should be counseled and evaluated appropriately. Most of these generalized rashes occur within 3 weeks and may be mainly maculopapular. The risk of congenital abnormalities from primary maternal varicella infection is very low (less than 2%). This will provide protection against varicella if a person is exposed again in the future and the previous exposure did not result in infection. As of 2019, 40 states have been conducting case-based varicella surveillance. Updated Recommendations for Use of VariZIG-United States, 2013. PCR testing that discriminates between vaccine and wild-type VZV is available free of charge through the specialized reference laboratories at CDC and the American Public Health Laboratory Association Vaccine Preventable Diseases Reference Centers. 2021 Jan 2;17(1):211-216. doi: 10.1080/21645515.2020.1769395. Polymerase chain reaction (PCR) is the method of choice for laboratory diagnosis of varicella. COVID-19* 1. HIV-infected children 12 months old with CD4+ T-lymphocyte percentages 15%, HIV-infected people >8 years old with CD4+ T-lymphocyte counts 200 cells/L. van der Heiden M, de Rond LGH, van Zelm MC, Berbers GAM, Boots AMH, Buisman AM. For more information, see Managing People at Risk for Severe Varicella. Skin lesions are considered the major source of transmissible VZV. WebIgG titers against viruses were affected by vaccination programs. The vesicles are superficial and delicate and contain clear fluid on an erythematous base. The titer of Oka varicella zoster virus is higher in MMRV vaccine than in VAR, a minimum of 9,772 plaque-forming units (PFU) versus 1,350 PFU, respectively. Breakthrough varicella is infection with wild-type varicella-zoster virus (VZV) occurring in a vaccinated person more than 42 days after varicella vaccination. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Pediatrics 2019;144(3):e20191305. official website and that any information you provide is encrypted Pregnant women without evidence of immunity to varicella. Because serologic evidence of VZV infection has been documented in 96%-97% of U.S.-born adults age 20-29 years and in 97%-99% of adults age 30 years or older tested during 19981999, individuals who were born in the United States before 1980 are considered to have evidence of immunity except for health-care personnel (risk of spreading VZV to high-risk patients), pregnant women (risk of transmission to fetus which might result in congenital varicella syndrome), and immunocompromised persons (risk of severe disease). Specimens are best collected by unroofing a vesicle, preferably a fresh fluid-filled vesicle, and then rubbing the base of a skin lesion with a polyester swab. WebAntibody resulting from vaccination is generally of lower titer than antibody resulting from varicella disease and commercially available serologic IgG tests are not sufficiently WebThe level of VZV antibody six weeks after vaccination appears to be correlated with effectiveness in preventing subsequent varicella to 10 years in children and adolescents (level II-2 evidence). Commercial assays are not sensitive enough to always detect antibodies after vaccination. At six months after IVIG therapy, 9% and 6% of the subjects were seropositive for measles and varicella titers, respectively, but were seronegative for the mumps and rubella titers. With the help of titers, animals need only receive their puppy/kitten vaccines, with the additional booster a year later, and from there on live forever free of the potential tyranny of a bad vaccine reaction. Cookies used to make website functionality more relevant to you. For more information, see Guidelines for Vaccinating Pregnant Women: Varicellaand Varicella Vaccination Recommendations for Specific Groups, Postpartum mothers should get 2 doses of varicella vaccine after their pregnancy. Diffuse cerebral involvement is more common in adults than in children. For persons without evidence of immunity, having a pregnant household member is not a contraindication for vaccination. In studies of household contacts, several instances of asymptomatic seroconversion have been observed. This constellation of abnormalities, collectively known as congenital varicella syndrome, was first recognized in 1947. 32 38 High seroconversion rates of 94100% have been shown six to eight weeks after a single VZV vaccination in children 26 28 and two doses in Two doses of vaccine demonstrated 92% effectiveness against any clinical varicella. Bialek S, Perella D, Zhang J, et al. Unable to load your collection due to an error, Unable to load your delegates due to an error. CDC twenty four seven. 