ID-Immunization
                                ===============

þ Tetanus Immunizations
  <Tetanus.TXT>

þ Varicella Immunizations
 - Indications for the immunization with this (attenuated) live virus vaccine
   include susceptible health care workers and others living or working in
   environments where contact with varicella is inevitable such as day care
   centers etc., and nonpregnant females of childbearing age. The rationale
   for this is the increased severity of varicella when contracted by
   nonimmune adults (such as the increased risk of pulmonary and CNS
   involvement) and the potential maternal and fetal complications when
   natural infection is acquired during pregnancy (2).
 - Many adults are found to have proptective antibody levels in spite of
   having no history of varicella.  Serologic testing is an option but no harm
   is done by immunizing immune adults.  So you can choose to go either way
   with this.
 - The vaccine has to be administered twice at 4-8 week interval to guarantee
   immunity in adolescents over the age of 13 and adults.  A single injection
   confers immunity in only about 78% of recipients. Vaccination may result in
   a mild febrile illness with or without rash in up to 10% of patients.
   Pregnant women should not be vaccinated and pregnancy should be deferred
   for at least one month after each dose of vaccine.
   --H. Louzon MD
 - (1) Gardner et al.  Adult Immunizations.  Ann Int Med 1996;12(1 Pt 1):35-40
 - (2) Katz VL, Kuller JA, McMahon MJ, Warren MA, Wells SR
       Varicella during pregnancy. Maternal and fetal effects.
       West J Med 1995 Nov;163(5):446-50
       "To determine the characteristics of maternal varicella at our
       institution, we reviewed all cases of primary varicella in pregnancy.
       Using a perinatal database that summarizes all obstetric admissions, we
       reviewed the medical records of women with varicella infections during
       pregnancy. Over a 5 1/2-year period, 31 pregnancies were affected by
       varicella infection among 11,753 deliveries. The mean age of those
       patients was 19.6 years, significantly different from our overall
       population of 25.3 years (P < .05). The racial composition of 35%
       Hispanic, 35% white, and 29% African American was different from that
       of our general population of 55% white, 38% African American, and 6%
       Hispanic (P = .023). The mean gestational age of the eruption of
       vesicles was 25 weeks. Of the 31 women, 7 had preterm labor within a
       week of their varicella, 3 delivered prematurely, and 3 infants had a
       birth weight of less than 2,700 grams. Respiratory symptoms developed
       in 6 women, and pneumonia developed in 4, 2 of whom required
       ventilatory support, 1 for 5 days, the other for 49 days. Eight women
       received acyclovir during gestation, and none suffered sequelae. In
       all, 6 infants had lesions and anomalies noted at birth, 5 possibly
       associated with varicella. Varicella infection is associated with a
       greater-than-expected level of both maternal and fetal morbidity. The
       fetal disease may occur due to maternal infection at any gestation and
       is most likely a spectrum of complications. The maternal disease
       appears to be worse in the latter half of pregnancy. Programs of
       prevention through vaccination must account for a possibly decreased
       level of immunity in different populations."