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):

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+ T- lymphocyte 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 5 o F (-15 o C) or colder AT ALL TIMES Protect from light Administer within 30 minutes of reconstitution

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