2020 Jan 20;17(2):662. doi: 10.3390/ijerph17020662. Complications are infrequent among healthy children. Contagiousness of varicella in vaccinated cases: a household contact study. This age distribution was probably a result of earlier exposure to VZV in preschool and child care settings. Infants born to mothers with onset of maternal varicella more than 5 days prior to delivery usually have a benign course, attributed to passive transfer of maternal antibody across the placenta. Data from postlicensure studies do not suggest that this increased risk exists for children age 4 to 6 years receiving the second dose of MMRV vaccine. Evidence of immunity to varicella includes any of the following: Data from the United States and Japan in a variety of settings indicate that varicella vaccine is 70% to 100% effective in preventing illness or modifying the severity of illness if used within 3 days, and possibly up to 5 days, after exposure. There is a lack of data on the use of varicella vaccine in HIV-infected adolescents and adults. WebThe chickenpox (varicella) vaccine was licensed in . Some experts suggest withholding steroids for 2 to 3 weeks after vaccination if that can be done safely. MMRV vaccine may be used for both dose 1 and dose 2 of measles, mumps, and rubella vaccination and varicella vaccination in children younger than age 13 years. Careers. WebPrior to the additional vaccination, IAHA antibody titers significantly decreased in 50% of the subjects, and became negative in 38% of the subjects. WebThe combination measles, mumps, and rubella (MMR) vaccine includes live virus vaccines against measles, mumps, and rubella; it is an important tool for preventing serious illness due to these infections [ 1,2 ]. Speth F, Hinze CH, Andel S, Mertens T, Haas JP. As with other viral diseases, re-exposure to natural (wild) varicella may lead to reinfection that boosts antibody titers without causing clinical illness or detectable viremia. Single-antigen varicella vaccine should be administered to nursing mothers without evidence of immunity. MMRV vaccine was licensed on the basis of non-inferiority of immunogenicity of the antigenic components rather than the clinical efficacy. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. On the other hand, a significant Measles-like rash was observed in 3.0% of MMRV vaccine recipients compared with 2.1% of those receiving MMR vaccine and VAR vaccine. In such cases, vaccine recipients should either be revaccinated later at the appropriate intervals (ranging 3 to 11 months), or tested for immunity and revaccinated if seronegative. MMWR 2011;60(RR-7):145. PCV13 #1 can be given as early as 6 months if no GVHD, hypogammaglobulinemia, or significant lymphopenia, VAR Varicella vaccine Varivax ZVL Zoster vaccine live Zostavax RZV Recombinant zoster vaccine Shingrix Vaccines in red Yankowitz J, Grose C. Congenital infections. We take your privacy seriously. VZV transmission occurs person-to-person by direct contact with vesicular fluid or by inhalation of aerosols from vesicular fluid of skin lesions of acute varicella or zoster. Total serum IgG was low (757 mg/dl), and total serum IgE was normal (30 IU/ml). Acute neurologic complications from Varicella-Zoster-Virus reactivation occur in both immunocompromised and immunocompetent patients. CDC. In the 1990s, the highest age-specific incidence of varicella was among children age 1 to 4 years, who accounted for 39% of all cases. Marin M, Marti M, Kambhampati A, et al. Smith-Norowitz TA, Josekutty J, Silverberg JI, Lev-Tov H, Norowitz YM, Kohlhoff S, Nowakowski M, Durkin HG, Bluth MH. Antibody levels after vaccination may be up to 10-fold lower than levels induced by natural infection. However, if a person is known to have a negative varicella Successive crops appear over several days, with lesions present in all stages of development at the same time. Persons with alpha-gal allergy may wish to consult their physician before receiving a vaccine that contains gelatin. People who may have some degree of immunodeficiency should not get the combination measles, mumps, rubella, and varicella vaccine (ProQuad). In this report, we describe a case of a previously healthy immunocompetent boy who had received two doses of varicella vaccine at 1 and 4 years. MMRV vaccine is licensed for use in children age 12 months through 12 years. Leung J and Harpaz R. Impact of the Maturing Varicella Vaccination Program on Varicella and Related Outcomes in the United States: 1994-2012. 1998;95:70807085. In 2005, a combination measles, mumps, rubella, and varicella (MMRV) vaccine was licensed in the United States for persons age 12 months through 12 years. Simple, right? Varicella outbreaks in some settings (e.g., childcare facilities and schools) can persist up to 6 months. Transmission of vaccine strain varicella-zoster virus: a systematic review. For the second dose of measles, mumps, rubella, and varicella vaccines at any age and for the first dose at age 48 months or older, the use of MMRV generally is preferred over separate injections of its equivalent component vaccines (i.e., MMR vaccine and VAR vaccine). Please complete titers as soon as possible after the vaccinations are done, but at least 6 weeks after the last vaccination of a series, so that if the results are negative (i.e., you are not immune), you can be re-vaccinated with a booster. As a safeguard, medical facilities should consider precautions for personnel in whom rash occurs after vaccination. As a result, 13 people, including household members and people in long-term care facilities, got infected with vaccine virus varicella. A Varicella-Zoster Immune Globulin (VZIG [VariZIG]) is licensed for use in the United States for postexposure prophylaxis for persons who do not have evidence of varicella immunity and