Varicella (chickenpox)

• Reporting criteria

• The disease and its epidemiology

• Case definition

• Laboratory testing

• Case investigation

• Disease control measures

• References

What and how to report to the Colorado Department of Public Health and Environment (CDPHE) or local public health agency  

• Individual varicella cases should be reported to the state or local health agency within four days of suspicion/diagnosis and can be reported online via the online chickenpox report form.
• Varicella outbreaks should be reported by phone within four hours of suspicion/clinical diagnosis to the state or local health agency. The chickenpox outbreak report form should also be submitted via email or fax.
• Report any laboratory specimen diagnostic of or highly correlated with varicella clinical illness within four days. 
• If a varicella death occurs, call the CDPHE vaccine preventable disease team at 303-692-2700. 
• Shingles (herpes zoster) is not a reportable disease.

Purpose of surveillance and reporting

• To monitor trends in disease incidence in the vaccine era
• Monitor changing age-specific epidemiology
• Facilitate more timely disease control of outbreaks
• Guide future immunization policy

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Etiologic agent

Chickenpox is caused by varicella-zoster virus (VZV), a DNA virus belonging to the herpes virus group. Primary infection with VZV causes varicella (chickenpox). Like other herpes viruses, VZV has the capacity to persist in the body as a latent infection after the primary infection. Shingles (which is not reportable), also known as herpes zoster, results from reactivation of the latent VZV infection.

Clinical description

Varicella (chickenpox) is a highly contagious febrile rash illness resulting from primary infection with the varicella-zoster virus. A mild prodrome may precede the onset of rash. Adults may have 1 to 2 days of fever and malaise prior to rash onset. However, in children, rash may be the first sign of chickenpox. The rash is generalized, pruritic (itchy), and rapidly progresses from macules to papules to vesicular lesions before crusting. Several crops of these vesicles, usually between 250-500 lesions, will develop over a period of 2 to 4 days, with lesions presenting in several stages of development. Lesions generally appear first on the head, then the trunk and the extremities. The lesions are usually concentrated on the trunk and may appear on mucous membranes.

Chickenpox immunity is generally lifelong. However, symptomatic reinfection with chickenpox can occur but is uncommon in immunocompetent people.

Complications

The disease is usually mild among children and can be more severe in adolescents and adults. Complications of varicella include secondary bacterial infection of skin lesions, encephalitis, pneumonia, and death. Invasive group A streptococcal infection has been reported as a complication of varicella, which may result in cellulitis, necrotizing fasciitis, septicemia, and toxic shock syndrome.

The following individuals are more likely to experience serious complications with chickenpox: pregnant women, immunocompromised people, children < 1 year of age, people with chronic cutaneous or pulmonary disorders, people receiving systemic corticosteroids or long-term salicylate therapy, and some adolescents and adults. The risk of complications is especially high when corticosteroids are given during the incubation period for chickenpox. Infants born to women having varicella within 5 days before delivery to 2 days after delivery are at risk of severe varicella infection. The infected neonates lack sufficient maternal antibodies to lessen the severity of disease, and the infection may be fatal.

Congenital varicella syndrome can occur among infants born to mothers having primary varicella infection during the first 20 weeks of their pregnancy (unborn child is infected while in-utero). The risk of congenital abnormalities from primary maternal varicella infection during pregnancy is very low (less than 2%). The newborn may have a variety of abnormalities, including developmental abnormalities, encephalitis, neurologic abnormalities, atrophy, chorioretinitis, microcephaly, and low birth weight.

Breakthrough varicella (chickenpox)

Vaccinated people who develop varicella more than 42 days after vaccination have breakthrough varicella disease. Breakthrough infection is significantly milder, with fewer lesions (generally fewer than 50), many of which are maculopapular rather than vesicular. Most people with breakthrough infection do not have a fever. People with breakthrough infection may be able to return to normal activities earlier, since they have fewer lesions. 

Herpes zoster (shingles)

Herpes zoster or shingles occurs when latent VZV reactivates and causes recurrent disease. Varicella virus remains inactive in clusters of nerve cells adjacent to the spinal cord after chickenpox resolves. Reactivation occurs in approximately one in three infected people during their lifetime. Shingles symptoms include red, painful, itchy and blistery rash, typically, in one area on one side of the body, usually without fever or other systemic symptoms. Currently, there is no adequate therapy available to treat shingles. However, there is a zoster vaccine to prevent shingles, which is recommended for adults ≥ 60 years. Contact with shingles lesions (prior to crusting) can cause chickenpox in a susceptible individual. Complications of shingles include postherpetic neuralgia, which may last a year or longer after the episode of zoster. Severe sequelae often occur if the ocular nerve or other organs are involved with the zoster infection.

