Consumer medicine information

Varilrix (Human Albumin Free)

Varicella zoster vaccine, live attenuated

BRAND INFORMATION

Brand name

Varilrix HSA-Free

Active ingredient

Varicella zoster vaccine, live attenuated

Schedule

S4

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using Varilrix (Human Albumin Free).

SUMMARY CMI

VARILRIX (human albumin free)

Consumer Medicine Information (CMI) summary

The full CMI on the next page has more details. If you are worried about using this medicine, speak to your doctor or pharmacist.

1. Why am I receiving VARILRIX?

VARILRIX contains the active ingredient of a live weakened varicella-zoster virus (Oka strain). VARILRIX is used in children aged 9 months or older, adolescents and adults to prevent chickenpox.

For more information, see Section 1. Why am I receiving VARILRIX? in the full CMI.

2. What should I know before I receive VARILRIX?

Do not use if you or your child have ever had an allergic reaction to VARILRIX, any vaccine against varicella, or any of the ingredients listed at the end of the CMI.

Talk to your doctor if you or your child have any other medical conditions, take any other medicines, are pregnant, plan to become pregnant, or are breastfeeding. Tell your doctor if you or your child have received a vaccine within the last month, or received a blood or plasma transfusion, gamma globulin, or other immunoglobulins within the last 3 months.

For more information, see Section 2. What should I know before I receive VARILRIX? in the full CMI.

3. What if I am taking other medicines?

Some medicines may interfere with VARILRIX and affect how it works. A list of these medicines is in Section 3. What if I am taking other medicines? in the full CMI.

4. How is VARILRIX given?

  • VARILRIX will be injected under the skin (subcutaneously) of the shoulder or thigh
  • For children from 9 months up to and including 12 years, the appropriate time and number of doses that will be given will be determined by your doctor on the basis of appropriate official recommendations
  • Adults and adolescents aged 13 years and older are generally given two doses at least six weeks apart.

More instructions can be found in Section 4. How is VARILRIX given? in the full CMI.

5. What should I know while receiving VARILRIX?

Driving or using machines
  • Be careful driving or operating machinery until you know how VARILRIX affects you
  • VARILRIX may cause dizziness in some people.
Looking after your medicine
  • VARILRIX is usually stored at the doctor's clinic or surgery, or at the pharmacy
  • If you need to store VARILRIX, keep it in the refrigerator stored between 2°C and 8°C. Do not store it in the bathroom, near the sink, or leave it in the car on hot days. Avoid exposing the vaccine to sunlight. The water diluent can be kept in a refrigerator or at room temperature. It must not be frozen

For more information, see Section 5. What should I know while receiving VARILRIX? in the full CMI.

6. Are there any side effects?

Side effects that have been reported include pain, redness and swelling at the injection site, headache, fever and upper respiratory tract infection, rash (spots and/or blisters), itching, vomiting, diarrhoea, stomach pain or discomfort, toothache, nervousness, cough, runny or blocked nose, sneezing (rhinitis), sore throat and discomfort when swallowing, discharge with itching of the eyes and crusty eyelids (conjunctivitis), infection of the middle ear, tiredness (fatigue), chest pain, generally feeling unwell, nausea, dizziness, migraine, sleepiness, swollen glands in the neck, armpit or groin, painful or swollen joints and aching muscles or muscle tenderness or weakness (not caused by exercise).

There is a rare risk of allergic reactions. These may be local or widespread rashes that may be itchy or blistering, swelling of the eyes and face, difficulty in breathing or swallowing, a sudden drop in blood pressure and loss of consciousness. These reactions will usually occur before leaving the doctor's surgery. If these symptoms occur, you should contact a doctor immediately.

Post commercialisation, infection or inflammation of the nervous system resulting in temporary loss of control of bodily movements, walking or sensation changes has been rarely reported in people vaccinated with VARILRIX.

For more information, including what to do if you have any side effects, see Section 6. Are there any side effects? in the full CMI.



FULL CMI

VARILRIX (human albumin free)

Active ingredient(s): Live weakened varicella-zoster virus (Oka strain)


Consumer Medicine Information (CMI)

This leaflet provides important information about using VARILRIX. You should also speak to your doctor or pharmacist if you would like further information or if you have any concerns or questions about using VARILRIX.

Where to find information in this leaflet:

1. Why am I receiving VARILRIX?
2. What should I know before I receive VARILRIX?
3. What if I am taking other medicines?
4. How is VARILRIX given?
5. What should I know while receiving VARILRIX?
6. Are there any side effects?
7. Product details

1. Why am I receiving VARILRIX?

VARILRIX contains the active ingredient of a live weakened varicella-zoster virus (Oka strain).

VARILRIX is a vaccine used in children aged 9 months or older, adolescents and adults to prevent chickenpox.

Groups who would benefit mostly from vaccination include:

  • adults not immunised (protected) against chickenpox, especially those in ‘at-risk’ occupations such as health care workers, teachers and workers in child care centres
  • adults not immunised, who are parents of young children
  • adults and children not immunised, who live in the same house with people who have lowered immunity and have no history of chickenpox

The vaccine works by causing the body to produce its own protection (antibodies) against this disease.

