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Immunization : Your Best Protection

Chickenpox

A second dose of the chickenpox (varicella) vaccine is now available for children born on or after January 1, 2000, who are at least 12 months to 11 years of age. This safe, effective booster will provide added protection against this highly contagious illness.

Two doses of varicella for better protection against chickenpox

The varicella vaccine protects against chickenpox, and now, two doses are publicly funded.

The first dose varicella vaccine is recommended for children between 12 and 15 months. The second dose of varicella should be given as MMRV vaccine at 4-6 years of age.

New MMRV vaccine adds chickenpox protection to the measles, mumps, and rubella vaccine

The measles-mumps-rubella-varicella (MMRV) vaccine is a four-in-one vaccine that protects against measles, mumps, rubella (German measles) and chickenpox.

Two doses of the measles, mumps and rubella vaccine containing vaccine (as either MMR or MMRV) are required for children to attend school in Ontario. You can find information on both vaccines on this page, as they are related.

• What is varicella (chickenpox)?
• What is measles?
• What is mumps?
• What is rubella (German measles)?
• The varicella vaccine
• The MMRV vaccine
• Be informed

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What is varicella (chickenpox)?

Chickenpox is caused by the varicella-zoster virus. About 90% of chickenpox cases occur before 12 years of age.

Symptoms

• flu-like symptoms
• fatigue
• mild headache
• fever up to 39°C
• chills and muscle or joint aches a day or two before the rash appears
• a rash of raised red blisters (sometimes called vesicles) anywhere on the body that are extremely itchy. Some children have only a few blisters while others can have as many as 500. These blisters dry up and form scabs in 4 to 5 days.

Complications

• bacterial skin infections and/or necrotizing fasciitis (“flesh-eating disease”)
• ear infections
• pneumonia (an infection of the lungs)
• central nervous system involvement like encephalitis, an infection of the brain that can cause brain damage and mental retardation
• infection of other sites (e.g., blood)
• birth defects may occur if the baby gets chickenpox from their mother before they are born.

The risk of complications increases with age.

How it spreads

Chickenpox is highly contagious. It spreads very quickly from person to person. The child will be most contagious from one to two days before the rash appears.

The most common way the infection is spread is through the air if someone with chickenpox coughs or sneezes. You can also get chickenpox if you touch a blister or the liquid from a blister.

A pregnant woman with chickenpox can pass it on to her unborn baby before birth. Mothers with chickenpox can also give it to their newborn baby after birth.

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What is measles?

Measles is a serious infection that lasts for one to two weeks.

Symptoms :

• high fever
• cough
• rash
• runny nose
• watery eyes

Complications

• ear infections (about 1 in 10 children)
• pneumonia (about 1 in 10 children)
• encephalitis (about 1 in 1000 children), an infection of the brain that can cause brain damage and mental retardation
• in pregnant women, measles can cause miscarriage or premature birth.

How it spreads

Measles spreads very easily from person to person. An infected person can pass it to others by coughing, sneezing or even talking.

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What is mumps?

Mumps is a viral infection that is characterized by fever, headache and swelling of the cheek, jaw and neck. It usually affects children between 5 and 9 years old, but can also affect very young children and can result in more serious complications such as such as meningitis.

Symptoms

• swelling of the salivary glands (around the cheeks and jaw)
• fever
• headache

Complications

• meningitis, especially when it affects younger children or adults. Fortunately, mumps meningitis does not usually cause permanent damage.
• deafness
• very painful, swollen testicles in about 1 out of 4 teenage boys or adult men
• a painful infection of the ovaries in 1 out of 20 women
• mumps infection during the first 3 months of pregnancy may increase the risk of miscarriage.

How it spreads

People can get mumps from an infected person coughing or sneezing around them or simply talking to them. It can also be spread through contact with the saliva of an infected person.

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What is rubella (German measles)?

Rubella is usually a mild illness in children; up to half of the infections with rubella occur without a rash. However, rubella is very dangerous in pregnant women.

If a woman gets rubella in the early part of a pregnancy, it is very likely that her baby will develop congenital rubella syndrome and be severely disabled or die.

