Finding and Controlling Varicella Outbreaks

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Varicella outbreaks should be identified, investigated and controlled promptly: even mild cases can be contagious. CDC works with state health departments to monitor them.

The current picture

Outbreaks still occur, even in settings such as schools where most children are vaccinated. But since the United States began its two-dose varicella vaccination program, fewer outbreaks have been reported, and they have been smaller and shorter. Most outbreak-related cases have been in unvaccinated people, and most vaccinated patients in these outbreaks had mild disease.

Reporting

States are encouraged to report varicella outbreaks to CDC every quarter. Sixty-four jurisdictions have received funding through CDC's Epidemiology and Laboratory Capacity program to strengthen varicella surveillance, including of outbreaks, so CDC receives outbreak data from all of them. The data help measure the two-dose program's effect; better outbreak control was a major reason for recommending the second dose. State health departments submit a standard reporting line list, the Reporting Line List Template for Varicella Outbreak Surveillance.

Controlling an outbreak

Varicella vaccination is the recommended way to prevent and control outbreaks.

Start early. Control efforts should ideally begin as soon as a case is identified.
Vaccinate even if it's late. Outbreaks in childcare centers, schools and institutions can last months, especially where coverage is low. Vaccinating during an outbreak can protect people not yet exposed and shorten it.

Vaccine doses during an outbreak:

People without evidence of immunity should get a first or second dose, as appropriate.
Those given a first dose as part of outbreak control should be scheduled for the second dose at the recommended interval.
In preschool outbreaks, two doses are recommended for children aged 1 to 4 for best protection.

Returning to school. People who get a first or second dose as part of outbreak control can go back to school right away.