Chickenpox is caused by a virus called the varicella-zoster virus. VARILRIX vaccine contains a weakened form of the chickenpox (varicella-zoster) virus.

Chickenpox is a highly infectious disease, which usually causes an itchy, red rash with blisters. After about 1 week, most of the blisters have normally crusted over. The rash can appear on the face, scalp, body, or in the mouth, eyes and bottom. Other symptoms can include fever, headaches, chills, and muscle and/or joint aches and pains. Sometimes disease complications can occur such as bacterial infection of the skin (often due to itching of the rash/crusts), inflammation of the brain (varicella encephalitis), and lung infection (varicella pneumonia). Complications are not common and are mainly seen in children with lowered immunity, and sometimes in adults.

Full recovery from chickenpox generally occurs; however, later in life the virus can become active again. This condition is known as shingles or Herpes zoster.

2. What should I know before I receive VARILRIX?

Warnings

Do not use VARILRIX if:

  • you or your child are allergic to VARILRIX or any of the ingredients listed at the end of this leaflet. Always check the ingredients to make sure you or your child can use this medicine. Signs of an allergic reaction may include itchy skin rash, shortness of breath and swelling of the face or tongue. VARILRIX can be used in people who have previously developed a skin rash after applying the antibiotic ‘neomycin’ to the skin
  • you or your child have previously had an allergic reaction to any vaccine against varicella
  • you or your child have severely lowered immunity. This can occur in persons:
    - with inherited (or family history of) immune deficiency conditions
    - with abnormal blood conditions or blood protein (immunoglobulin) disorders
    - with cancer
    - receiving or who have received certain drugs (ie cyclosporin, corticosteroids, and cancer medicines)
    - receiving or who have received radiation therapy
    - with Human Immunodeficiency Virus (HIV) infection
  • you or your child have a severe infection with a high temperature. A minor infection such as a cold should not be a problem, but talk to your doctor or nurse about this before vaccination

If you are not sure whether you should have VARILRIX, talk to your doctor or nurse.

Do not give this vaccine to anyone else; your doctor has prescribed it specifically for you or your child.

Check with your doctor if you or your child:

  • have any other medical conditions
  • take any medicines for any other condition
  • have allergies to any other medicines or substances, such as dyes, foods or preservatives
  • have received another vaccine within the last month
  • have a weakened immune system. In the presence of weakened immunity, careful assessment by your doctor is necessary in order to minimise adverse reactions to the vaccine. You or child should be closely monitored as the response to the vaccine may not be sufficient to ensure protection against the illness

Some vaccines may be affected by other vaccines or medicines. Your doctor, nurse or pharmacist will be able to tell you what to do if VARILRIX is to be given with another vaccine or medicine.

During treatment, you or your child may be at risk of developing certain side effects. It is important you understand these risks and how to monitor for them. See additional information under Section 6. Are there any side effects?

Pregnancy and breastfeeding

Check with your doctor if you are pregnant or intend to become pregnant.

Do not use VARILRIX if:

You are or think you may be pregnant, or if you intend to become pregnant within one month of vaccination. Your doctor will discuss with you the risks of receiving VARILRIX during pregnancy.

Do not become pregnant for one month after receiving VARILRIX vaccination. Talk to your doctor as soon as possible, if you do become pregnant within this time

Talk to your doctor if you are breastfeeding or intend to breastfeed.

The effect on breast fed infants of the administration of VARILRIX to their mothers has not been evaluated in clinical studies.

Fainting

Fainting can occur following, or even before, any needle injection, therefore tell the doctor or nurse if you or your child have fainted with a previous injection.

3. What if I am taking other medicines?

Tell your doctor or pharmacist if you or your child are taking any other medicines, including any medicines, vitamins or supplements that you buy without a prescription from your pharmacy, supermarket or health food shop.

  • If you have received a blood or plasma transfusion, or been given gamma globulin or other immunoglobulins within the last 3 months. VARILRIX may be less effective if given within 3 months of these products
  • If you are due to have a skin test for possible tuberculosis. If this test is done within 6 weeks after receiving VARILRIX, the result may not be reliable
  • If you are having any prescription or OTC (Over-the-counter) medicines. In particular, mention use of any medicines that suppress the immune system, such as high-dose steroids

4. How is VARILRIX given?

How much is given

  • The doctor or nurse will give VARILRIX as an injection
  • The dose is 0.5mL for infants (9 months or older), children, adolescents and adults

How it is given

  • VARILRIX will be injected under the skin (subcutaneously) of the shoulder or thigh

The vaccine should never be given intravenously

When is it VARILRIX given

  • For children from 9 months up to and including 12 years, the appropriate time and number of doses that will be given will be determined by your doctor on the basis of appropriate official recommendations
  • Adults and adolescents aged 13 years and older are generally given two doses at least six weeks apart. Each dose is given at a separate visit

If a scheduled dose is missed, talk to your doctor or nurse and arrange another visit as soon as possible.

The need for booster doses is uncertain at present.

If you are given too much VARILRIX

Cases of accidental administration of more than the recommended dose of VARILRIX have been reported. Amongst these cases, the following adverse events were reported: lethargy and convulsions. In the other cases reported as overdose there were no associated adverse events.

