Immunizations Part II: Shingles Vaccine
This podcast discusses older adults and shingles, as well as the importance of getting the shingles vaccine. It is primarily targeted to public health and aging services professionals.

Running time: 7:05

Date Released: 9/24/2008
Author: National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) and National Center for Immunization and Respiratory Diseases (NCIRD)

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Indication and Cause

Zostavax is indicated for the prevention of:
1) Herpes Zoster (HZ) or “Shingles” and
2) Post-Herpetic Neuralgia (PHN)

Symptoms and Statistics

Herpes Zoster (HZ) or Shingles is a painful skin rash, often with blisters. A Shingles rash usually appears on one side of the face or body and may last for 2 to 4 weeks. Its main symptom is pain, which can be quite severe.

Post-herpetic Neuralgia (PHN) is pain (can be severe) that continues after the rash clears up. Pain occurs in about 1 in 5 persons.In the United States, Herpes Zoster (HZ) is seen in approximately 20% of the population, and although it can occur at any age, it is most common in those over the age of 50. Among those surviving to age 85 years or older, the incidence may be as high as 50%. Experts estimate that one million or more cases occur each year in the United States and as the population ages that number is likely to increase. Of the estimated 1,000,000 U.S. adults who develop Herpes Zoster (HZ) or “Shingles” annually, approximately 40% of patients aged 60 years or older will experience Postherptic Neuralgia (PHN).

Herpes zoster (shingles) is caused by the same virus that causes chickenpox; the varicella-zoster virus. After an initial infection with chickenpox (varicella), the virus becomes latent and lies dormant in the cranial sensory nerve and spinal dorsal root ganglia (i.e. spinal cord). The virus can reactivate later in life via renewed replication and spread of Varicella Zoster Virus in sensory ganglia and afferent peripheral nerves (nervous system pathways) causing shingles. The frequency and severity of the infectious disease increases with advancing age due to a decline in the body’s immune system to recognize VZV-specific T-cells. Zostervax is a unique vaccine. It is not to prevent a new infection but to prevent the reemergence of (a latent) infection; it is a “booster” vaccination to prevent viral reactivation. Simply the zoster vaccine is believed to boost VZV-specific immunity by providing attenuated live virus and stimulating the patient’s immune system to reestablish memory cells.

Herpes Zoster (also known as shingles) presents itself on the human body as a unilateral vesicular rash that distributes in a corresponding pattern or dermatone (area of skin that has sensation from the infected nerve root). Initial symptoms typically involve unusual or painful sensations on one side (unilateral) of the body or face, followed by a blistering rash. The rash is the most notable feature which is accompanied with debilitating pain.

Approximately half of the affected individuals suffer from prolonged pain (postherpetic neuralgia or PHN) for months; even years after the rash resolves, and treatment for the associated nerve pain is notoriously difficult. Postherpetic neuralgia has been described as burning, throbbing, stabbing, or shooting pain that may be accompanied by allodynia (pain from an otherwise innocuous stimulus such as a light breeze or even the touch of soft clothing).

Who should get vaccinated with the Hepatitis-A Vaccine?

Zostavax is indicated for prevention of shingles and is FDA approved for individuals aged 60 years or older, including those who have had a previous episode. Zostavax is only considered appropriate for immuno-competent adults (meaning people who have not been diagnosed or being treated for cancer, leukemia, HIV/AIDS, organ transplants, are on high dose corticosteroids, or any other immune system problems). Also the vaccine is not recommended for people who have active or untreated tuberculosis or females who are pregnant or plan to become pregnant.

Administration and Dosing

Zostavax is one (1) time 0.65ml single vaccine dose administered subcutaneously in the upper arm.

Common (Adverse) Side Effects

The most common adverse events reported after immunization with Zostavax were injection site reactions: erythema (injection site) pain and tenderness or swelling. Less common adverse effects included hematoma (bruising), pruritus (itching), headache, and warmth.

Conclusion

There are clinically significant advantages to receiving the vaccine in terms of decreasing the incidences of getting shingles (by 64% in adults between the ages of 60 to 69) and in the severity and duration of postherpetic neuralgia (66.5% overall). The VZV vaccination appears to reduce the incidence of long term nerve pain in vaccinated individuals who went on to develop shingles, especially those over 70 years of age.

As with all “Live Vaccines”, there is a theoretical risk of transmitting the vaccine virus to varicella-susceptible individuals, including pregnant women and children who have not been vacinated, as well as “close” immunocompromised persons.

Varicella Zoster Virus Vaccine (VZV) is a new live attenuated vaccine manufactured by and distributed by Merck & Company under the Trade Name of *Zostavax and became available on June 12, 2006.