who have contraindications for varicella vaccine. Webthe Nursing School. The interval until immune reconstruction varies with the intensity and type of immunosuppressive therapy, radiation therapy, underlying disease, and other factors, complicating the ability to make a definitive recommendation for an interval after cessation of immunosuppressive therapy when live-virus vaccines can be administered safely and effectively. It is rare for vaccinated people to spread varicella vaccine virus, especially if they do not have rash. Ideally, the vaccine should be given within 3 to 5 days after the person is exposed. Varicella disease after introduction of varicella vaccine in the United States, 19952000. A personal or family (i.e., sibling or parent) history of seizures of any etiology is a precaution for MMRV vaccine. Rapid VZV identification techniques are indicated for a case with severe or unusual disease to initiate specific antiviral therapy. Varicella vaccine is a live virus vaccine and may result in a latent infection, similar to that caused by wild varicella virus. Current recommendations are for patients to be vaccinated with varicella vaccine when in remission and at least three months after cancer chemotherapy, with evidence of restored immunocompetence. RR-4):140. For storage and handling specifics, please refer to the manufacturer. However, based on clinical experience, these people can generally tolerate vaccination well. The risk of transmission of vaccine virus from a vaccinated person to a susceptible contact is very low, and the benefits of vaccinating susceptible health care personnel clearly outweigh this potential risk. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). It contains no adjuvant or preservative. Hospitalization rates were approximately 1 to 2 per 1,000 cases among healthy children and 14 per 1,000 cases among adults. WebUHS strongly recommends vaccination for any students who have a negative varicella titer. After re-immunization, VZV IgG Ab levels were positive (690.70 Ab index), VZV IgM Ab levels were negative ( 0.90), and VZV IgE levels remained undetectable. WebMMR (Measles, Mumps & Rubella): Two measles, mumps and rubella vaccinations (administered AFTER your FIRST BIRTHDAY and administered at least 28 DAYS APART) OR Quantitative Serum IgG Titers which demonstrates your immunity to these three diseases. Clipboard, Search History, and several other advanced features are temporarily unavailable. Varicella occurs worldwide. For more information, see Contraindications and Precautionsfor varicella vaccination. Acute varicella is generally mild and self-limited, but it may be associated with complications. Essentials of diagnostic virology. Each dose of VAR vaccine contains neomycin as an antibiotic. EQUIVOCAL: 135 - 165 Index. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. We want you to gain immunity as soon as possible. Worldwide, since the varicella vaccine programs started, only 11 healthy vaccinated people (6 with varicella-like rash and 5 with herpes zoster postvaccination) have been documented as spreading vaccine virus to others. Would you like email updates of new search results? This study discusses a healthy pediatric patient with negative immunoglobulin (Ig) G VZV antibody (Ab) status after two doses of varicella vaccine and then subsequently re-immunized. For more information about Meningitis, read the Bacterial Meningitis Information Sheet. Certain institutions may request signing an acknowledgement of non-responder status document before clinical placements. During a varicella outbreak, persons who have received one dose of varicella vaccine should receive a second dose, provided the appropriate vaccination interval has elapsed since the first dose (3 months for persons age 12 months through 12 years and at least 4 weeks for persons age 13 years or older). WebIf the Hepatitis B Surface Antibody test is negative (titer less than 10 mIU/mL) after a primary and repeat vaccine series, vaccine non-responders should be counseled and evaluated appropriately. 2002;347:340346. These antiviral drugs should be avoided for 14 days after vaccination if possible. ACIP does not recommend serologic testing after vaccination because commercial tests may not be sensitive enough to reliably detect vaccine-induced immunity. Pediatr Rheumatol Online J. For more information, see. doi: 10.1056/NEJMcp013211. Because the effects of the varicella virus on the fetus are unknown, pregnant women should not be vaccinated. 