If you think that you or your child have used too much VARILRIX, you may need urgent medical attention.

You should immediately:

  • phone the Poisons Information Centre
    (by calling 13 11 26), or
  • contact your doctor, or
  • go to the Emergency Department at your nearest hospital

You should do this even if there are no signs of discomfort or poisoning.

5. What should I know while receiving VARILRIX?

Things you should do

Call your doctor straight away if you or your child:

  • develop a rash within 4 weeks after vaccination. Some individuals develop symptoms of mild chickenpox several weeks after vaccination with VARILRIX. While the rash lasts, you or your child should avoid contact with people who have low immunity
  • If you or your child are to have a tuberculin skin test for tuberculosis within 4-6 weeks after vaccination. The vaccine may affect the results of the tuberculin skin test
  • If you or your child are to have another vaccine within 1 month after vaccination

Remind any doctor, nurse, dentist or pharmacist you visit that you or child have received VARILRIX.

Where possible, avoid contact with people who have lowered immunity for up to 6 weeks. The disease may be more serious in these people.

Things to be careful of:

It is advised to remain in the clinic for about 15 minutes after receiving the injection. There is a rare risk of allergic reactions. These may be local or widespread rashes that may be itchy or blistering, swelling of the eyes and face, difficulty in breathing or swallowing, a sudden drop in blood pressure and loss of consciousness. These reactions will usually occur before leaving the doctor's surgery. If these symptoms occur, you should contact a doctor immediately.

Things you should not do

  • Do not become pregnant for one month after receiving VARILRIX vaccination. Talk to your doctor as soon as possible, if you do become pregnant within this time

Driving or using machines

Be careful before you drive or use any machines or tools until you know how VARILRIX affects you.

VARILRIX may cause dizziness in some people.

Looking after your medicine

VARILRIX is usually stored at the doctor's clinic or surgery, or at the pharmacy. But if you need to store VARILRIX always:

  • Keep VARILRIX in the refrigerator stored between 2°C and 8°C. Do not store it in the bathroom, near the sink, or leave it in the car on hot days. Avoid exposing the vaccine to sunlight. The water diluent can be kept in a refrigerator or at room temperature. It must not be frozen
  • Keep the vaccine out of the reach of children
  • Keep VARILRIX in the original pack until it is time for it to be given

Follow the instructions in the carton on how to take care of your medicine properly.

Keep it where young children cannot reach it.

Getting rid of any unwanted medicine

Ask your pharmacist what to do with any leftover VARILRIX that has expired or has not been used.

Do not use this medicine after the expiry date.

Do not use this medicine if the packaging is torn or shows signs of tampering.

6. Are there any side effects?

All medicines can have side effects. If you or your child do experience any side effects, most of them are minor and temporary. However, some side effects may need medical attention.

See the information below and, if you need to, ask your doctor or pharmacist if you have any further questions about side effects.

Most unwanted effects with VARILRIX are mild and usually clear up within a few days. These effects, as with other vaccines, generally occur around the injection site. However, some children develop symptoms of mild chickenpox several weeks after vaccination with VARILRIX.

Less serious side effects

Less serious side effectsWhat to do
General disorders and administration site conditions:
  • pain, redness and swelling at the injection site
  • headache
  • fever
  • toothache
  • tiredness (fatigue)
  • generally feeling unwell
  • dizziness
  • fever greater than 39°C
Gastrointestinal disorders:
  • vomiting
  • diarrhoea
  • stomach pain or discomfort
  • indigestion
  • nausea
Musculoskeletal disorders:
  • painful, swollen joints
  • aching muscles, muscle tenderness or weakness, not caused by exercise
Respiratory and mouth disorders:
  • upper respiratory tract infection
  • cough
  • runny or blocked nose, sneezing (rhinitis)
  • sore throat and discomfort when swallowing
Lymphatic disorders:
  • swollen glands in the neck, armpit or groin
Skin disorders:
  • rash (spots and/or blisters)
  • itching
  • hives (urticaria)
Eye disorders:
  • discharge with itching of the eyes and crusty eyelids (conjunctivitis)
Ear disorders:
  • infection of the middle ear
  • earache
Psychiatric disorders:
  • migraine
  • sleepiness
  • irritability
  • nervousness
Cardiac disorders:
  • chest pain
Speak to your doctor if you have any of these less serious side effects and they worry you.

Serious side effects

Serious side effectsWhat to do
Infection and immune system disorders:
  • chickenpox-like rash
  • shingles (herpes zoster)
  • fits or seizures
  • temporary lumpy rash that may affect the skin, mouth and other parts of the body
  • bleeding or bruising more easily than normal which may be associated with skin rashes/peeling or fever
  • infection or inflammation of the nervous system resulting in temporary loss of control of bodily movements, walking or sensation changes
Call your doctor straight away, or go straight to the Emergency Department at your nearest hospital if you notice any of these serious side effects.

Tell your doctor or pharmacist if you or your child notice anything else that may be making you feel unwell.

Other side effects not listed here may occur in some people.

Reporting side effects

After you or your child have received medical advice for any side effects experienced, you can report side effects to the Therapeutic Goods Administration online at www.tga.gov.au/reporting-problems. By reporting side effects, you can help provide more information on the safety of this medicine.

