|Target disease||Herpes zoster, postherpetic neuralgia, Ramsay Hunt syndrome type II, chickenpox|
The zoster vaccine (trade name Zostavax) is a live vaccine developed by Merck & Co. that has been shown to reduce the incidence of herpes zoster (known as shingles) by 51.3% in a study of 38,000 adults aged 60 and older who received the vaccine. The vaccine also reduced by 66.5% the number of cases of postherpetic neuralgia and reduced the severity and duration of pain and discomfort associated with shingles, by 61.1%. The zoster vaccine is, essentially, a larger-than-normal dose of the chickenpox vaccine (Varivax, Varilrix), as both shingles (prevented by Zostavax) and chickenpox (prevented by Varivax/Varilrix, even prevented by Zostavax as well) are caused by the same virus, the varicella zoster virus (VZV).
- Composition 1
Official recommendations 2
- In the United States 2.1
- In the European Union 2.2
- In the United Kingdom 2.3
- Duration of protection and side effects 3
- References 4
- External links 5
The vaccine contains a minimum of 19,400 plaque-forming units (PFU) of the Oka/Merck strain of live, attenuated varicella-zoster virus. It is sterile and does not contain any preservatives. It is injected subcutaneously (under the skin) in the upper arm.
In the United States
The zoster vaccine was approved and licensed by the U.S. Food and Drug Administration (FDA) in May 2006. The FDA originally recommended it only for individuals 60 years of age or older who met the following requirements:
- Has not had a life-threatening allergic reaction to gelatin, the antibiotic neomycin, or other component of the herpes zoster vaccine.
- Does not have a weakened immune system due to HIV/AIDS or another disease or medications (such as steroids, radiation and chemotherapy) that affect the immune system.
- Does not have a history of cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma.
- Does not have active, untreated tuberculosis.
On October 25, 2006, the U.S. Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP) voted to recommend that the zoster vaccine be given to all adults age 60 and over, including those who have had a previous episode of shingles, and those who do not recall having had chickenpox, since more than 99% of Americans ages 40 and older have had chickenpox.
On March 24, 2011, the FDA approved the zoster vaccine for individuals 50 to 59 years of age.
In the European Union
On May 19, 2006, the European Medicines Agency (EMEA) issued a marketing authorisation for the zoster vaccine to Sanofi Pasteur for routine vaccination in individuals aged 60 and over. In 2007, the EMEA updated the marketing authorisation for routine vaccination in individuals aged 50 and over.
In the United Kingdom
From 2013 the UK National Health Service started offering shingles vaccination, with Zostavax, to older people. People aged either 70 or 79 on 1 September 2013 were offered the vaccine. People aged 71 to 78 on that date would only have an opportunity to have the shingles vaccine after reaching the age of 79. The original intention was for people aged between 70 and 79 to be vaccinated, but the NHS later said that the vaccination programme was being staggered as it would be impractical to vaccinate everyone in their 70s in a single year.
Duration of protection and side effects
The duration of protection beyond 4 years after vaccination with the zoster vaccine is unknown. The need for re-vaccination has not been defined.
WebMD and other authorities say that the zoster vaccine is very safe; one to a few percent of the patients develop a mild form of chickenpox, often with about five or six blisters around the injection site, and without fever. The blisters are harmless and temporary.
RxList reported results from case-control studies that were more cautious. In one study 64 percent of the Zostavax group and 14 percent of the controls had some adverse reaction. However, the rates of serious adverse events were comparable between the Zostavax group (0.6 percent) and those receiving the placebo (0.5 percent).
A study including children with leukaemia found that the risk of getting shingles after vaccination is much lower than the risk of getting shingles for children with natural chicken pox in their history. Data from healthy children and adults point into the same direction.
One study has indicated that anti-VZV vaccine protects against oral and genital herpes outbreaks.
- Oxman MN, Levin MJ, Johnson GR, et al. (June 2005). "A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults" (PDF).
- Oxman MN, Levin MJ, Shingles Prevention Study Group (March 2008). "Vaccination against Herpes Zoster and Postherpetic Neuralgia".
- Mitka M. (July 2006). "FDA approves shingles vaccine: herpes zoster vaccine targets older adults" (PDF). JAMA 296 (2): 157–8.
- "FDA Licenses New Vaccine to Reduce Older Americans' Risk of Shingles" (Press release).
- Zostavax Full Prescribing Information. Merck & Co. March 2011.
- "Patient Information (Text) about Zostavax-May 2006".
- "Patient Information about Zostavax (Text) 12/2008".
- "CDC's Advisory Committee Recommends "Shingles" Vaccination" (Press release).
- Vaccines: VPD-VAC/Shingles/Shingles (Herpes zoster) Vaccination: What You Need to Know
- "FDA approves Zostavax vaccine to prevent shingles in individuals 50 to 59 years of age" (Press release).
- "Zostavax European Public Assessment Report".
- "Zostavax-H-C-674-II-03 Scientific Discussion". June 21, 2007. Retrieved March 27, 2011.
- NHS:Shingles vaccination, 2013
- Pulse:GPs given green light to start shingles vaccination, 2 November 2012
- NHS: Who can have the shingles vaccine?
- Harris, Scott (January 18, 2011). "Never Too Late to Seek Protection Against 'Debilitating' Virus". http://www.webmd.com. WebMD. Retrieved 4 January 2014.
- Cunha, John P. "Zostavax Side Effects Center". http://www.rxlist.com/. RxList. Retrieved 4 January 2014.
- "Efficacy of the anti-VZV (anti-HSV3) vaccine in HSV1 and HSV2 recurrent herpes simplex disease: a prospective study". Retrieved 25 November 2014.
- Official website Merck & Co. product page
- Official website Zostavax web page
- Zostavax Product Page U.S. Food and Drug Administration (FDA)
- Vaccine Information Statement U.S. Centers for Disease Control and Prevention (CDC)
- Zostavax (Herpes Zoster Vaccine) Questions and Answers Food and Drug Administration
- Zostavax product information European Medicines Agency (EMEA)
- Zostavax Patient Information Merck & Co.
- Zostavax Prescribing Information Merck & Co.
- Zostavax Full Prescribing Information Merck & Co.
- "Zoster (Herpes Zoster)" Australian Immunisation Handbook 9th Edition April 2009