Chickenpox (varicella) and shingles (herpes zoster) are caused by the varicella-zoster virus; chickenpox is the acute invasive phase of the virus, and shingles represents reactivation of the latent phase. For information about the chickenpox vaccine see varicella vaccine.
For more information, see Zoster (Shingles) Advisory Committee on Immunization Practices Vaccine Recommendations and Centers for Disease Control and Prevention (CDC): Shingles (Herpes Zoster) Vaccination Information for Healthcare Providers.
(See also Overview of Immunization.)
Preparations of Herpes Zoster Vaccine
A live-attenuated herpes zoster vaccine is no longer available for use in the United States, as of November 2020 (see CDC: Shingles (Herpes Zoster) Vaccination).
Indications for Herpes Zoster Vaccine
CDC: Adult Immunization Schedule by Age). Indications for the zoster vaccine include
Adults ≥ 50 years whether they have had episodes of herpes zoster or been given the 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.
Contraindications and Precautions for Herpes Zoster Vaccine
include
A severe allergic reaction (eg, anaphylaxis) to a vaccine component or after a previous dose of the vaccine
Precautions include
Moderate or severe acute illness with or without fever (vaccination is postponed until illness resolves)
Clinical trials for the recombinant vaccine excluded pregnant women and women who are breastfeeding. 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. (See also CDC: Shingrix Recommendations.)
Dose and Administration of Herpes Zoster Vaccine
zoster vaccine are necessary regardless of previous history of shingles or previous receipt of the live-attenuated herpes zoster vaccine.
Zoster vaccine should be given ≥ 14 days before immunosuppressive therapy is begun; some experts prefer waiting 1 month after zoster vaccination to begin immunosuppressive therapy if possible. (See also CDC: Clinical Considerations for Use of Recombinant Zoster Vaccine (RZV, Shingrix) in Immunocompromised Adults Aged ≥19 Years.)
Adverse Effects of Herpes Zoster Vaccine
The most common adverse effects of the recombinant zoster vaccine are pain, redness, and swelling at the injection site and myalgia, fatigue, headache, shivering, fever, and gastrointestinal symptoms.
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
Advisory Committee on Immunization Practices (ACIP): Zoster (Shingles) ACIP Vaccine Recommendations
ACIP: Recommended Adult Immunization Schedule, United States, 2024
European Centre for Disease Prevention and Control (ECDC): Herpes Zoster: Recommended vaccinations