Symptoms

• fever
• sore throat
• swollen glands in the neck
• a rash on the face and neck
• temporary aches and pains and swelling of the joints are common in adolescents and adults, especially females

Complications

• chronic arthritis
• temporary blood clotting problems
• encephalitis, an infection of the brain that can cause brain damage and mental retardation
• if a woman gets rubella in the early part of a pregnancy, it is very likely that her baby will die or be severely disabled. The most common disabilities are blindness, deafness, mental retardation and heart defects.

How it spreads

Rubella spreads by contact with an infected person through coughing, sneezing or talking to them. It can also be spread by contact with the saliva of infected people.

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The varicella vaccine

The Ministry of Health and Long-Term Care recently expanded the varicella vaccine program for children from one dose to two doses. Two doses reduce the child’s chance of getting chickenpox, and reduce the severity of the disease if he or she does get chickenpox.

Why is the varicella vaccine important?

Chickenpox can be very severe or even life-threatening to newborn babies and anyone with a weak immune system. Complications include flesh-eating disease and encephalitis, an infection of the brain. Getting both doses of the varicella vaccine helps you and your family stay healthy.

How well does the varicella vaccine protect against chickenpox?

It is estimated that the varicella vaccine will offer 70 to 90% protection against chickenpox of any severity. The second dose of the varicella vaccine is estimated to offer 98 to 99.9% protection against chickenpox.

Who is eligible to receive the publicly funded vaccine?

Children born on or after January 1, 2000, who are at least 12 months of age.

Children who have received two doses of MMR vaccine and one dose of single varicella vaccine, will be offered a second dose of the single varicella vaccine.

People with medical conditions that put them at increased risk

In addition, people with the following medical conditions that put them at increased risk for complications due to chickenpox will also be eligible :

• children and adolescents given chronic salicylic acid therapy
• people with cystic fibrosis
• immunocompromised individuals – this should be determined on an individual basis. The vaccine is recommended for some immunocompromised persons, but not for others. Please discuss this with your doctor.

At what age should the chickenpox vaccine be given?

In Ontario, the chickenpox vaccine is publicly funded for children born on or after January 1, 2000, who are at least 12 months of age. The following dosing schedule is recommended :

First dose : 15 months of age

As part of the routine childhood immunization program, the publicly funded chickenpox vaccine will be offered to children at 15 months of age for the first dose.

Second dose: 4-6 years

The second dose of the chickenpox vaccine will be offered to children from 4 to 6 years of age in the form of the MMRV (measles-mumps-rubella-varicella) vaccine.

Catch-up for children who missed their vaccination

Children who missed their first dose can receive it up until they are 11 years old.

As part of the catch-up program for the second dose of chickenpox vaccine, children who have already received two doses of the MMR vaccine will be eligible to receive a second dose of the chickenpox vaccine separately.

Children can receive the second dose three months after the first dose, until they are 11 years old (i.e., children born on or after January 1, 2000).

Who should not get the varicella vaccine?

Children should not receive the vaccine if they :

• have allergies to the vaccine or any component of the vaccine
• have known allergies to neomycin or gelatin
• had an anaphylactic reaction to a prior dose of the vaccine
• have received blood or blood products up to 5 months ago

Please consult with your health care provider if your child :

• has a weakened immune system or is on medications that suppress the immune system
• has received blood or blood products
• has a severe infection with high fever, greater than 38°C

You should always discuss the benefits and risks of any vaccine with your health care provider or local public health unit.

Do not give aspirin (acetylsalicylic acid, ASA) for pain or fever after vaccination. The use of aspirin in has been associated with an increased risk of Reye’s syndrome (a severe disorder of the liver and brain) after vaccination.

Is the varicella vaccine safe?

Yes

The chickenpox vaccine is considered a safe vaccine. Most reactions tend to be mild and include some soreness, redness, itching and/or a rash where the needle was given. A low-grade fever (approximately 38°C) may occur.

Some children may get a very mild case of chickenpox one or two weeks after they get the vaccine but are not likely to be contagious. Severe reactions are rare.

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The MMRV vaccine

The MMRV vaccine has been recently added to Ontario’s publicly funded immunization schedule for children 4 to 11 years old.

