Adult Immunization 2010

Herpes Zoster (Shingles) Segment

This material is in the public domain

This information is valid as of May 25, 2010

Herpes Zoster (shingles)

Caused by reactivation of a latent
varicella zoster virus infection
Can occur years or decades after illness
with chickenpox
Generally associated with normal aging
and with anything that causes reduced
immunocompetence
Lifetime risk of 32% in the United States
Estimated 1 million cases zoster
diagnosed annually in the U.S.

Herpes Zoster Vaccine

(Zostavax)
Contains live attenuated varicella
virus in an amount that is
approximately 14 times greater than
that in regular varicella vaccine
Approved for persons 60 years of age
and older
Administered by the subcutaneous
route

Zostavax Clinical Trial

Compared to the placebo group the
vaccine group had:
51% fewer episodes of zoster
less severe disease
66% less postherpetic neuralgia
No significant safety issues were
identified

NEJM 2005;352(22):2271-84.

ACIP Recommendations
for Zoster Vaccine
Single dose of zoster vaccine for
adults 60 years of age and older
whether or not they report a prior
episode of shingles
Persons with a chronic medical
condition may be vaccinated unless a
contraindication or precaution exists
for their condition

MMWR 2008;57(RR-5)

Screening for Zoster Vaccine Eligibility

Screening for a history of varicella
disease is NOT necessary or
recommended to administer zoster
vaccine to a person 60 years of age
or older
Persons born in the U.S. before 1980
can be assumed to have had
chickenpox regardless of their
recollection of chickenpox
MMWR 2008;57(RR-5)

Screening for Zoster Vaccine Eligibility

Do NOT test the person for varicella
antibody
Negative test is more likely to
indicate waning antibody level rather
than true susceptibility
Seronegative persons should receive
2 doses of single-antigen varicella
vaccine
MMWR 2008;57(RR-5)

Zoster Vaccine Contraindications

Severe allergic reaction to a vaccine
component or following a prior dose
Pregnancy or planned pregnancy
within 4 weeks
Immunosuppression

MMWR 2008;57(RR-5)

Zoster Vaccine Contraindications

Immunosuppression
Leukemia, lymphoma or other malignant
neoplasm affecting the bone marrow or
lymphatic system
persons whose leukemia or lymphoma is
in remission and who have not received
chemotherapy or radiation for at least 3
months can be vaccinated
AIDS or other clinical manifestation of HIV
infection
includes persons with CD4+ Tlymphocyte values less than 200 per
mm3 or less than 15% of total
lymphocytes
MMWR 2008;57(RR-5)

Zoster Vaccine Contraindications

Immunosuppression
High-dose corticosteroid therapy
20 milligrams or more per day of
prednisone or equivalent lasting 2
or more weeks
vaccination should be deferred for
at least 1 month after
discontinuation of therapy

MMWR 2008;57(RR-5)

Zoster Vaccine Contraindications

Immunosuppression
Hematopoietic cell transplant
recipients
experience is limited
assess the immune status of the
recipient on a case-by-case basis
if a decision is made to vaccinate,
the vaccine should be administered
at least 24 months after
transplantation
MMWR 2008;57(RR-5)

Zoster Vaccine Contraindications

Immunosuppression
Recombinant human immune
mediators and immune modulators
preferable to administer zoster
vaccine before treatment
assess the immune status of the
recipient on a case-by-case basis
vaccination should be deferred for
at least 1 month after
discontinuation of treatment
MMWR 2008;57(RR-5)

Zoster Vaccine Precautions

Moderate or severe acute illness
Current treatment with an antiviral
drug active against herpes viruses
discontinue at least 24 hours before
administration of zoster vaccine
should not be taken for at least 14
days after vaccination
Recent receipt of a blood product is
NOT a precaution
MMWR 2008;57(RR-5)

Zoster and Pneumococcal

Polysaccharide (PPSV) Vaccines
Zoster package insert advises that zoster
and PPSV should not be administered
concurrently
Based on a study that showed the titer
against VZV was lower in persons who
received zoster and PPSV at the same
visit compared to persons who received
these vaccines 4 weeks apart
CDC has not changed its recommendation
for either vaccine
Zoster and PPSV should be administered
at the same visit if the person is eligible
for both vaccines

Zoster Vaccine Storage and Handling

Must be stored at 5o F (-15oC) or
colder AT ALL TIMES
Protect from light
Administer within 30 minutes of
reconstitution

National Center for Immunization

and Respiratory Diseases
Contact Information

Telephone
Email
Website

(800) CDC-INFO
nipinfo@cdc.gov
http://www.cdc.gov/vaccines/

Broadcast Updates and Resources

Web Page
http://www.cdc.gov/vaccines/ed/webcasts.htm