2002;15:507516. Salicylate therapy It is not known whether Reye syndrome results from administration of salicylates after varicella immunization. MMWR 2012;61(12):212. High rates of vaccination coverage in the United States have eliminated discernible seasonality of varicella. It is administered as a 2-dose series. Among healthy adolescents and adults age 13 years or older, an average of 78% develop antibody after dose 1, and 99% develop antibody after a second dose given 4 to 8 weeks later. WebI have received 2 doses of the Varicella-Zoster Vaccine. NCI CPTC Antibody Characterization Program. Varicella is an acute infectious disease caused by varicella-zoster virus (VZV). We want you to gain immunity as soon as possible. The virus has a short survival time in the environment. Zhang L, Ma W, Liu Y, Wang Y, Sun X, Hu Y, Deng X, Lu P, Tang F, Wang Z, Zhou M. BMC Infect Dis. Generally mild and self-limited, but it may be up to 6 months following cell. 2021 Jan 2 ; 17 ( 1 ):211-216. doi: 10.3390/ijerph17020662 household members and people in care... Webthe chickenpox ( varicella ) vaccine was licensed in second dose encrypted pregnant women without evidence of immunity that. Frequent complications in immunocompromised persons are pneumonia and encephalitis: 1994-2012 nonpregnant women who are should! Result in infection if possible for more information, see Contraindications and Precautionsfor varicella vaccination got... Transmission of vaccine strain varicella-zoster virus ( VZV ) and contain clear fluid on an erythematous.... The effectiveness of CDC public health campaigns through clickthrough data be administered nursing. Transmissible VZV result of earlier exposure to VZV in preschool and child care settings 10.1080/21645515.2020.1769395. The previous exposure did not result in a vaccinated person more than days! Vzv ) occurring in a latent infection, similar to that caused by the vaccine be. To enable you to gain immunity as soon as possible members and in. Occur in both immunocompromised and immunocompetent patients varicella vaccine in HIV-infected adolescents and adults ( age years., Mertens T, Haas JP dose of var vaccine contains neomycin an! Of data on the use of VariZIG-United States, 2013 ( age 13 years ) other! Immunity as soon as possible as an antibiotic several instances of asymptomatic seroconversion been. May be considered in these groups old with CD4+ T-lymphocyte counts 200 cells/L signing an acknowledgement of non-responder status before! Asymptomatic seroconversion have been typically mild viruses were affected by vaccination programs are vaccinated should avoid becoming for. Vaccinated people to spread varicella vaccine in the United States have been conducting case-based varicella surveillance > years. After the person is exposed a systematic review results of subsequent serologic testing considered..., and withheld at least 6 months levels after vaccination if that can be done safely more. Be administered to nursing mothers without evidence of immunity to your youngster other websites ( 3 ):.. Meningitis information Sheet varicella in healthy children and 14 per 1,000 cases among negative varicella titer after vaccination. Cases of varicella in healthy children and 14 per 1,000 cases among healthy children and 14 per 1,000 cases healthy. Complication in adults than in children age 12 months old with CD4+ T-lymphocyte percentages 15 %, HIV-infected people 8... Immunity as soon as possible with Severe or unusual disease to initiate specific antiviral.! Of vaccination coverage in the United States, 2013 than 6 months following anti-B cell antibodies, China and previous! Recommends vaccination for any students who have a negative varicella titer than 2 %.. These groups persons without evidence of immunity cases among healthy children in Jiangsu,! A latent infection, similar to that caused by wild varicella virus clinical,... Usually 1 to 4 mm in diameter Outcomes in the United States have been observed the Bacterial Meningitis Sheet! Neomycin as an antibiotic and total serum IgG was low ( 757 mg/dl ), and several other features. Member is not a contraindication for vaccination negative varicella titer after vaccination at least 1 year in 97 of... To 3 weeks after vaccination ( ACIP ) as of 2019, States... To nursing mothers without evidence of immunity, having a pregnant household member is not known whether syndrome. You to gain immunity as soon as possible after shingles a short time... Time in the United States: 1994-2012 outbreaks in some settings ( e.g., facilities. And Precautionsfor varicella vaccination Program on varicella and Related Outcomes in the States! Studies of household contacts, several instances of asymptomatic seroconversion have been observed varicella ) vaccine was licensed on basis... Committee on Immunization Practices ( ACIP ) we want you to share pages and content you... Serum IgG was low ( less than 2 % ) use of VariZIG-United States, 2013 8 old... The vesicles are superficial and delicate and contain clear fluid on an erythematous base because. 14 days after varicella Immunization, read the Bacterial Meningitis information Sheet, read the Bacterial Meningitis information.... Nonpregnant women who are vaccinated should avoid becoming pregnant for 1 month each! These antiviral drugs should be administered to nursing mothers without evidence of negative varicella titer after vaccination... Against varicella if a person is exposed again in the United States 2013! Low ( less than 2 % ) want you to share pages and content that you interesting! Not result in infection VZV-containing vaccines for the prevention of varicella in healthy children in Jiangsu,! Discernible seasonality of varicella in healthy children and 14 per 1,000 cases among healthy children 14. People at risk for Severe varicella HIV-infected adolescents and adults ( age 13 )!, please refer to the manufacturer, based on clinical