The National Immunisation Advisory Committee (NIAC) recommends Varicella vaccine as part of the Primary Childhood Immunisation Programme (PCIP) to reduce the significant burden of Varicella (Chickenpox) zoster virus morbidity and its complications.
The varicella vaccine is recommended at the 12 month-visit. This means that babies eligible for varicella vaccine will begin receiving it from 1st October 2025, as part of their routine 12-month vaccines.
Eligible children will receive a second dose of varicella vaccine when they are aged 4-5 years, in junior infants during the school year (2029/2030).
| For more information see Frequently Asked Questions on the Primary Childhood Immunisation Programme, including Varicella (Chickenpox) Vaccine available at www.hse.ie/eng/health/immunisation/hcpinfo/hcppci/faq-on-the-pcip-including-varicella-vaccine See also the NIAC Guidelines Chapter 2 and Chapter 23 (note other chapters may not yet be updated) Email [email protected] if you have immunisation queries |
In what order should I give the vaccines at 12 months of age?
The following order is advised:
At 12 months:
- Give MenB vaccine in Left anterolateral thigh first
- Give Varicella vaccine in the Right anterolateral thigh next
- Give MMR in the Right anterolateral thigh last (this allows the MMR vaccine, which is the most painful vaccine, to be given last).
Should children living with a pregnant woman or an immunocompromised person have the varicella vaccine?
Yes, they should have the vaccine. Vaccinating children with varicella vaccine protects them from the complications of severe varicella infection and also reduces the risk of exposure of non-immune pregnant women, non-immune infants and immunocompromised individuals to varicella infection, which can have serious, life-threatening complications for these groups.
If the vaccinated child living with a pregnant woman or immunocompromised person develop a rash what is the advice?
About 2.2% of children may develop a post vaccination rash. The onset of this rash is between 5-26 days after immunisation. The rash tends to be mild. The rash is usually near the injection site (median 2 lesions), but there may be a generalised rash (median 5 lesions). The rash resolves spontaneously and does not need treatment. If a vaccinated child develops a varicella like rash, after vaccination, NIAC advise that as a precaution, while they have the rash they should not come into contact with:
• people with severe immunocompromise from disease or treatment
• women who are pregnant and non-immune to varicella,
• non-immune neonates in 1st week of life.
This is as a precaution because in theory the weakened (attenuated) vaccine virus could cause infection in someone who is immunocompromised, or in a non-immune pregnant woman. However, the risk of this is negligible (see below).
Is there any risk of transmission of varicella virus if a child develops a rash after vaccination?
The risk of transmission of the attenuated vaccine virus is negligible.
Over a 10-year period in the USA, 56 million doses of varicella vaccine were administered. Only five cases of transmission of the attenuated vaccine virus from a vaccinated individual with a rash were documented, resulting in 6 cases of secondary infection. All of these cases were mild. This equates to one case of mild chickenpox infection for every 9 million doses of vaccine administered.
Should a child who has had confirmed chickenpox prior to the first birthday get the first dose of Varicella (Chickenpox) vaccine at age 1 year?
Yes, the Varicella (Chickenpox) vaccine is still recommended at 12 months of age, as children may get sub-optimal natural immunity from Varicella (Chickenpox) infection before 12 months of age.
What should I advise parents who ask why a child who gets varicella vaccine at 12 months needs to wait until they are 4-5 years of age to get a second dose?
Parents can be reassured that 1 dose of varicella vaccine has an efficacy of 90-100% against the severe complications of varicella.
https://www.hiqa.ie/sites/default/files/NIAC/Immunisation_Guidelines/Chapter_23_Varicella_Zoster.pdf
NIAC considered giving the 2nd varicella vaccine dose earlier than at age 4-5 years in junior infants however
- Both dose 1 and 2 dose 2 prevent 90%-100% of severe varicella infections. (So, children should only get mild chicken pox if they do get an infection before the 2nd varicella vaccine is given).
- It was not feasible to add another visit to childhood immunisation programme at 14 months of age and as it would increase the number of visits needed to complete the schedule and could affect uptake.
What is the recommended varicella vaccine interval when sourced privately?
All children born before the 1st of October 2024 are not eligible for varicella vaccine as part of the PCI programme. If a parent request varicella vaccination this will need to be sourced privately.
NIAC advises an interval of 4 weeks may be used between does of varicella vaccine in this situation.
If children eligible for Varicella vaccine in the Irish schedule (i.e. born on or after 1st October 2024) have missed the Varicella vaccine, is catch-up recommended?
Yes, NIAC recommend that the vaccine may be offered up to and including the age of 18 years to all non-immune children and adolescents born on or after October 1st 2024. (When the vaccine is given in general practice, there is a payment agreed for GPs for catch-up vaccination of eligible children up to age of 10 years)
Is encephalitis a known side effect of varicella vaccine?
Encephalitis is a known complication of chickenpox infection.
Very rarely encephalitis cases have been reported in connection with chickenpox vaccination. In most instances, a direct link has not been established. Notably, confirmed cases involved immunocompromised individuals in the main, such as those recently treated with high-dose steroids. NIAC advises that immunocompromise from disease or treatment is a contraindication to varicella vaccine.