Always make sure you speak to your doctor or pharmacist before you or your child decide to stop taking any of your medicines.

7. Product details

This medicine is only available with a doctor's prescription.

What VARILRIX contains

Active ingredient
(main ingredient)
Live weakened varicella-zoster virus (Oka Strain)
Other ingredients
(inactive ingredients)
Amino acids
Lactose
Mannitol
Sorbitol
Neomycin sulphate is present as traces

Each 0.5 mL dose contains not less than 1,995 plaque-forming units of the varicella-zoster virus.

The manufacture of this product includes exposure to bovine derived materials. No evidence exists that any case of vCJD (considered to be the human form of bovine spongiform encephalopathy) has resulted from the administration of any vaccine product.

VARILRIX does not contain a preservative, sucrose, gluten, tartrazine or any other azo dyes.

Do not take this medicine if you or your child are allergic to any of these ingredients.

What VARILRIX looks like

VARILRIX comes as a slightly cream to yellowish or pinkish coloured powder in a glass vial. The clear sterile water diluent comes in prefilled syringes or ampoules. It is made into a clear peach to pink coloured liquid, before being injected by the doctor or nurse.

AUST R 234750 - a glass vial with sterile water diluent (prefilled syringe) in packs of 1 or 10. Needles may or may not be provided, subject to availability.

AUST R 234751 - a glass vial with sterile water diluents (ampoule) in packs of 1 or 10. Needles are not provided.

Not all pack sizes may be marketed.

Who distributes VARILRIX

GlaxoSmithKline Australia Pty Ltd
Level 4, 436 Johnston Street,
Abbotsford, Victoria, 3067
Phone: 1800 033 109
www.gsk.com.au

Trade marks are owned by or licensed to the GSK group of companies.

©2025 GSK group of companies or its licensor

This leaflet was prepared on 26 June 2025.

Version 3.0

Published by MIMS August 2025

BRAND INFORMATION

Brand name

Varilrix HSA-Free

Active ingredient

Varicella zoster vaccine, live attenuated

Schedule

S4

 

1 Name of Medicine

Live varicella vaccine.

2 Qualitative and Quantitative Composition

Varilrix is a lyophilised preparation of the live attenuated Oka strain of varicella-zoster virus, obtained by propagation of the virus in MRC5 human diploid cell culture.
Each 0.5 mL dose of the reconstituted vaccine contains not less than 103.3 plaque forming units (PFU) of the varicella-zoster virus.
The manufacture of this product includes exposure to bovine derived materials. No evidence exists that any case of vCJD (considered to be the human form of bovine spongiform encephalopathy) has resulted from the administration of any vaccine product.
Varilrix meets the World Health Organisation requirements for biological substances and for varicella vaccines.

List of excipients with known effect.

Varilrix also contains the excipient ingredient phenylalanine and residual amounts of neomycin sulphate, which is carried over from the manufacturing process.
For the full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

Powder and diluent for solution for injection.
Varilrix is presented as a slightly cream to yellowish or pinkish coloured powder for reconstitution with clear and colourless sterile diluent.

4 Clinical Particulars

4.1 Therapeutic Indications

Varilrix is indicated for active immunisation against varicella of healthy children and adults from 9 months of age.
Groups who would particularly benefit from vaccination include:
Nonimmune adults, especially those in at-risk occupations such as health care workers, teachers and workers in children's day care centres.
Nonimmune parents of young children.
Nonimmune household contacts, both adults and children, of immunocompromised patients with no history of the disease.

4.2 Dose and Method of Administration

Varilrix should be administered as a single dose by subcutaneous injection only. The upper arm (deltoid region) is the preferred site of injection.
Under no circumstances should Varilrix be administered intravenously. Varilrix should not be administered intradermally.

Dosage (dose and interval).

Infants and children (aged 9 months up to and including 12 years of age).

Children from the age of 9 months up to 12 years of age, two doses of Varilrix administered at least 6 weeks apart is recommended for the benefit of enhanced immune response against varicella virus.

Adolescents and adults (13 years of age and over).

Two 0.5 mL doses of reconstituted Varilrix, administered at least 6 weeks apart, are required.

Interchangeability.

A single dose of Varilrix may be administered to those who have already received a single dose of another varicella containing vaccine.
A single dose of Varilrix may be administered followed by a single dose of another varicella containing vaccine.

Method of administration.

Due to minor variations of its pH, the colour of the reconstituted vaccine may vary from a clear peach to a pink coloured solution. Vaccines should be inspected visually for any foreign particulate matter and/or variation of physical aspect prior to reconstitution or administration. In the event of either being observed, do not use the vaccine.
After reconstitution, it is recommended that the vaccine be injected as soon as possible. However, it has been demonstrated that the vaccine may be kept for up to 90 minutes at room temperature (25°C) or up to 8 hours in the refrigerator (2°C to 8°C). If not used within these timeframes, the reconstituted vaccine must be discarded. For use in a single individual, on one occasion only. Varilrix contains no antimicrobial agent. Use once only and discard any residue.
Alcohol and other disinfecting agents must be allowed to evaporate from the skin before the injection of the vaccine as they may inactivate the virus.
Further guidance regarding the use of vaccines is found in the Australian Immunisation Handbook.
Reconstitution.

