HIV In Children
 
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VARICELLA VACCINE

Q. What is the schedule?
A. It is to be given subcutaneous over left arm or thigh. It is given at 12-15 months of age. In children < 13 years, only one dose is required. In children > 13 years and adults, 2 doses are given at 6-8 weeks interval. Immuno-compromised patients need 2 doses irrespective of age.

Q. What are the side effects?
A. It is a very safe vaccine. Local side effects seen include pain, redness, swelling in <5% of vaccines. Systemic side effects like fever are rare. 3-7% of vaccines can develop varicella like rash, which are very mild with rapid recovery. It can occur within 6 weeks of vaccination.

Q. What are the contraindications to Varicella vaccine?
A. Firstly it is not indicated in those who have definite history of chickenpox in the past. It is contraindicated in-patients with neomycin hypersensitivity as the vaccine contains traces of neomycin. It is contraindicated in patients with immunodeficiency including symptomatic HIV and in children with acute leukemia on chemotherapy.

For patients with leukemia in remission, chemotherapy should be withheld for at least 2 weeks before and after the first dose of vaccine. Similarly patients on high dose of long-term steroids should be given the vaccine when steroids are temporarily withheld for at least 2 weeks before and after vaccine.

It is contraindicated during pregnancy and in fact pregnancy should be avoided for at least 6-8 weeks after vaccination.


Q. What is herpes zoster?
A. Varicella and herpes zoster are manifestations of the same virus i.e. varicella virus. When a person comes in contact with the virus for the first time, he develops chickenpox. Even when he recovers, the virus remains latent in the nerves for years. In 15-20% of them, the virus is able to spread albeit locally along the nerve root causing herpes zoster. This occurs due to natural fading of immunity and hence occurs after the age of 40-50 years.

Herpes zoster, though usually a benign disease lasting for 7-10 days can lead to complications. Firstly, it can lead to pain, which can go on for months to years. Secondly, if it involves the face, it could also involve the eyes and unless one takes proper precaution, this can lead to permanent damage to vision. Lastly, herpes zoster if it occurs in immuno-compromised patients like HIV, it can lead to complications like pneumonia and brain damage.


Q. Can herpes zoster be prevented?
A. Yes, by giving varicella vaccine before chickenpox develops. As seen, early herpes zoster occurs only after one contracts chickenpox virus and develops initially. When one takes chickenpox vaccine, one prevents contact with wild virus and hence prevents both chickenpox and herpes zoster.

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