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Varicella Vaccination — SCE Infectious Diseases MCQ

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ModerateTravel Medicine & VaccinationVaricella VaccinationSCE Infectious Diseases

A 35-year-old woman with systemic lupus erythematosus is about to start Belimumab. She has never had chickenpox and her VZV IgG is negative. What vaccination should be offered before starting Belimumab?

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Correct answer: E — Two-dose varicella vaccine (Varivax) at least 4 weeks before starting Belimumab

VZV-seronegative immunocompromised patients are at risk of primary varicella, which can be severe. The varicella vaccine (Varivax) is a live vaccine and must be given at least 4 weeks BEFORE starting immunosuppressive therapy. It cannot be given once the patient is on Belimumab or other immunosuppressants. Two doses are required (4–8 weeks apart). Shingrix is for prevention of herpes zoster reactivation in previously infected individuals, not for primary varicella prevention.

Reference: UKHSA 2024 – Green Book Ch 34: Varicella; BSR 2024 – Vaccination in immunosuppression