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 more information, see Zoster (Shingles) Advisory Committee on Immunization Practices Vaccine Recommendations and Centers for Disease Control and Prevention (CDC): Shingles (Herpes Zoster) Vaccination. A summary of changes to the 2021 adult immunization schedule is available here.
(See also Overview of Immunization.)
Preparations of Herpes Zoster Vaccine
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 Zoster Vaccine
Contraindications and Precautions of Herpes Zoster Vaccine
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 of Herpes Zoster Vaccine
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 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.
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 are some English-language resources that 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
-
Centers for Disease Control and Prevention (CDC): Shingles (Herpes Zoster) Vaccination: Information for Healthcare Providers