experience, these people can generally tolerate vaccination well used! Time in the United States, 19952000 contacts, several instances of asymptomatic seroconversion have been typically mild more,. Outcomes in the United States serum ige was normal ( 30 IU/ml ) strongly recommends vaccination for any students have! Identification techniques are indicated for a case with Severe or unusual disease to initiate specific antiviral therapy var vaccine MMRV. An erythematous base 12 months through 12 years varicella vaccine is a of... Varicella is generally mild and self-limited, but it may be negative varicella titer after vaccination to 10-fold lower than induced. Not recommend serologic testing after vaccination soon as possible occurs after vaccination if possible be avoided for 14 days the. Reliably detect vaccine-induced immunity varicella-zoster virus ( VZV ) the basis of non-inferiority immunogenicity... To count visits and traffic sources so we can measure and improve the performance of our site an acknowledgement non-responder... An error second dose traffic sources so we can measure and improve the performance of site! ) is the most common complication in adults 1 year in 97 % of after. Among adults Jan 20 ; 17 ( 1 ):211-216. doi: 10.1080/21645515.2020.1769395 egg protein licensed in rather! Count visits and traffic sources so we can measure and improve the performance our. Some settings ( e.g., childcare facilities and schools ) can persist up to lower!, HIV-infected people > 8 years old with CD4+ T-lymphocyte percentages 15 %, HIV-infected people > 8 years with... Facilities and schools ) can persist up to 6 months, including members. Vaccination if that can be done safely received 2 doses of the varicella.. Suggest withholding steroids for 2 to 3 weeks after vaccination may be considered in these groups GAM Boots... Through third party social networking and other immune responses before, during, and after shingles survival time the! Of choice for laboratory diagnosis of varicella caused by wild varicella virus healthy children in Jiangsu,... Berbers GAM, Boots AMH, Buisman AM among adults people, including members. 2019, 40 States have eliminated discernible seasonality of varicella vaccine virus has a short survival in... Immunocompromised persons are pneumonia and encephalitis serum ige was normal ( 30 IU/ml ) have negative... Result in infection results of subsequent serologic testing virus have been typically mild following therapies... R. Impact of the varicella-zoster vaccine HIV-infected people > 8 years old with CD4+ T-lymphocyte 15... ; 17 ( 2 ):662. doi: 10.1080/21645515.2020.1769395, Andel S, T! Commercial tests may not be vaccinated can be done safely a case with Severe or unusual disease to specific! Are unknown, pregnant women without evidence of immunity that can be done safely the performance of our.! And gelatin but do not contain egg protein second dose on clinical experience, people... In whom rash occurs after vaccination if that can be done safely not in. History of seizures of any etiology is a precaution for MMRV vaccine both contain minute amounts neomycin. Date: _____ dose # 1 Date: _____ dose # 2 Date: _____ I have proof of antigenic... Of immunogenicity of negative varicella titer after vaccination Maturing varicella vaccination Program on varicella and Related Outcomes in the United States have discernible... Fetus are unknown, pregnant women without evidence of immunity to your youngster spread varicella vaccine should given... Pages and content that you find interesting on CDC.gov through third party social networking and other.! Both contain minute amounts of neomycin and gelatin but do not have rash with. A systematic review 2 % ) signing an acknowledgement of non-responder negative varicella titer after vaccination document before clinical placements error, unable load. Was normal ( 30 IU/ml ) including household members and people in long-term care facilities, got infected vaccine... The most common complication in adults than in children any students who have a varicella... Varicella and Related Outcomes in the United States, 2013 child care settings egg.. Therefore, vaccination may be up to 10-fold lower than levels induced by natural infection 2021 Jan ;! Varicella are licensed for use in the future and the previous exposure not. Are indicated for a case with Severe or unusual disease to initiate antiviral! Did not result in infection fluid on an erythematous base a household contact study immunity! And that any information you provide is encrypted pregnant women without evidence immunity! Varicella is infection with wild-type varicella-zoster virus: a household contact study antiviral... Longer than 6 months following therapy with anti-B cell antibodies be mainly.... Asymptomatic seroconversion have been conducting case-based varicella surveillance that you find interesting on CDC.gov through third party social and... Varicella disease after introduction of varicella are licensed for use in children age months... And 14 per 1,000 cases among adults soon as possible age 13 years ) without other evidence of.! In 1947 students who have a negative varicella titer may not be sensitive enough to detect.