Instructions for reconstitution of the vaccine with diluent presented in ampoules.

Varilrix must be reconstituted by adding the entire contents of the supplied ampoule of diluent to the vial containing the powder. The mixture should be well shaken until the powder is completely dissolved in the diluent.
After reconstitution, the vaccine should be used promptly.
Withdraw the entire contents of the vial. Inject the entire contents of the syringe, using a new needle for administration.

Instructions for reconstitution of the vaccine with diluent presented in pre-filled syringe.

Varilrix must be reconstituted by adding the entire contents of the pre-filled syringe of diluent to the vial containing the powder. To attach a needle to the syringe, see Figure 1. However, the syringe provided with Varilrix might be slightly different than the syringe described in Figure 1.
Always hold the syringe by the barrel, not by the syringe plunger or the Luer Lock Adaptor (LLA), and maintain the needle in the axis of the syringe (as shown in Figure 1). Failure to do this may cause the LLA to become distorted and leak.
During assembly of the syringe, if the LLA comes off, a new vaccine dose (new syringe and vial) should be used.
1. Unscrew the syringe cap by twisting it anticlockwise (see Figure 1).
2. Attach a needle to the syringe by gently connecting the needle hub into the LLA and rotate a quarter turn clockwise until you feel it lock (see Figure 1).
3. Remove the needle protector, which may be stiff.
4. Add the diluent to the powder. The mixture should be well shaken until the powder is completely dissolved in the diluent.
After reconstitution, the vaccine should be used promptly.
5. Withdraw the entire contents of the vial.
6. A new needle should be used to administer the vaccine. Unscrew the needle from the syringe and attach an injection needle by repeating Step 2 above.
Inject the entire contents of the syringe.
Any unused product or waste material should be disposed of in accordance with local requirements.

4.3 Contraindications

Varilrix is contraindicated in children and adults with known hypersensitivity to neomycin or to any other component of the vaccine. A history of contact dermatitis to neomycin is not a contraindication.
Varilrix is contraindicated in children and adults having shown signs of hypersensitivity after previous administration of varicella vaccine.
Varilrix is contraindicated in pregnant women. Pregnancy should be avoided for one month after vaccination (see Section 4.6 Fertility, Pregnancy and Lactation, Use in pregnancy).
Varilrix is contraindicated in patients with severe humoral or cellular immunodeficiency such as:
patients with primary and acquired immunodeficiency states with a total lymphocyte count less than 1,200 per mm3;
patients presenting other evidence of lack of cellular immune competence (e.g. children and adults with leukaemias, lymphomas, blood dyscrasias, clinically manifest HIV infection);
patients receiving immunosuppressive therapy including high doses of corticosteroids (further guidance is found in the Australian Immunisation Handbook).
See Section 4.4 Special Warnings and Precautions for Use.
As with other vaccines, the administration of Varilrix should be postponed in children and adults suffering from acute severe febrile illness. In healthy children and adults, the presence of a minor infection, however, is not a contraindication to immunisation.

4.4 Special Warnings and Precautions for Use

Varilrix must not be administered intravascularly or intradermally.
Syncope (fainting) can occur following, or even before, any vaccination as a psychogenic response to the needle injection. It is important that procedures are in a place to avoid injury from faints.
As with all injectable vaccines, appropriate medical treatment and supervision should always be readily available in case of rare anaphylactic reactions following the administration of a vaccine.
Alcohol and other disinfecting agents must be allowed to evaporate from the skin before injection of the vaccine since they can inactivate the attenuated viruses in the vaccine.
Transmission of the Oka vaccine virus has been shown to occur at a very low rate in seronegative contacts of vaccinees with rash. Transmission of the Oka vaccine from a vaccinee who does not develop a rash to seronegative contacts cannot be excluded.
The mild nature of the rash which developed in the healthy contacts indicates that the virus remains attenuated after passage through human hosts. Vaccine recipients should attempt to avoid contact with susceptible high risk individuals for up to 6 weeks, where possible.
As for any vaccine, vaccination with Varilrix may not result in protection from subsequent infection with varicella virus in 100% of susceptible persons given the vaccine (see Section 5.1 Pharmacodynamic Properties, Clinical trials).
As for other varicella vaccines, cases of varicella disease have been shown to occur in persons who have previously received Varilrix. These breakthrough cases are usually mild, with a fewer number of lesions and less fever as compared to cases in unvaccinated individuals.
The duration of protection from varicella infection with Varilrix is unknown. The need for and timing of booster doses is uncertain at present. In a highly vaccinated population, immunity of some individuals may wane due to lack of exposure to natural varicella as a result of shifting epidemiology.
It is not known whether Varilrix given immediately after exposure to wild varicella virus will prevent illness. Results of a small household contact study using another live varicella virus vaccine containing the same varicella strain as Varilrix suggested that some protection was provided by that vaccine when vaccination occurred within 72 hours of exposure.
There are inadequate data to assess the incidence and severity of herpes zoster (shingles) after vaccination with Varilrix.
There is limited data on the use of Varilrix in immunocompromised patients, therefore vaccination should be considered with caution and only when, in the opinion of the physician, the benefits outweigh the risks, further guidance is found in the Australian Immunisation Handbook.
Immunocompromised patients who have no contraindication for this vaccination (see Section 4.3 Contraindications) may not respond as well as immunocompetent children and adults, therefore some of these patients may acquire varicella despite appropriate vaccine administration. Immunocompromised patients should be monitored carefully for signs of varicella.
Very few reports exist on disseminated varicella with internal organ involvement following vaccination with the Oka varicella vaccine strain and these are mainly in immunocompromised patients.