Reservoirs

Humans are the only host.

Modes of transmission

VZV is transmitted person to person by the following means:

From chickenpox cases

• Respiratory contact with airborne droplets, and/or
• Direct contact with nasopharyngeal secretions or vesicular fluid from lesions (prior to crusting)

From shingles cases

• Direct contact with vesicular fluid from lesions (prior to crusting)

Varicella is highly infectious ,with secondary infection rates in susceptible household contacts ranging from 61% to 100%. Exposure to chickenpox does not cause shingles (exposure to shingles can result in chickenpox in a susceptible person but cannot cause shingles).

Incubation period

The incubation period for varicella is usually 14 to 16 days, with a range of 10 to 21 days. The incubation period may be prolonged for as long as 28 days after receipt of varicella zoster immune globulin (VariZIG) and shortened in immunocompromised people.

Infectious period

The infectious period for chickenpox is usually 1 to 2 days (may be as long as five days) before the rash appears and until all of the vesicles have formed scabs, usually within 4-7 days of rash onset. The period of communicability may be prolonged in immunocompromised patients.

Epidemiology

Before the availability of varicella vaccine in the United States, it was considered an almost universal childhood experience. In the early 1990s (the prevaccine era), this resulted in an average of about 4 million cases of varicella, 10,500–13,500 hospitalizations, and 100–150 deaths each year. Varicella vaccine was licensed and has been recommended in the United States since 1995, and subsequent high vaccine coverage led to substantial declines in varicella cases and associated complications in the United States. During the two-dose era, there has been an 89% decline in varicella incidence. Incidence declined in all age groups, with the greatest declines among children 5–14 years of age (92%–95%). Compared with the prevaccine years, by 2018–2019, varicella hospitalizations declined 90%, and deaths with varicella as the underlying cause of death declined 89% for all ages. Varicella occurs worldwide, and some data suggest that in tropical areas, acquisition of infection occurs at later ages. 

Varicella cases are reported throughout the year in Colorado. However, incidence is highest in winter and early spring. In 2004, varicella became a reportable disease in Colorado. Colorado varicella statistics are available at CDPHE’s Colorado reportable disease data webpage.

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Clinical description

In the absence of a more likely alternative diagnosis

• An acute illness with a generalized rash with vesicles (maculopapulovesicular rash), or
• An acute illness with a generalized rash without vesicles (maculopapular rash)

In vaccinated people who develop varicella more than 42 days after vaccination (breakthrough disease), the disease is almost always mild with fewer than 50 skin lesions and shorter duration of illness. The rash may also be atypical in appearance (maculopapular with few or no vesicles).

Laboratory criteria for diagnosis

Confirmatory laboratory evidence:

• Positive polymerase chain reaction (PCR), or 
• Isolation of varicella virus (VZV) from a clinical specimen, or
• Significant rise in serum anti-varicella immunoglobulin G (IgG) antibody level by any standard serologic assay, or
• Positive direct fluorescent antibody (DFA)

Supportive laboratory evidence:

• Positive serologic test for varicella-zoster immunoglobulin M (IgM) antibody

Note: Commercial test kits for varicella immunoglobulin M (IgM) antibody are unreliable and not recommended for the diagnosis of acute varicella infection. A negative IgM result should not be used to rule out the diagnosis, and a positive varicella IgM in the absence of rash should not be used to confirm diagnosis. False positive IgM results are common in the presence of high IgG levels on these tests. Clinical varicella cases with positive IgM tests are classified as confirmed only if accompanied with symptoms, unless they are linked to another probable or confirmed case.

