Vaccine type: Live-attenuated virus vaccine
Schedule and administration
One dose of Zostavax® is indicated for the prevention of herpes zoster and the painful complications of herpes zoster (shingles). Prevention of shingles prevents acute shingles-related pain and the risk of chronic pain, known as post-herpetic neuralgia. It is not used as treatment during an episode of shingles or to treat post-herpetic neuralgia. Receipt of Zostavax within the 5 years before an episode of shingles may help to reduce the disease severity, i.e. immunisation may make a subsequent episode of shingles less painful or reduce the risk of post-herpetic neuralgia.
A single dose of Zostavax is approved for use for adults aged 50 years and older. There is no upper age limit for administration of Zostavax.
There are no recommendations for booster doses of Zostavax at this time.
There are two distinct Zostavax eligibility groups.
Former catch-up programme ended on 31 December 2021
Funded vaccine doses will only be available through general practice.
See Shingrix for non-funded zoster vaccine options from the age of 50 years.
Storage and preparation
Store the vaccine and diluent as per cold chain between 2°C to 8°C. Protect from light.
The Ministry of Health recommends that Zostavax vaccine is administered via the IM route. However, administration of Zostavax vaccine by either the IM or SC injection route delivers a valid dose of vaccine. In the original clinical trials, Zostavax vaccine was given by SC injection and this became the recommended route of injection. Since then, data have shown that administration of Zostavax by IM injection generates an immune response equal to the response when the vaccine is given via the SC route and the vaccine is also well-tolerated, with vaccine recipients less likely to report a reaction at the injection-site.
Zostavax can be administered to adults:
- At the same visit as other vaccines, including influenza, pneumococcal, tetanus/diphtheria and other Schedule vaccines. Separate syringes and different injection sites should be used.
- Allow at least seven days between Zostavax and COVID-19 vaccination (Comirnaty, Nuvaxovid or Vaxzevria/AstraZeneca).
- Whether or not they recall a history of chickenpox disease. Do not do serology to check varicella immunity.
- If they have had herpes zoster in the past - it is recommended to allow 12 months between zoster episode and zoster vaccination.
- If they are living with someone who is immunocompromised.
Unlike other live injected vaccines, Zostavax can be administered at any time before or after blood/blood products.
Antiviral medications, such as acylovir, should be stopped for 24 hours prior to vaccination and for 14 days after vaccination to prevent interference with replication of the live-attenuated vaccine virus.
If Zostavax is not given at the same visit as another live vaccine a 4 week interval between the two live virus vaccines should be observed. However, there are no other live viral vaccines indicated for this age group in New Zealand at this time.
Zostavax has an excellent safety record since it was introduced in the U.S. in 2006. The vaccine is generally well tolerated. The most common vaccine side effects occur around the injection site, including redness, swelling and/or pain, and headache. Occasionally itching or a rash around the injection site may occur.
Data from ten years of post-marketing adverse events reports submitted to the Merck Sharpe and Dohme global safety database found that more than 9 out of 10 reports were non-serious and local injection site reactions were the most common. Herpes zoster (HZ) cases occurring within two weeks of vaccination were caused by wild-type, not vaccine-type virus. Disseminated HZ was very rare (18 cases reported, <0.1%), and all the cases found to be due to the vaccine-type virus were in immunocompromised patients.
Administration of Zostavax vaccine should be postponed in individuals suffering from a fever over 38°C. The presence of a minor infection is not a reason to delay immunisation.
Zostavax should not be given to:
- Individuals with current leukaemia, lymphoma, or other bone/marrow/lymphatic neoplasms.
- Individuals with acquired immune deficiency syndrome (AIDS) or other medical condition causing cellular immunodeficiency.
- Individuals with tuberculosis (TB).
- Anyone with severe allergy (anaphylaxis) to a previous dose of herpes zoster virus vaccine or a component of the vaccine.
Specialist advice should be sought for the following groups:
- Individuals taking immunosuppressive medication or who are recovering from immunosuppressive treatment.
- Individuals who are HIV-positive.
If there is any doubt about the safety of administering a live attenuated zoster vaccine – DEFER VACCINATION until you obtain more information.
In clinical trials, the zoster vaccine is most effective at preventing shingles in people aged 50–59 years (around 7 in 10 immunised protected) and becomes less effective with advancing age. Around 5 in 10 people aged 65–69 years and around 4 in 10 people aged 80 years or older. The real-life effectiveness of Zostavax, particularly against severe disease and post herpetic neuralgia (PHN), appears to be better than was shown during clinical trials and especially for those aged 70–79 years. Protection for those aged 80 years when they were vaccinated aged 80 years or older has also been shown to be similar to vaccine effectiveness in those aged 60–69 years when vaccinated.
Three years after introducing a zoster immunisation programme in the UK for adults aged 70–79 years, the vaccine effectiveness was calculated to be 64% against shingles and 61–91% against post-herpetic neuralgia in the targeted age group who did not have a history of shingles. Vaccine effectiveness in preventing an episode of shingles decreased to 47% in the 70–79 years age group who had a history of shingles.
In adults who get shingles even though they have been immunised, Zostavax may reduce the pain associated with shingles, the effect of shingles pain on daily activities and the risk of post-herpetic neuralgia.
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.