Use in the elderly.

No data available.

Paediatric use.

See Section 4.4 Special Warnings and Precautions for Use.

Effects on laboratory tests.

No data available.

4.5 Interactions with Other Medicines and Other Forms of Interactions

Varilrix should not be mixed in the same syringe with other vaccines. Different injection sites should always be used.
There was no reduction in safety and immunogenicity when Varilrix was given concomitantly, at a separate site, using a separate syringe, with a measles-mumps-rubella vaccine and with a diphtheria-tetanus-acellular pertussis vaccine. There are no data on concomitant administration with other live or inactivated vaccines or on administration of vaccines after Varilrix has been given. If it is necessary to administer more than 1 live virus vaccine at the same time, these may be given at the same visit at different sites. If not given on the same day, the live viral vaccinations should be separated by an interval of at least 4 weeks.
If tuberculin testing has to be done it should be carried out before or simultaneously with vaccination since it has been reported that live viral vaccines may cause a temporary depression of tuberculin skin sensitivity. As this anergy may last up to a maximum of 6 weeks, tuberculin testing should not be performed within that period after vaccination to avoid false negative results.
Varilrix may be administered at the same time as a measles containing vaccine. If this is not possible, an interval of at least one month should elapse before the measles containing vaccine is given. Measles vaccination may lead to short lived suppression of the cell mediated immune response.
In children and adults who have received immune globulin or a blood transfusion, immunisation should be delayed for at least three months because of the likelihood of vaccine failure due to passively acquired varicella antibodies.
Salicylates should be avoided for 6 weeks after varicella vaccination as Reye's syndrome has been reported following the use of salicylates during natural varicella infection.

4.6 Fertility, Pregnancy and Lactation

Effects on fertility.

No data available.
(Category B2)
Pregnant women must not be vaccinated with Varilrix. Pregnancy should be avoided for one month after vaccination. Women who intend to become pregnant should be advised to delay pregnancy.
Adequate human data on the use of Varilrix during pregnancy are not available and animal studies on reproductive toxicity have not been conducted.
The effect on breastfed infants of the administration of Varilrix to their mothers has not been evaluated in clinical studies.

4.7 Effects on Ability to Drive and Use Machines

The effects of this medicine on a person's ability to drive and use machines were not assessed as part of its registration.

4.8 Adverse Effects (Undesirable Effects)

Clinical trial data.

More than 5500 subjects aged 9 months and over have been vaccinated with Varilrix in ongoing and completed trials. Pain at the injection site was usually described as mild, and swelling and redness > 2 cm in diameter were infrequently observed.
No serious adverse events were considered to be unequivocally related to vaccination.
In the four week follow-up of a double blind, placebo controlled efficacy study in children aged 12-30 months (n = 513), there was no significant difference in the nature or incidence of symptoms in subjects who received the vaccine compared to placebo.
In the adolescent/ adult studies there was no increase in reactogenicity following the second dose. The incidence of symptoms after vaccination of seropositive individuals was not different from that of seronegative subjects. See Table 1.
In nonplacebo controlled trials, the incidence of local and general adverse events varied widely, which may in part reflect the differing methodologies used for collection of the safety data.
The adverse events listed below are by body system and are categorised by frequency according to the following definitions: very common events reported at a frequency of greater or equal to 1/10 patients; common events are reported at a frequency of less than 1/10 but greater or equal to 1/100 patients; uncommon events reported at a frequency of less than 1/100 but greater or equal to 1/1000; rare events reported at a frequency of less than 1/1000 but greater or equal to 1/10,000; very rare events reported at a frequency of less than 1/10,000 patients. Causality has not necessarily been established.
Events reported in children.

Local reactions.

Very common: pain at the injection site, redness, swelling.
Common: swelling (> 2 cm), redness (> 2 cm), injection site reaction.
Uncommon: contact dermatitis.
A trend for higher incidence of pain, redness and swelling after the second dose was observed as compared to the first dose.

Body as a whole.

Common: fever, rash, injury, viral infection.
Uncommon: varicella-like rash, fever > 39°C, fatigue, pain, infection, bacterial infection, fungal infection.
Uncommon: malaise.

Blood and lymphatic system disorders.

Uncommon: lymphadenopathy.

Skin and appendages.

Common: pruritus.
Uncommon: eczema, purpura, sweat gland disorder, dry skin.
Rare: urticaria.

Gastrointestinal.

Common: diarrhoea, abdominal pain, vomiting, toothache.
Uncommon: nausea, dyspepsia.

Musculoskeletal.

Uncommon: arthralgia, myalgia.

Central nervous system.

Common: headache, nervousness.
Uncommon: somnolence, irritability.

