Cartoon image of a man showing his arm where he received a vaccination

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covid.immune.org.nz

Visit our COVID-19 website for more information

covid.immune.org.nz

Visit our influenza website for more information

influenza.org.nz

Overview

Almost everyone is at risk of shingles because they are likely to have been exposed to chickenpox, even if they have no history of clinical chickenpox or chickenpox vaccination. Following chickenpox infection, the virus lies dormant in the nerves near the spine and may re-emerge many years later as shingles. Shingles most commonly affects older adults or people of any age with a weakened immune system.

Zostavax contained a weakened form of the varicella-zoster virus, and as a live viral vaccine, was not suitable for some people with medical conditions or who are receiving treatments that affect their immune system.

Until 2022, one dose of Zostavax was given at age 65 years. It was replaced in September 2022 with a non-live recombinant zoster vaccine, Shingrix.

See Shingrix for zoster vaccine unfunded options from the age of 50 years and from age 18 years if at increased risk of zoster, and funded at age 65 years.


Responses to vaccine

Zostavax (ZV)
Common reponses
  • Mild pain, redness and swelling around injection site
  • Itching or rash around injection site.
  • Headache
Rare responses

In Depth

Vaccine Safety

Vaccine Effectiveness

Duration of protection

Vaccine effectiveness against an episode of shingles was shown to decrease quickly over the first year after vaccination from around 69% to 50%, and then decreases gradually until effectiveness decreases from around 33% to 17% by the seventh year after vaccination and then decreases to around 4% during the eighth year after vaccination. Although the duration of protection against getting shingles declines, vaccine effectiveness against the severe outcomes of shingles, such as PHN and herpes zoster-associated hospitalisation, remained around at least 50% regardless of age and chronic illness.

References

  • Amirthalingam G, Andrews N, Keel P, Mullett D, Correa A, de Lusignan S, et al. Evaluation of the effect of the herpes zoster vaccination programme 3 years after its introduction in England: a population-based study. Lancet Public Health. 2018;3(2):e82-e90.
  • Baxter R, Tran TN, Hansen J, Emery M, Fireman B, Bartlett J, et al. Safety of Zostavax™ - A cohort study in a managed care organization. Vaccine. 2012;30(47):6636-41.
  • Baxter R, Bartlett J, Fireman B, Marks M, Hansen J, Lewis E, et al. Long-term effectiveness of the live zoster vaccine in preventing shingles: A cohort study. Am J Epidemiol. 2018;187(1):161-9.
  • Diez-Domingo J, Weinke T, Garcia de Lomas J, Meyer CU, Bertrand I, Eymin C, et al. Comparison of intramuscular and subcutaneous administration of a herpes zoster live-attenuated vaccine in adults aged ≥50 years: A randomised non-inferiority clinical trial. Vaccine. 2015;33(6):789-95.
  • Doan HQ, Ung B, Ramirez-Fort MK, Khan F, Tyring SK. Zostavax: a subcutaneous vaccine for the prevention of herpes zoster. Expert Opin Biol Ther. 2013;13(10):1467-77.
  • Keating GM. Shingles (herpes zoster) vaccine (Zostavax®): A review in the prevention of herpes zoster and postherpetic neuralgia. BioDrugs. 2016;30(3):243-54.
  • Gnann Jr JW. Vaccination to prevent herpes zoster in older adults. J Pain. 2008;9(Suppl 1):31-6.
  • Izurieta HS, Wernecke M, Kelman J, Wong S, Forshee R, Pratt D, et al. Effectiveness and duration of protection provided by the live-attenuated herpes zoster vaccine in the medicare population ages 65 years and older. Clin Infect Dis. 2017;64(6):785-93.
  • Ministry of Health. Immunisation handbook [Internet]. Wellington: Ministry of Health; 2020 [updated 2020 September 25; cited 2020 September 28]. Available from: https://www.health.govt.nz/publication/immunisation-handbook-2020
  • Morrison VA, Oxman MN, Levin MJ, Schmader KE, Guatelli JC, Betts RF, et al. Safety of zoster vaccine in elderly adults following documented herpes zoster. J Infect Dis 2013 208 (4): 559-563.
  • Pharmaceutical Management Agency (PHARMAC). Online pharmaceutical schedule - November 2020 [Internet]. Wellington: Pharmaceutical Management Agency; [updated 2020 November 18; cited 2020 November 19]. Available from: https://schedule.pharmac.govt.nz/ScheduleOnline.php
  • Schmader KE, Oxman MN, Levin MJ, Johnson G, Zhang JH, Betts R et al. Persistence of the efficacy of zoster vaccine in the Shingles Prevention Study and the Short-Term Persistence Substudy. Clin Infect Dis. 2012;55(10):1320-8.
  • Tseng HF, Smith N, Sy LS, Jacobsen SJ. Evaluation of the incidence of herpes zoster after concomitant administration of zoster vaccine and polysaccharide pneumococcal vaccine. Vaccine. 2011;29(20):3628-32.
  • Tseng HF, Liu A, Sy L, Marcy SM, Fireman B, Weintraub E, et al. Safety of zoster vaccine in adults from a large managed-care cohort: A Vaccine Safety Datalink study. J Intern Med. 2012;271(5):510-20.
  • Tseng HF, Harpaz R, Luo Y, Hales CM, Sy LS, Tartof SY, et al. Declining effectiveness of herpes zoster vaccine in adults aged ≥60 Years. J Infect Dis. 2016;213(12):1872-5.
  • Walker JL, Andrews NJ, Amirthalingam G, Forbes H, Langan SM, Thomas SL. Effectiveness of herpes zoster vaccination in an older United Kingdom population. Vaccine. 2018;36(17):2371-7.
  • Willis ED, Woodward M, Brown E, Popmihajlov Z, Saddier P, Annunziato PW, et al. Herpes zoster vaccine live: A 10year review of post-marketing safety experience. Vaccine. 2017;35(52):7231-9.
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