Shingles Vaccine (Zostavax® II)
Vaccine brands: Zostavax® II
Herpes Zoster (Shingles) Virus
Shingles is an infection caused by the varicella zoster virus (VZV), the same virus that causes chickenpox. After getting chickenpox, the virus stays in the nerve cells of the body. The virus may be there for many years and not cause any problems until it becomes active again, causing shingles. You can only get shingles if you have previously had the chickenpox.
Shingles presents as a painful, blister like rash and can have severe complications such as skin infections or scarring, pneumonia, hearing problems, brain and nerve problems and rarely, death. It can cause herpes zoster ophthalmicus (HZO), which affects the eyes and cause scarring and blindness. The most common complication of the shingles is Post Herpetic Neuralgia (PHN); severe nerve pain which lasts longer than ninety days after the rash is gone.
The lifetime risk of having the shingles virus is estimated to be as high as 30%. The risk of developing shingles increases with age and most cases occur in people over 50 years of age. People with weakened immune systems are also at increased risk.
Recommendations for use
The shingles vaccine is recommended for persons without contraindications 60 years of age and older, and may be used in adults 50 years of age and older to prevent shingles infection. Effective September 15, 2016, Ontario will introduce herpes zoster (shingles) vaccine for individuals 65 to 70 years of age, as part of Ontario's publicly funded immunization program. Those outside of this age range will be required to receive the vaccine by prescription through their health care provider.
The vaccine can prevent 50% of cases of shingles. If shingles develops in a vaccinated person, it is likely to be milder compared to infection in an unvaccinated person. Immunization decreases the risk of PHN by about 66% in those who later develop shingles.
Cases of recurrent HZO have occurred following immunization with shingles vaccine. There is no current recommendation for a booster dose of shingles vaccine. The protection from the vaccine has not been assessed beyond 7 years. This is an area of ongoing research. Serological testing is not recommended before or after immunization. Anyone aged 60 years and older should get the shingles vaccine regardless of whether they recall having had chickenpox, as almost all Canadians eligible for the vaccine will have had prior varicella exposure. In the event that a person is known to be susceptible to VZV (i.e. based on testing for another reason), two doses of univalent varicella vaccine should be administered.
Vaccine side effects
Common side effects may include pain, redness, swelling, itching, warmth and bruising where the needle was given. Severe allergic reactions are rare. Signs of severe allergy include hives, swelling of the mouth and throat, wheezing, chest tightness, difficulty breathing, difficulty swallowing, hypotension and shock.
A chickenpox-like rash sometimes develops near the site where the needle was given. As a precaution, this rash should be covered until it disappears. There is a theoretical risk of transmission of chickenpox to susceptible individuals who come in direct contact with the rash.
You should report any side effects or severe vaccine reactions to your health care provider.
Who should not get the vaccine?
- People who are less than 50 years of age. The shingles vaccine has only been approved for people 50 years of age and over.
- Those who have had shingles in the past year.
- Individuals with a history of HZO; see an ophthalmologist to assess risks and benefits.
- Those who have had an allergic reaction to any component found in the vaccine.
- Those who may be pregnant, or are trying to become pregnant. Women should delay pregnancy for one month after receiving the shingles vaccine
- Individuals who have received immunoglobulin in the last 3 months.
- Those who have recently received another live vaccine (e.g., MMR).
- People with any type of illness that weakens the immune system, including cancers (including leukemia and lymphoma), HIV and transplant recipients.
- Those with active untreated tuberculosis.
- People taking medication that weakens the immune system, including high dose steroids.
- Individuals undergoing tuberculin skin testing as it can result in false negative results. The shingles vaccine can be administered any time after skin testing has been performed and/or read.
- Those on an antiviral therapy you should discontinue these drugs, if possible, at least 24 hours before administration of the vaccine and should not restart antiviral therapy until 14 days after vaccination.
- Individuals with moderate or severe acute illness with or without fever.
Your record of protection
After you receive an immunization, make sure your healthcare provider updates your personal immunization record such as the "Yellow Card". Keep it in a safe place. If your child is 17 years of age or under and receives this vaccine please report this information to KFL&A Public Health online or by calling 613-549-1232. Health care providers do not automatically send immunization information to KFL&A Public Health. It is the responsibility of parents or guardians to provide this information.
References
Revised: 2016