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 (eg, fever... 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 information about the chickenpox vaccine see varicella vaccine Varicella Vaccine Varicella vaccination provides effective protection against varicella (chickenpox). It is not known how long protection against varicella lasts. But, live-virus vaccines, like the varicella... read more .
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 Information for Healthcare Providers. For a summary of changes to the 2023 adult immunization schedule, see the Advisory Committee on Immunization Practices (ACIP) Recommended Adult Immunization Schedule, United States, 2023: Changes to the 2023 Adult Immunization Schedule.
(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
The zoster vaccine available in the United States is a recombinant vaccine.
A live-attenuated herpes zoster vaccine is no longer available for use in the United States, as of November 2020 (see CDC: Shingles (Herpes Zoster) Vaccination).
Indications for Herpes Zoster Vaccine
The zoster vaccine is a routine adult vaccination (see CDC: Adult Immunization Schedule by Age). Indications for the zoster vaccine include
Adults ≥ 50 years whether they have had episodes of herpes zoster or been given the live-attenuated zoster vaccine or not
Adults ≥ 19 years who are or will be immunodeficient or immunosuppressed because of disease or therapy
Serologic evidence of prior varicella infections is not necessary for zoster vaccination. However, if serologic evidence becomes available and indicates no previous varicella infection, health care professionals should follow ACIP guidelines for varicella vaccination. Recombinant zoster vaccine is not indicated for the prevention of varicella, and there are limited data on use in people without a history of varicella.
Contraindications and Precautions for 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
Moderate or severe acute illness with or without fever (vaccination is postponed until illness resolves)
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, health care professionals should 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. Two doses of the recombinant zoster vaccine are necessary regardless of previous history of shingles or previous receipt of the live-attenuated herpes zoster vaccine.
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. (See also CDC: Clinical Considerations for Use of Recombinant Zoster Vaccine (RZV, Shingrix) in Immunocompromised Adults Aged ≥19 Years.)
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 following English-language resources 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
ACIP: Recommended Adult Immunization Schedule, United States, 2023 including Changes to the 2023 Adult Immunization Schedule
European Centre for Disease Prevention and Control (ECDC): Herpes Zoster: Recommended vaccinations
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