A 15-month-old child received varicella vaccine 3 days ago. The child's 4-year-old sibling is now diagnosed with leukemia and is about to begin immunosuppressive chemotherapy. The vaccinated child has developed a mild varicelliform rash (5 lesions). What is the CORRECT advice regarding contact between the vaccinated child and the leukemic sibling?
- A Transmissible vaccine virus is possible; the vaccinated child with rash should avoid contact with the immunocompromised sibling ✓
- B The vaccinated child poses no risk since the rash is mild and will resolve
- C The leukemic sibling should immediately receive varicella vaccine
- D No precautions needed; vaccine strain is never transmissible
Correct answer: A. Transmissible vaccine virus is possible; the vaccinated child with rash should avoid contact with the immunocompromised sibling
Explanation
Transmission of vaccine-strain varicella (Oka strain) to immunocompromised contacts is a rare but documented event and is most likely when the vaccinated person develops a post-vaccination varicelliform rash. The rash indicates viral replication. While the overall risk of transmission is very low, during the period of rash, contact between the vaccinated child and immunocompromised individuals should be avoided. This is a specific contraindication caveat in the varicella vaccine prescribing information.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.