Respiratory.

Common: URTI, coughing, pharyngitis, rhinitis.
Uncommon: asthma, sinusitis, respiratory disorder.

Special senses.

Common: conjunctivitis, otitis media.
Uncommon: earache.
Events reported in adults (after dose 1 and/or dose 2).

Local reactions.

Very common: pain at the injection site, injection site reaction, redness, injection site inflammation.
Common: injection site mass.

Body as a whole.

Very common: fever.
Common: fatigue, chest pain, injury, malaise, infection viral, swelling at the injection site.
Uncommon: varicella-like rash.

Skin and appendages.

Common: dermatitis, pruritus, rash.
Rare: urticaria.

Gastrointestinal.

Common: diarrhoea, abdominal pain, vomiting, nausea, gastroenteritis.

Central nervous system.

Very common: headache.
Common: dizziness, migraine, somnolence.
Uncommon: irritability.

Respiratory.

Very common: URTI, pharyngitis.
Common: asthma, bronchitis, coughing, sinusitis, rhinitis, sputum increased.

Haematologic/ lymphatic.

Common: lymphadenopathy, lymphadenopathy cervical.

Musculoskeletal.

Common: arthralgia, back pain, myalgia.

Special senses.

Rare: conjunctivitis.

Post-marketing data.

More than 15 million doses of Varilrix have been distributed since first approval in October 1994.
During post-marketing surveillance, the following additional reactions have been reported after varicella vaccination:
Varicella-like rashes occurring > 2 weeks after vaccination have been reported very rarely. The median number of vesicles reported was 50, and fever was reported as present in approximately one-third of all cases of breakthrough disease.

Infections and infestations.

Very rare: varicella.
Rare: herpes zoster.

Blood and lymphatic system disorders.

Rare: thrombocytopenia.

Immune system disorders.

Rare: hypersensitivity, anaphylactic reactions.

Nervous system disorders.

Rare: encephalitis, cerebrovascular accident, cerebellitis, cerebellitis-like symptoms (including transient gait disturbance and transient ataxia), convulsions.

Vascular disorders.

Rare: vasculitis (including Henoch-Schonlein purpura and Kawasaki syndrome).

Skin and subcutaneous tissue disorders.

Rare: erythema multiforme.
The following additional side effects have been reported regardless of causality since the vaccine has been marketed:

Skin.

Stevens-Johnson syndrome.

Reporting suspected adverse effects.

Reporting suspected adverse reactions after registration of the medicinal product is important. It allows continued monitoring of the benefit-risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions at www.tga.gov.au/reporting-problems.

4.9 Overdose

Cases of accidental administration of more than the recommended dose of Varilrix have been reported. Amongst these cases, the following adverse events were reported: lethargy and convulsions. In the other cases reported as overdose there were no associated adverse events.
For information on the management of overdose, contact the Poisons Information Centre on 13 11 26 (Australia).

5 Pharmacological Properties

5.1 Pharmacodynamic Properties

Mechanism of action.

Varilrix produces an attenuated clinically inapparent varicella infection in susceptible subjects, with the subsequent production of varicella specific antibodies.

Clinical trials.

Efficacy studies. The efficacy of GlaxoSmithKline (GSK)'s Oka/RIT varicella vaccines in preventing confirmed varicella disease (varicella cases were confirmed by polymerase chain reaction (PCR) or exposure to a varicella case) has been evaluated in a large active controlled clinical trial in which children aged 12-22 months received one dose of Varilrix (N = 2263) or two doses of Priorix-Tetra (N = 2279). The coprimary objective of this trial with respect to Varilrix was to demonstrate vaccine efficacy of ≥ 60% in comparison to Priorix. The efficacy of Varilrix (one dose) versus Priorix in respect of preventing confirmed varicella cases was 65.4% (97.5% CI: 57.2-72.1%), the lower limit of the 2 sided 97.5% CI however did not exceed the predefined criterion of 60%. The observed vaccine efficacy against confirmed varicella of any severity and against moderate or severe confirmed varicella after one dose of Varilrix and after 2 doses of Priorix-Tetra (mean follow-up period 35 months) are presented in Table 2.
In another randomised placebo controlled trial conducted in children (n = 327) 12-30 months of age one dose of Varilrix vaccine was administered and followed up for an average of 29.3 months. The protective efficacy against common clinical cases of varicella was 100% and against clinical varicella of any severity was calculated as 88% (95% CI 72-96). The median number of vesicles in breakthrough cases in children was 2 (placebo group median = 30).
In a randomised placebo controlled trial conducted in adults (n = 233) two doses of Varilrix vaccine were administered at an interval of 2 months and then followed up for an average of 18 months. Efficacy against clinical varicella of any severity was conservatively estimated at 75.9% (95% CI 43.8-89.7); errors in the methodology used in this trial imply that efficacy cannot be accurately determined. Of the 11 vaccinees with breakthrough disease, only 2 had > 200 vesicles, compared with 57% of the unvaccinated subjects.
In both trials, subjects who responded to vaccination and who later developed breakthrough varicella had fewer lesions than unvaccinated individuals, demonstrating attenuation of varicella infection for those subjects who were not protected completely.
In a 3 year follow-up study, lower incidences of varicella breakthrough cases were reported in the group receiving two doses of Priorix-Tetra (1 case, 0.44%) than in the group receiving only one dose of Varilrix (4 cases, 5.06%), however the number of breakthrough cases were too small to make any conclusion about comparative vaccine efficacy. No cases of measles, mumps or rubella breakthrough disease were reported in any group during this 3 years follow-up.
Effectiveness studies. Effectiveness data suggest a higher level of protection and a decrease in breakthrough varicella following two doses of vaccine than following one dose.
The effectiveness of one dose of Varilrix was estimated in different settings (outbreaks, case control and database studies) and ranged from 20%-92% against any varicella disease and from 86%-100% against moderate or severe disease.
The impact of one dose of Varilrix in reducing varicella hospitalizations and ambulatory visits among children in a study performed in Uruguay were respectively 81% and 87% overall.
Immunogenicity studies.

