Drug information of Zoster Vaccines

Zoster Vaccines

Drug group: Vaccines

It is used to prevent shingles.

Mechanism of effect

A decline in VZV-specific immunity increases the risk of developing zoster infection. As a live, attenuated vaccine (Oka/Merck strain of varicella-zoster virus), zoster virus vaccine stimulates active immunity to disease caused by the varicella-zoster virus. Administration has been demonstrated to protect against the development of herpes zoster. It may also reduce the severity of complications, including postherpetic neuralgia, in patients who develop zoster following vaccination.

Zoster vaccine live reduced the incidence of zoster by ~70% in those 50 to 59 years of age, 64% in those 60-69 years of age, and 38% in those ≥70 years of age (CDC/ACIP [Dooling 2018]). Additional benefit was afforded to vaccine recipients who developed zoster by reduction in the incidence of PHN: 5% for those 60-69 years of age, 55% for those 70-79 years of age, and 26% for those 80 years and older. Other prespecified zoster-related complications were reported less frequently in subjects who received zoster vaccine compared with subjects who received placebo


Onset of Action
Seroconversion: ~6 weeks (CDC/ACIP [Harpaz, 2008])
Duration of Action
Duration of protection decreases over time with substantial decrease after 1 year. Effectiveness of ZVL in preventing herpes zoster decreased to 32% after 8 years in individuals ≥50 years (Baxter 2017; CDC/ACIP

Drug indications

Herpes zoster prevention


Usual Adult Dose for Herpes Zoster - Prophylaxis
mL subcutaneously in the deltoid once

Drug contraindications

Safety and efficacy have not been established in patients younger than 50 years

History of anaphylactic/anaphylactoid reaction to gelatin, neomycin (excluding contact dermatitis to neomycin), or any other component of the vaccine; immunosuppression or immunodeficiency, including individuals with leukemia, lymphomas, or other malignant neoplasms affecting the bone marrow or lymphatic systems; primary and acquired immunodeficiency states; AIDS or clinical manifestations of HIV; those receiving immunosuppressive therapy (including high-dose corticosteroids); pregnancy

Side effects

>10%: Local: Pain at injection site, erythema at
injection site, swelling at injection site, localized tenderness, injection site pruritus
 to 10%
Cardiovascular: Cardiac failure
Central nervous system: Headache
Gastrointestinal: Diarrhea
Local: Warm sensation at injection site, hematoma at injection site, induration at injection site
Neuromuscular & skeletal: Asthenia, limb pain
Respiratory: Pulmonary edema, respiratory tract disease
, postmarketing, and/or case reports: Anaphylaxis, arthralgia, exacerbation of asthma, facial nerve paralysis, fever, Guillain-Barre syndrome, herpes zoster infection, hypersensitivity reaction, lymphadenopathy (transient), myalgia, nausea, necrotizing retinitis (patients on immunosuppressive therapy), polymyalgia rheumatica, rash at injection site, skin rash, urticaria at injection site, varicella zoster infection (in immunocompromised patients

Acyclovir-Valacyclovir, Axicabtagene Ciloleucel, AzaTHIOprine, Belimumab, Brivudine [INT],
Corticosteroids (Systemic), Daclizumab, Deflazacort, Dimethyl Fumarate, Dupilumab, Famciclovir, Fingolimod, Guselkumab, Immunosuppressants, Leflunomide, Mercaptopurine,
Methotrexate, Ocrelizumab, Pneumococcal Polysaccharide Vaccine (23-Valent), Risankizumab,
Tildrakizumab, Tisagenlecleucel, Tuberculin Tests, Vaccines (Live),Venetoclax


If the patient is a child. Do not give zoster vaccine (live/attenuated) to a child

Immediate treatment (including epinephrine 1 mg/mL) for anaphylactoid and/or hypersensitivity reactions should be available during vaccine use

Syncope has been reported with use of injectable vaccines and may result in serious secondary injury (eg, skull fracture, cerebral hemorrhage); typically reported in adolescents and young adults and within 15 minutes after vaccination. Procedures should be in place to avoid injuries from falling and to restore cerebral perfusion if syncope occurs

Points of recommendation

What do I need to tell my doctor BEFORE I take Zoster Vaccine?
If you have any of these health problems: Active TB (tuberculosis) that is not being treated, certain blood or bone marrow problems like leukemia or lymphoma, a fever, a weak immune system, or a disease that may cause a weak immune system like HIV or AIDS.
If you are taking any drugs to suppress your immune system. This may be certain doses of steroids like prednisone. There are many drugs that can suppress your immune system. Ask your doctor or pharmacist if you are not sure.
If you are pregnant or plan to get pregnant within the next 3 months. Do not take zoster vaccine (live/attenuated) if you are pregnant or if you are planning to get pregnant within the next 3 months

Tell your doctor if you will be in close contact with newborns, pregnant women who have not had chickenpox or have not had the chickenpox vaccine, or people with a weak immune system. You could spread the vaccine virus to these people. Your doctor will tell you who to avoid close contact with

If you have a weak immune system, talk with your doctor. Deadly viral disease has happened in people with a weak immune system after getting zoster vaccine (live/attenuated

Tell your doctor if you have recently had a vaccine or before getting any other vaccine

This medicine may cause harm to the unborn baby if you take it while you are pregnant.
If you get pregnant within 3 months after getting zoster vaccine (live/attenuated), call your doctor right away

Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby

It is given as a shot into the fatty part of the skin

Do not give IV or intramuscularly

Pregnancy level

Contraindicated for use in pregnant women because the vaccine contains live, attenuated varicella-zoster virus, and it is known that wild-type varicella-zoster virus, if acquired during pregnancy, can cause congenital varicella syndrome (see Contraindications

Breast feeding warning

Unknown whether varicella-zoster vaccine virus is excreted in human milk

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