The EMA Pharmacovigilance Risk Assessment Committee (PRAC) have recently advised they will add some details to the product information following a report of a fatal case of encephalitis which occurred after vaccination with a live attenuated varicella vaccine, and carry out a review. The EMA reported there is no advice to change the recommendations for the live varicella vaccine in line with the product information.
The varicella vaccine has been in use in the United States since 1995, for persons aged 12 months or older. The European Medicine Agency has licensed Varicella vaccine since 2003 and the vaccine has been given in Germany, Italy, Spain and other European countries for many years. The vaccine has been given safely in the childhood vaccination schedule to millions of children in many countries.
There has been no change in the recommendations of the National Immunisation Advisory Committee (NIAC) or European Medicines Agency (EMA) for varicella vaccine.
In relation to encephalitis, the SMPC advises:
These selected adverse events reported with varicella vaccine (live) (Oka/Merck strain) are also a consequence of wild-type varicella infection. There is no indication of an increased risk of these adverse events following vaccination compared with wild-type disease from active post-marketing surveillance studies or passive post-marketing surveillance reporting
Children Born on or after 1st October 2024- a 4th 6 in 1 vaccine is recommended at the 13 months visit
The 4th 6in1 will provide the Hib vaccine already recommended at 13 months and a booster dose of tetanus, diphtheria, polio and pertussis vaccine to bring Ireland in line with the vaccination schedule in the rest of Europe.
- NIAC now advise if a child is delayed receiving the 3rd dose of 6 in 1 recommended at 6 months of age and the vaccine is given <12 months of age, it is not necessary to leave an interval of 6 months between the 3rd and 4th 6 in1 vaccine. The 4th dose of 6 in 1 should still be given at 13 months of age provided there is a minimum interval of 4 weeks between the 3rd and 4th dose of 6in1 vaccine.
- However if a child is delayed receiving the 3rd dose of 6 in 1 and it is given at ≥12 months, the 4th dose of 6 in 1 should be replaced by a 4 in 1 (DTaP/IPV) vaccine. The 4 in 1 vaccine should be given ≥ 6 months after the 3rd dose of6 in 1 (i.e. a minimum interval of 6 months applies). If the 4 in 1 vaccine is not available, a 6 in 1 vaccine may be given.
For General Practices, if 4 in 1 (Tetravac) vaccine is needed, please email [email protected] to request the vaccine
Children coming to Ireland from countries using Oral Polio Vaccine (OPV):
Since 2016, as recommended by the World Health Organization (WHO) all oral polio vaccines (OPV) vaccines provide protection against two types of polio virus (1 and 3) only.
WHO advised that children vaccinated with OPV vaccine since 2016 should also receive inactivated polio vaccine (IPV) x 2 to complete Primary immunisation against polio infection.
IPV still provides protection against 3 types of polio virus.
NIAC now advise children coming to Ireland from countries using Oral Polio Vaccine (OPV) who were vaccinated since 2016 should have IPV vaccine catch up to give a total of 3 doses of IPV so they are protected against all 3 types of polio virus.
NIAC have not recommended a polio vaccine catch up programme for children who have already come to Ireland since 2016
- If a child has already received three doses of OPV, they should receive two doses of an IPV-containing vaccine to complete the primary series. There should be a minimum interval of four weeks between IPV-containing vaccine doses.
A booster dose of an IPV-containing vaccine is recommended at aged 4-5 years, usually in Junior Infants or at least six months after their final catch-up polio vaccine.
- If a child has received two doses or less (including none or unknown) of OPV, they should receive three doses of IPV-containing vaccine (DTaP/Hib/HepB/IPV or DTaP/IPV if aged <10 years and Td/IPV if aged ≥10 years). A booster dose of an IPV-containing vaccine is recommended at least six months after their third IPV-containing vaccine.
Children who would have been vaccinated with OPV before 2016 have received protection against 3 types of polio virus.
Please refer to NIAC guidelines Chapter 2 for details: https://www.hiqa.ie/reports-and-publications/niac-immunisation-guideline/chapter-02-general-immunisation-procedures
6 in 1 or 4 in 1 vaccines may be needed to catch-up with IPV in children < 10 years of age, depending on which vaccines the child has already received. For general practice please email [email protected] to request 4 in 1 vaccine if this is required.
Do you need to delay the childhood vaccinations if the child recently received Nirsevimab for RSV?
No. there is no need to delay any of the childhood vaccines when a child has received Nirsevimab. Nirsevimab is an antibody against RSV. Nirsevimab does not stimulate the child’s immune system to produce antibodies. Nirsevimab does not interfere with the child’s immune response to vaccines in the childhood immunisation schedule.
Therefore, children can commence the childhood immunisation schedule at two months of age. Children can have the vaccines recommended in the childhood immunisation schedule at any interval before or after a Nirsevimab injection.
For more information see FAQ at https://www.hpsc.ie/a-z/respiratory/respiratorysyncytialvirus/immunisation/frequentlyaskedquestions/