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Herpes Zoster Vaccine

(Shingles Vaccine)


Margot L. Savoy

, MD, MPH, Lewis Katz School of Medicine at Temple University

Last review/revision Oct 2022
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Preparations of Herpes

There are 2 zoster vaccines:

  • A recombinant vaccine, which is the preferred zoster vaccine because it provides better and longer-lasting protection than the live-attenuated vaccine

  • A live-attenuated vaccine, which is similar to the varicella vaccine but has a larger amount of the attenuated virus. The live-attenuated vaccine is no longer available for use in the US.

Indications for Herpes

Indications for the zoster vaccine include

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

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

  • Recombinant vaccine or live-attenuated vaccine: Adults ≥ 60 years (the recombinant vaccine is preferred)

Contraindications and Precautions of Herpes

Contraindications for the recombinant zoster vaccine include

Contraindications for the live-attenuated zoster vaccine include

Precautions include

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

  • For the live-attenuated zoster vaccine, use of specific antiviral drugs: acyclovir, famciclovir, or valacyclovir (if possible, vaccination is postponed until 24 hours after use of these drugs, and the drugs are not resumed for 14 days after vaccination)

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, providers should consider delaying administration of the recombinant vaccine until after pregnancy and breastfeeding. (See also CDC: Shingrix Recommendations.)

Dose and Administration of Herpes

The recombinant zoster vaccine dose is given IM in 2 doses (0.5 mL each), 2 to 6 months apart.

For adults who previously received the live-attenuated zoster vaccine, 2 doses of the recombinant vaccine are given 2 to 6 months apart and ≥ 2 months after the live-attenuated vaccine was given.

The live-attenuated zoster vaccine is given as a single 0.65-mL subcutaneous dose 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 month after zoster vaccination to begin immunosuppressive therapy if possible.

Adverse Effects of Herpes

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.

The most common adverse reactions of the live-attenuated zoster vaccine are soreness, redness, swelling, and itching at the injection site and headache.

More Information

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

Drugs Mentioned In This Article

Drug Name Select Trade
SITAVIG, Zovirax, Zovirax Cream, Zovirax Ointment, Zovirax Powder, Zovirax Suspension
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NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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