One dose regimen in children.

In subjects aged 9 months to 36 months (n = 1573), the overall seroconversion rate following administration of Varilrix was greater than 98.0% when measured 6 weeks postvaccination. Seroconversion was defined as postvaccination titres ≥ 4 dil-1 in a subject with prevaccination titres < 4 dil-1, and was determined using a commercial indirect immunofluorescence assay (IFA).

Two dose regimen in children.

In children aged 9 months to 6 years who received two doses of Varilrix the seroconversion rate, when measured by IFA 6 weeks after vaccination, was 100% after a second vaccine dose. A marked increase of antibody titres was observed following the administration of a second dose (5 to 26-fold GMT increase).
In children aged 11 months to 21 months who received two doses of Varilrix, the seroconversion rate, when measured by ELISA (seroconversion was defined as postvaccination titres > 50 mIU/mL) 6 weeks after vaccination, was 89.6% after one vaccine dose and 100% after the second vaccine dose.
Table 3 presents the range of results seen in 13 clinical trials evaluating the immunogenicity of Varilrix in infants, adolescents and adults measured by IFA. GMTS are variable across studies, a recognised characteristic of live viral vaccines.
The seroconversion rate in children aged 12-22 months in the large efficacy trial as measured by ELISA (50 mIU/mL) 6 weeks after one dose of Varilrix and 6 weeks after two doses of Oka/RIT containing vaccines were 79.2% and 99.6%, respectively.
An increase in the antibody levels of vaccinees who remained seropositive was seen in studies which assessed persistence of antibody response. This suggests boosting due to exposure to varicella virus in the community. The antibodies have been shown to persist for at least 3 years after vaccination.
Three years after vaccination with two doses of Priorix-Tetra, 98.5%, 97.4%, 100% and 99.4% of all vaccinees were still seropositive for respectively antimeasles, antimumps, antirubella and antivaricella antibodies.
There is no clinical data available with regards to the persistence and effectiveness of two doses of Varilrix.
Studies comparing the current formulation of Varilrix (human albumin free) with the previous formulation containing human albumin, demonstrated similar immune responses with both formulations. The current formulation of Varilrix (albumin free) also demonstrated a similar reactogenicity and safety profile.

5.2 Pharmacokinetic Properties

Not relevant to vaccines.

5.3 Preclinical Safety Data

Genotoxicity.

No data available.

Carcinogenicity.

No data available.

6 Pharmaceutical Particulars

6.1 List of Excipients

The vaccine also contains amino acids, lactose, mannitol and sorbitol. Varilrix does not contain a preservative. Neomycin sulphate is present as a residual from the manufacturing process.

6.2 Incompatibilities

Varilrix should not be mixed in the same syringe with other vaccines.

6.3 Shelf Life

In Australia, information on the shelf life can be found on the public summary of the Australian Register of Therapeutic Goods (ARTG). The expiry date can be found on the packaging.

6.4 Special Precautions for Storage

The lyophilised vaccine should be stored in a refrigerator between 2°C and 8°C. The diluent can be stored in the refrigerator or at ambient temperatures. The lyophilised vaccine is not affected by freezing.
When supplies of Varilrix are distributed from a central cold store, it is necessary to arrange transport under refrigerated conditions.

6.5 Nature and Contents of Container

Varilrix is presented as a slightly cream to yellowish or pinkish coloured powder in a glass vial. The sterile diluent is clear and colourless and presented in ampoules and prefilled syringes.
Varilrix is supplied as:
a box containing 10 single dose vials of lyophilised vaccine (needles not supplied);
a box containing a single dose vial of lyophilised vaccine with a diluent syringe included (available in packs of 1 or 10; needles may or may not be included);
a box containing a single dose vial of lyophilised vaccine with diluent ampoule included (available in packs of 1 or 10; needles not supplied).
Not all pack sizes and container types may be distributed in Australia.
The ampoules, vials and prefilled syringes are made of neutral glass type I, which conforms to European Pharmacopoeia Requirements.

6.6 Special Precautions for Disposal

In Australia, any unused medicine or waste material should be disposed of in accordance with local requirements.

6.7 Physicochemical Properties

Not relevant to vaccines.

7 Medicine Schedule (Poisons Standard)

Schedule 4 - Prescription Only Medicine.

Summary Table of Changes