Herpes Zoster Vaccine

The zoster vaccine available in the United States is a recombinant vaccine.The zoster vaccine available in the United States is a recombinant vaccine.

The zoster vaccine is a routine adult vaccination (The zoster vaccine is a routine adult vaccination (1). Indications for the zoster vaccine include the following:

• Adults ≥ 50 years whether they have had episodes of herpes zoster or been given the previously available live-attenuated zoster vaccine or not

• Adults ≥ 19 years who are or will be immunodeficient or immunosuppressed because of disease or therapy

Serologic evidence of prior varicella infections is not necessary for zoster vaccination. However, if serologic evidence becomes available and indicates no previous varicella infection, health care professionals should follow ACIP guidelines for varicella vaccination. Recombinant zoster vaccine is not indicated for the prevention of varicella, and there are limited data on use in people without a history of varicella.

The main contraindication for the recombinant zoster vaccineThe main contraindication for the recombinant zoster vaccine is:

• A severe allergic reaction (eg, anaphylaxis) to a vaccine component or after a previous dose of the vaccine

The main precautions for the recombinant zoster vaccineThe main precautions for the recombinant zoster vaccine include:

• Moderate or severe acute illness with or without fever (vaccination is postponed until illness resolves)

• Current episode of herpes zoster

Clinical trials for the recombinant vaccine excluded pregnant and/or breastfeeding (chestfeeding) patients. There is currently no CDC recommendation for recombinant zoster vaccine use during pregnancy; therefore, health care professionals should consider delaying administration of the recombinant vaccine until after pregnancy and breastfeeding.

The recombinant zoster vaccine dose is administered IM in 2 doses (0.5 mL each), 2 to 6 months apart. Two doses of the recombinant The recombinant zoster vaccine dose is administered IM in 2 doses (0.5 mL each), 2 to 6 months apart. Two doses of the recombinantzoster vaccine are necessary regardless of previous history of shingles or previous receipt of the live-attenuated herpes zoster vaccine.

Zoster vaccine should be administered ≥ 14 days before immunosuppressive therapy is begun; some experts prefer waiting 1 month after zoster vaccination to begin immunosuppressive therapy if possible.

The most common adverse effects of the recombinant zoster vaccine include pain, erythema, and swelling at the injection site and myalgia, fatigue, headache, shivering, fever, and gastrointestinal symptoms.

For more information about adverse effects of the recombinant vaccine, refer to the prescribing information.

The following English-language resources may be useful. Please note that The Manual is not responsible for the content of these resources.

1. Advisory Committee on Immunization Practices (ACIP): ACIP Recommendations: Zoster (Shingles) Vaccine

2. ACIP: CDC: Adult Immunization Schedule by Age

3. Centers for Disease Control and Prevention (CDC): Shingles (Herpes Zoster)

4. CDC: About Shingles (Herpes Zoster)

5. European Centre for Disease Prevention and Control (ECDC): Herpes Zoster: Recommended vaccinations