Zoster Vaccine (Zostavax)
What is Zostavax?
Zostavax is a live attenuated vaccine.
Who can get Zostavax?
It is indicated for prevention of herpes zoster also known as shingles in patients ages 50 and older. It can be utilized in patients regardless of prior herpes zoster. Research has shown highest efficacy in patients ages 60-69; due to supply concerns, ACIP recommends the vaccine in ages 60 and older.
Who should not get Zostavax?
Contraindications to the vaccine include pregnancy, immunodeficiency, anaphylaxis, moderate illness (fever > 101.3F).
Also, it is also important to discontinue antivirals 24hrs prior to vaccination and till 14 days after vaccination.
How is Zostavax given?
0.65ml subcutaneous injection.
What are Zostavax side effects?
The most common side effects are injection site reactions and headache.
Can Zostavax be given with other vaccines?
Yes, CDC recommends that Zostavax can be administered with all other live and inactivated vaccines including the pneumococcal vaccine which is commonly given to older adults. According to the package insert, a Merck-sponsored, randomized clinical trial determined a reduced immune response to Zostavax when it co-administered with Pneumovax 23 compared to individuals who received these vaccines 4 weeks apart.
How effective is the Zostavax vaccine?
The vaccine helped reduce the incidence of shingles approximately 50% in patients who received the vaccine. How does Zostavax (shingles vaccine) compare to Varivax (chicken pox vaccine)?
They are both live subcutaneous injection vaccines of the same virus with Zostavax being 14 times more potent than Varivax. Zostavax is for older adults (age 60 and older) and Varivax is for children (1 year and older). The two vaccines cannot be used in exchange for each other in adults and children.
The dosing in children for Varivax is 0.5ml two doses subcutaneous.
For children ages 1 to 12 years, there should be a minimum interval of 3 months between doses.
For children ages 13 and older, there should be a minimum interval of 4 weeks between doses.
How is Zostavax stored?
Live vaccines such as (Zoster, Varicella, MMR, MMRV) should be stored in the freezer -58°F and +5°F (-50°C and -15°C).
Other live vaccines such that are refrigerated at 2° to 8°C (35° to 46°F) include:
rotavirus (Rotarix, RotaTeq)
yellow fever (YF-Vax)
polio (IPOL, KINRIX, Pediarix, Pentacel, Quadracel)
tuberculosis (BCG vaccine)
typhoid (Vivotif, TYPHIM Vi)
Where can I get more information?
Zostamax [package insert]. Whitehouse Station, NJ: Merck & Co., Inc.; 2015. Available at: https://www.merck.com/product/usa/pi_circulars/z/zostavax/zostavax_pi2.pdf
Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Hamborsky J, Kroger A, Wolfe S, eds. 13th ed. Washington D.C. Public Health Foundation, 2015. Available at: http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/varicella.pdf