Epidemiologic linkage

Confirmatory epidemiologic linkage evidence

• Exposure to or contact with a laboratory-confirmed varicella case, or
• Can be linked to a varicella cluster or outbreak containing ≥one laboratory-confirmed case, or
• Exposure to or contact with a person with herpes zoster (regardless of laboratory confirmation)

Presumptive epidemiologic linkage evidence

• Exposure to or contact with a probable varicella case that had a generalized rash with vesicles

Case classification

Confirmed

• Meets clinical description and confirmatory laboratory evidence; or 
• Meets the clinical description and is epidemiologically linked to a confirmed or probable case

Probable

• Meets clinical description with a generalized rash with vesicles; or
• Meets clinical description with a generalized rash without vesicles, and
  • Confirmed or presumptive epidemiologic link, or
  • Supportive laboratory evidence
• Health care record contains a diagnosis of varicella or chickenpox but no rash description, and
  • Confirmed or presumptive epidemiologic link, or
  • Confirmatory or supportive laboratory evidence 

Outbreak case definition

An outbreak is defined as three or more varicella cases clustered in time (e.g., occurring within 21 days of each other) and sharing common space (e.g., school, child care facility, household) regardless of household status.

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Varicella PCR testing is available at the CDPHE Laboratory with prior approval.

• Laboratory testing is a useful tool to identify cases, particularly in cases with less typical symptom presentation or breakthrough infection.
• Enables public health to confirm varicella as the cause of outbreaks.
• Confirms varicella in severe cases (hospitalizations or deaths) or unusual cases.
• Serologic testing may be done to determine susceptibility.

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Individual cases of varicella are not required to be investigated, except when a death occurs. Outbreak investigations of varicella are dependent upon available resources. Prioritizing the investigation of varicella outbreaks is described in section C (Outbreaks), below. The following guidance is for local public health agencies, which elect to investigate reported cases of varicella.

Forms

Determine reported case classification, probable versus confirmed, and complete all sections of the “Varicella investigation” tab in EpiTrax or the chickenpox report form, which is located on the CDPHE chickenpox webpage. 

If a varicella outbreak (≥three cases) is identified, complete the chickenpox outbreak report form, which is located on the CDPHE chickenpox webpage. Reports can be emailed or faxed.

Identify and evaluate contacts

The main purpose of identifying contacts is to determine which contacts are susceptible to varicella and provide information for post-exposure prophylaxis with varicella vaccine or varicella zoster immune globulin (VariZIG) for high-risk contacts.

Evidence of immunity to varicella includes any of the following:

• Documentation of age-appropriate vaccination
  • Preschool-aged children 12 months or older: one dose. However, a second dose should be administered if there is an exposure to varicella and it has been at least three months since the first varicella vaccination.
  • School-age children, adolescents, and adults: two doses administered at least 28 days apart (for children < 13 years, the second dose should be administered three months after the first dose. However, second doses inadvertently administered at least 28 days after the first dose do not need to be repeated).
• Laboratory evidence of immunity or laboratory confirmation of disease 
  • Commercial assays can be used to assess disease-induced immunity but lack adequate sensitivity to reliably detect vaccine-induced immunity (i.e., they may yield false-negative results).
• Born in the United States before 1980 
  • For health care personnel, pregnant women, or immunocompromised people, birth before 1980 should not be considered evidence of immunity. People born outside the United States should meet one of the other criteria for varicella immunity.
• Diagnosis or verification of varicella disease by a health care provider 
  • A physician should assess people reporting a history of or presenting with atypical or mild varicella symptoms or their designee, and one of the following should be sought:
    • An epidemiological link to a typical varicella case or a laboratory-confirmed case, or 
    • Evidence of laboratory confirmation if testing was performed at the time of acute disease
    • When such documentation is lacking, a person should not be considered to have a valid history of disease, because other diseases may mimic mild atypical varicella.
• Diagnosis or verification of a history of herpes zoster (shingles) by a health care provider

Symptomatic contacts 

• Contacts of a varicella case who have a vesicular rash should be excluded from school, child care, or work and should voluntarily isolate themselves at home until all lesions have formed scabs or crusts (usually 4 to 5 days after rash onset).
• Contacts who have an atypical rash following exposure should be excluded from school, child care, or work and isolated until their rash is gone or a health care provider determines they are non-infectious. 
• Symptomatic contacts that meet the clinical case definition should be reported to CDPHE as confirmed cases, since cases linked to another case are considered confirmed.

Asymptomatic contacts 

• Recommend susceptible contacts receive varicella vaccine if it is not contraindicated.
• Administration of varicella vaccine to susceptible contacts may abort infection or modify the disease if given within 3 to 5 days of exposure.
• Varicella vaccine should be given even if more than five days have passed since exposure to provide future immunity, as not every exposure leads to infection.
• Contacts should be informed of the incubation period for varicella (10 to 21 days), the symptoms of disease, and asked to isolate themselves at home if they develop symptoms.

