Chickenpox Chickenpox Chickenpox is an acute, systemic, usually childhood infection caused by the varicella-zoster virus (human herpesvirus type 3). It usually begins with mild constitutional symptoms that are followed... read more 
(varicella) and shingles ( herpes zoster Herpes Zoster Herpes zoster is infection that results when varicella-zoster virus reactivates from its latent state in a posterior dorsal root ganglion. Symptoms usually begin with pain along the affected... read more 
) 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 Overview of Immunization Immunity can be achieved Actively by using antigens (eg, vaccines, toxoids) Passively by using antibodies (eg, immune globulins, antitoxins) A toxoid is a bacterial toxin that has been modified... read more .)
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
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 of Herpes Zoster Vaccine
Contraindications for the recombinant zoster vaccine include
A severe allergic reaction (eg, anaphylaxis Anaphylaxis Anaphylaxis is an acute, potentially life-threatening, IgE-mediated allergic reaction that occurs in previously sensitized people when they are reexposed to the sensitizing antigen. Symptoms... read more ) 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 Overview of Immunodeficiency Disorders Immunodeficiency disorders are associated with or predispose patients to various complications, including infections, autoimmune disorders, and lymphomas and other cancers. Primary immunodeficiencies... read more (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
