Varicella Information for Healthcare Professionals
The Rhode Island Department of Health (RIDOH) encourages healthcare professionals to confirm every varicella (chickenpox) diagnosis through laboratory testing. Healthcare professionals must also report all varicella cases to RIDOH within 4 days of diagnosis.
The best protection against varicella is immunization. In Rhode Island, 98% of children age 19-59 months have received one or more doses of varicella-containing vaccine. More than half of varicella cases in Rhode Island occur in unvaccinated children.
What you should do
Identify and Test
Clinical features of breakthrough varicella are often mild and atypical. It can be difficult to make a varicella diagnosis on clinical presentation alone as many other rashes can resemble varicella, including hand, foot, and mouth disease, poison ivy, allergic reaction, viral rash, or molluscum contagiosum. CDC’s photographs demonstrate several examples of varicella in vaccinated and unvaccinated children.
Laboratory testing for varicella can help avoid unnecessary public health action and parental concern and can ensure that cases of varicella are properly identified and isolated.
Molecular (polymerase chain reaction or PCR) testing is the most reliable method to confirm varicella infection. If you suspect varicella in a patient, please collect a swab and submit it to a commercial laboratory for PCR testing. Use a polyester or Dacron tipped swab and follow the commercial laboratory's instructions for specimen collection and submission. Serologic (IgM) testing is not a reliable or efficient method for routine varicella confirmation, especially in vaccinated people.
Vaccinate
Two doses of varicella-containing vaccine are at least 90% effective at preventing varicella disease. Children should get one dose from age 12-15 months, and a second dose from age 4-6 years.
The varicella vaccine can also prevent varicella or significantly lower disease severity if given within 3-5 days after exposure. It’s recommended for unvaccinated people without evidence of immunity to get the first dose as soon as possible, ideally within 3 days.
Report
All cases of varicella are reportable to RIDOH within 4 days of diagnosis. While we encourage laboratory testing, if you have diagnosed varicella by symptoms alone, the case is still reportable. Fill out the varicella case report form and fax it to 401-222-2488. Suspected cases may also be reported at 401-222-2577.