Reported incidence is higher than usual/outbreak suspected

Investigation of varicella outbreaks should be prioritized as follows:

• Outbreaks involving deaths
• Outbreaks involving patients and staff in health care settings or correctional facilities
• Outbreaks associated with severe complications (e.g., pneumonia, encephalitis, hemorrhagic complications or serious infectious complications such as invasive Group A streptococcal infection) and/or hospitalizations
• Outbreaks among people who are immunocompromised due to HIV infection, cancer, or immunosuppressive therapy
• Outbreaks involving adolescents and adults
• Outbreaks occurring among vaccinated populations
• Clusters of varicella reports, which may suggest improper storage and handling of vaccines
• Outbreaks involving a large number of cases

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Treatment

The only therapy for varicella is antiviral drugs (e.g., acyclovir). However, antiviral drugs are only recommended in certain circumstances. Antiviral drugs (e.g., acyclovir) are not recommended for routine use among otherwise healthy infants and children with varicella. Antiviral therapy is not recommended for post-exposure prophylaxis. Clinical studies indicate that antiviral drugs given within 24 hours of rash onset may reduce the number of days new lesions appear, fever duration, and the severity of cutaneous and systemic signs and symptoms. Antiviral drugs have not been shown to decrease transmission of varicella, reduce the number of days an infected person misses school/work, or reduce complications.

Varicella antiviral drugs are only recommended in the following circumstances:  

• Oral acyclovir should be considered for people ≥ 13 years old. 
• Consider oral acyclovir for people with chronic cutaneous or pulmonary disorders, long-term salicylate therapy, or steroid therapy.
• Intravenous antiviral therapy is recommended for immunocompromised people, including people being treated with chronic corticosteroids.

Prophylaxis

Vaccination 

• Varicella vaccine is recommended for post-exposure prophylaxis of people without evidence of varicella immunity and who do not have contraindications to vaccination. Refer to Case Investigation, Identify and Evaluate Contacts for evidence of varicella immunity. 
• Administration of varicella vaccine to susceptible contacts may abort infection or modify the disease if given within 3 to 5 days of exposure.
• In June 2006, the Advisory Committee on Immunization Practices (ACIP) recommended all children routinely receive two doses of varicella vaccine. The first dose should be given at age 12 to 15 months and the second dose at age 4 to 6 years.
• For children ages 12 months through 12 years, the minimum interval between varicella vaccine doses is three months; for people 13 years and older, the minimum interval is 28 days. However, second varicella vaccinations inadvertently administered to children 12 months through 12 years old at least 28 days after the first dose do not need to be repeated. 
• During a varicella outbreak, people having only one dose of varicella vaccine should receive a second dose, provided the appropriate vaccination interval has elapsed since the first dose (three months for people 12 months to 12 years old and at least 28 days for people ≥ 13 years old). 
• Varicella vaccination of non-immune contacts may be recommended, even if the time since exposure is > five days, to provide protection from future exposure, especially if there is ongoing transmission in a particular setting such as a child care, school, or work.
• A small portion of individuals receiving varicella vaccine may develop a rash from 7 to 42 days following vaccination. It is usually caused by the vaccine strain of the virus. Individuals who develop a vesicular rash within seven days of varicella vaccination should be treated as having wild type varicella, unrelated to vaccination. Additional information regarding rash following varicella vaccine is available online: Guidelines for Students Developing a Rash Following Varicella Vaccination.

Varicella zoster immune globulin (VariZIG)

• VariZIG is recommended for susceptible individuals with significant exposure to varicella who are at increased risk of developing complications from varicella and for whom varicella vaccine is contraindicated. VariZIG should be given as soon as possible after exposure to varicella-zoster virus and within 10 days. VariZIG administration may increase the incubation period by a week or more. Therefore, any patient who receives VariZIG should be observed closely for symptoms of varicella for 28 days after exposure.
• The only varicella zoster immune globulin product currently available in the United States is VariZIG (manufactured in Canada). The patient groups recommended by ACIP to receive VariZIG include the following:
  • Immunocompromised patients without evidence of immunity
  • Neonates whose mothers have signs and symptoms of varicella around the time of delivery (i.e., 5 days before to 2 days after)
  • Hospitalized preterm infants born at 28 weeks gestation or later who are exposed at any time during hospitalization for their prematurity care and whose mothers do not have evidence of immunity
  • Hospitalized preterm infants born earlier than 28 weeks gestation or who weigh 1,000 g or less at birth and are exposed at any time during hospitalization for their prematurity care, regardless of maternal history of varicella disease or vaccination
  • Pregnant women without evidence of immunity
• VariZIG can be obtained commercially through health care providers. Public health does not provide VariZIG.
• For further details regarding VariZIG use, see Updated Recommendations for the Use of VariZIG – United States, 2013.

