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Herpes Zoster Vaccine

(Shingles Vaccine)

By

Margot L. Savoy

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

Last full review/revision Jul 2019| Content last modified Jul 2019
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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version

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.

Preparations

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

Indications

Indications for the zoster vaccine include

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

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

Contraindications and Precautions

Contraindications for the recombinant zoster vaccine include

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

Contraindications for the live-attenuated zoster vaccine 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)

  • 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. The CDC recommends to consider delaying administration of the recombinant vaccine until after pregnancy and breastfeeding. (See also CDC: Shingrix Recommendations.)

Dose and Administration

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

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

Drugs Mentioned In This Article

Drug Name Select Trade
VALTREX
FAMVIR
ZOVIRAX
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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
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