Two doses of the measles, mumps and rubella vaccine (i.e., MMR or MMRV) are required for children to attend school in Ontario. The second dose of MMR and varicella vaccines should be given as MMRV between 4 to 6 years of age (preferably before starting school).

Why is the MMRV vaccine important?

Required for school attendance

In Ontario, measles, mumps and rubella are designated communicable diseases under the Immunization of School Pupils Act (ISPA). Under the ISPA, school pupils are required to provide a record of immunization or a valid exemption for measles, mumps and rubella before attending school.

Four vaccines in one injection

The MMRV vaccine offers parents an option to have their child immunized for four diseases in one vaccine. This vaccine reduces the number injections for children.

Your best protection against diseases with serious complications

The MMRV vaccine is the best way to protect children and families against mumps, measles, rubella and varicella. All of these illnesses can have very serious complications, such as :

• encephalitis, an infection of the brain (chickenpox, measles)
• bacterial skin infections (chickenpox)
• deafness (mumps)
• chronic arthritis (rubella)

How well does the MMRV protect against measles, mumps, rubella and/or chickenpox?

Almost all children who receive two doses of vaccine against these four diseases are protected against all of them. Protection from measles, mumps and rubella after getting the vaccine is probably life long.

However, sometimes children may be infected with the diseases after vaccination, but the disease will be milder.

Who is eligible to receive the publicly funded vaccine, and at what age?

Children between 4 and 11 years old

In Ontario, children are eligible to receive the publicly funded MMRV vaccine from 4 to 11 years of age to protect against measles, mumps, rubella and chickenpox. The MMRV vaccine will be offered to these children as part of their routine immunization schedule at 4 to 6 years of age.

The MMRV vaccine is currently approved for children up to 12 years of age.

Who should not get the MMRV vaccine?

Children should not receive the vaccine if they :

• have allergies to the vaccine or any component of the vaccine
• are allergic to neomycin
• have previously experienced an allergic reaction to any measles, mumps, rubella and/or varicella vaccines

Please consult with your health care provider if your child has :

• a weakened immune system or is on medications that suppress the immune system
• a personal history of febrile seizures
• received blood or blood products
• a severe infection with high fever, greater than 38°C

You should always discuss the benefits and risks of any vaccine with your health care provider or local public health unit.

Is the MMRV vaccine safe?

Yes

The MMRV vaccine is considered a safe vaccine; most children will have no side effects. Some common side effects from the MMRV include redness, swelling, and tenderness in the area where the needle is given. Fever, and/or a rash can occur 4–12 days after getting the vaccine. The rash can be a blotchy red rash (measles-like) and/or spots that look like blisters (chickenpox). Severe reactions are rare.

There is no risk of a pregnant woman or anyone else catching measles, mumps, rubella or chickenpox from a child who has been vaccinated recently. Please report any side effects or severe vaccine reaction to your health care provider or local public health unit.

Do not give aspirin (acetylsalicylic acid, ASA) for pain or fever after vaccination. The use of aspirin in has been associated with an increased risk of Reye’s syndrome (a severe disorder of the liver and brain) after vaccination.

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Be informed

Be sure you read and understand the information that will be provided to you by your local public health unit and by your health care provider.

Contact your local public health unit for additional information.

When should I call my health care provider?

Call your health care provider or go to the nearest hospital emergency department if your child has any of the following reactions within three days of receiving the vaccine :

• hives
• swelling of the face or mouth
• trouble breathing, hoarseness or wheezing
• high fever (over 40°C)
• convulsions or seizures
• other serious reactions to the vaccine (e.g., paraesthesia, a numbness, tingling or pricking sensation in the skin)

Who should I talk to if I have any questions?

For more information please contact your health care provider or your local public health unit.

Your record of protection

After any immunization, make sure your personal immunization record (i.e., the “Yellow Card”) is updated.  If your child is attending child care or school, inform your local public health unit each time your child receives an immunization.

An immunization record is required for child care, school attendance, for certain types of travel and work, so keep it in a safe place.

Find more information on the vaccines for varicella, measles, mumps and rubella.

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