Education

• Advise contacts of signs and symptoms of varicella.
• Recommend varicella vaccine for exposed susceptible contacts.
• Recommend VariZIG for exposed susceptible individuals at increased risk of developing complications of varicella.
• A CDPHE sample letter, Chickenpox exposure letter, which includes varicella symptoms and vaccine information, is located on the CDPHE chickenpox webpage. 

Managing special situations

Child care/school

Refer child care providers to the CDPHE infectious disease guidelines for schools and child care settings webpage, and to the CDPHE chickenpox webpage for additional varicella information.

• Varicella cases should be excluded from child care and school and be voluntarily isolated at home until all lesions have formed scabs or crusts (usually five days after onset). Children with breakthrough infection may have fewer lesions and may be able to return to child care earlier than five days if all lesions have formed scabs or the rash is gone. 
• Determine the dates the varicella case attended child care or school while infectious.
• Consider suggesting that the child care center or school notify parents and staff of the possible exposure to chickenpox. If there is sustained transmission, recommend the child care center or school send an exposure notification letter. A sample letter is available on the CDPHE chickenpox webpage. 
• Identify and assess contacts that could have been exposed if the case attended child care or school while infectious. Refer to Case Investigation, Case Investigation, Identify and Evaluate Contacts regarding evidence of varicella immunity.
• Provide post-exposure prophylaxis recommendation as needed. See Disease Control Measures, Prophylaxis - Vaccination for information regarding the minimum interval between varicella vaccine doses. 
• Child care and school personnel should report all varicella cases to CDPHE or their local public health agency, including reports from parents saying their child has chickenpox.

Health care setting

Hospitals and long-term care facilities generally have written infection control policies and procedures for handling cases of communicable disease among patients and staff members. If a facility does not have such policies in place, provide the following recommendations apply:

• Identify exposed health care personnel (HCP) and patients to determine their immune status. Refer to Case Investigation, Identify and Evaluate Contacts for evidence of immunity to varicella.
• VariZIG should be administered to exposed susceptible patients and HCP at increased risk of developing varicella complications.

1. Health care personnel (HCP)
   • HCP with unknown varicella immune status should test for immunity to varicella (prior to symptom development if exposed).
   • Recommend varicella immunization for susceptible HCP if there are no contraindications to vaccination. If the susceptible person is being tested for immunity to varicella, blood should be collected prior to or at the time of vaccination.
   • Efforts should be made to vaccinate HCP within 3 to 5 days of exposure if vaccination is not contraindicated. 
   • All susceptible, exposed HCP (including those receiving their first varicella vaccine dose within 3 to 5 days of exposure) should be excluded from patient contact from Day 10 to Day 21 after exposure or until Day 28 after exposure for people who receive VariZIG.
   • HCP with one dose of varicella vaccine should receive a second dose within 3 to 5 days after exposure (provided 28 days have elapsed since the first dose). HCP receiving a second varicella vaccine dose do not need to be excluded, but should be monitored daily for fever, skin lesions, and other systemic symptoms during Days 10 to 21 following exposure. 
   • HCP who have previously received two varicella vaccinations should monitor for fever, skin lesions, and systemic symptoms during Day 10 to 21 following exposure.
   • Serologic testing for immunity is not necessary for HCP who have documented two doses of varicella containing vaccination (separated by at least 28 days). 
   • Instruct HCP to report any symptoms immediately.
   • Immunized HCP who develop breakthrough infection should be considered infectious. 
2. Patients
   • Patients who are diagnosed with varicella while hospitalized should be isolated using standard airborne and contact precautions for a minimum of five days after onset of rash and until all lesions are crusted, which in immunocompromised patients may be longer. 
   • Exposed, susceptible patients should receive varicella vaccine within 3 to 5 days of exposure, if possible, and vaccination is not contraindicated.
   • All exposed, susceptible patients should be discharged as soon as possible.
   • All exposed, susceptible patients (including those receiving their first varicella vaccine dose within 3 to 5 days of exposure) unable to be discharged should be placed in airborne and contact precautions from Day 10 to Day 21 after exposure. Patients who received VariZIG or IGIV should continue precautions until 28 days after exposure. 

