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Herpes Zoster Vaccine

By William D. Surkis, MD, Clinical Associate Professor of Medicine; Director, Internal Medicine Residency Program, Jefferson Medical College; Lankenau Medical Center
Jerome Santoro, MD, Clinical Professor of Medicine; Chief, Department of Medicine, Jefferson Medical College; Lankenau Medical Center

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The vaccine contains an attenuated wild strain of varicella, similar to the varicella vaccine but with a higher amount of the attenuated virus.


The zoster vaccine is recommended for adults 60 yr whether they have had herpes zoster or not. It is not routinely recommended for people aged 50 to 59 yr but can be used in this age group.

Contraindications and Precautions

Contraindications include

  • A severe allergic reaction (eg, anaphylaxis) to a vaccine component

  • Known severe primary or acquired immunodeficiency (eg, due to leukemia, lymphomas, solid tumors, tumors that affect bone marrow or the lymphatic system, AIDS, severe HIV infection, treatment with chemotherapy, or long-term use of immunosuppressants)

  • Pregnancy

Precautions include

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

  • Use of specific antiviral drugs: acyclovir, famciclovir, or valacyclovir (if possible, vaccination is postponed until 24 h after use of these drugs, and the drugs are not resumed for 14 days after vaccination)

Dose and Administration

The vaccine is given as a single 0.65-mL dose sc in the deltoid region of the upper arm.

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

This vaccine must be kept frozen between -50° C (-58° F) and -15° C (5° F) and must be reconstituted immediately after removal from the freezer.

Adverse Effects

No serious adverse effects have been reported. Soreness at the site of the injection may occur.