Jails and detention centers

A resource document for prisons is available from the Federal Bureau of Prisons: Management of Varicella Zoster Virus (VZV) Infections: Federal Bureau of Prisons Clinical Guidance, December 2016.

• Varicella cases should be isolated from other incarcerated or detained people and susceptible personnel until all lesions have formed scabs or crusts (usually five days after onset). 
• Determine dates the varicella case was infectious and identify exposed incarcerated or detained people and staff. 
• Determine the varicella immunity status of exposed personnel and incarcerated or detained people. Refer to Case Investigation, Identify and Evaluate Contacts for evidence of immunity to varicella.
• Consider testing staff and incarcerated or detained people with unknown varicella immune status for immunity to varicella.
• Provide varicella immunization to susceptible personnel and incarcerated or detained people within 3 to 5 days of exposure, if possible, and vaccination is not contraindicated. If the susceptible person is being tested for immunity to varicella, blood should be collected prior to or at the time of vaccination.
• All susceptible exposed incarcerated or detained people (including those receiving with their first varicella vaccine dose within 3 to 5 days of exposure) should be placed in airborne (if available) and contact precautions from Day 10 to Day 21 after exposure to the index patient. People who received VariZIG or IGIV should continue precautions until 28 days after exposure. 
• All susceptible exposed personnel (including those receiving with their first varicella vaccine dose within 3 to 5 days of exposure) should be furloughed or excused from contact with incarcerated or detained people from Day 10 to Day 21 after exposure or until Day 28 after exposure for people who received VariZIG.
• Serologic testing for immunity is not necessary for personnel who have been appropriately immunized. 
• Immunized personnel and incarcerated or detained people who develop breakthrough infection should be considered infectious until their rash is gone. 

Airline passengers

• Varicella cases should not travel by airplane until all lesions have formed scabs or crusts (usually five days after onset).
• Currently, the Federal Quarantine Station does not investigate or follow up on varicella cases on domestic or international flights.

Environmental measures

No specific environmental measures are recommended.

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American Academy of Pediatrics. Red Book 2024-2027: Report of the Committee on Infectious Diseases, 33rd Edition.  Illinois, American Academy of Pediatrics, 2024. 

American Public Health Association. 2022. Varicella/Herpes Zoster. Control of Communicable Diseases Manual. Heymann, D. ed. 21st Edition. Washington, DC. American Public Health Association.

CDC. FDA approval of an extended period for administering VariZIG for postexposure prophylaxis of Varicella. MMWR. 61 (12): 212, 2012. Accessed at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6112a4.htm?s_cid=mm6112a4_w
CDC. National Notifiable Diseases Surveillance Systems (NNDSS). Case definitions. Accessed at https://ndc.services.cdc.gov/case-definitions/varicella-2024/

CDC. Updated recommendations for the use of VariZIG – United States, 2013. MMWR. Accessed at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6228a4.htm

CDC. 2021. Varicella. Epidemiology and Prevention of Vaccine-Preventable Diseases. Hall, E et. al, eds. 14th Edition. Washington, DC. Public Health Foundation. Accessed at https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-22-varicella.html

CDC. Manual for the Surveillance of Vaccine-Preventable Diseases. Roush S, Baldy L, eds. 4. Atlanta, GA, last reviewed 05/16/2024 https://www.cdc.gov/vaccines/pubs/surv-manual/index.html 

CDC.Varicella Vaccine Recommendations. Accessed at https://www.cdc.gov/chickenpox/hcp/vaccine-considerations/index.html

Colorado Department of Public Health and Environment (CDPHE). Immunization. https://www.colorado.gov/pacific/cdphe/school-immunizations

Colorado Department of Public Health and Environment (CDPHE). Infectious disease in child care settings: guidelines for child care providers. Infectious Disease Guidelines and Resources. Accessed at https://cdphe.colorado.gov/communicable-diseases/infectious-disease-guidelines-schools-childcare

Federal Bureau of Prisons. Management of Varicella Zoster Virus (VZV) infections. Federal Bureau of Prisons Clinical Practice Guideline. 2016. Accessed at https://www.bop.gov/resources/pdfs/varicella2016.pdf

Important telephone and fax numbers

CDPHE Communicable Disease Branch

• Phone: 303-692-2700 or 800-866-2759
• Fax: 303-782-0338
• After hours: 303-370-9395

CDPHE Microbiology Laboratory: 303-692-3480

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