A Clinician’s Handbook for Childhood & Adult Immunizations in Georgia

Zoster Vaccine Live (ZVL) Zostavax®

Pathophysiology

  • A manifestation of the reactivation of varicella zoster virus which, as a primary infection, produces chickenpox (varicella). Following initial infection, the virus remains latent in the dorsal root or cranial sensory ganglia until it reactivates, producing zoster.
  • Zoster is characterized by a unilateral, painful, vesicular cutaneous eruption with a dermatomal distribution.

Vaccine Description

Live, attenuated virus vaccine

Dose & Route

  • 0.65 mL single dose unit given subQ
  • Reconstituted, lyophilized vaccine

Administration Schedule

Dose           Minimum Age

1 Dose……Age 60 and older

Minimum Intervals

  • *A single dose of zoster vaccine live (ZVL) is recommended for adults aged 60 years and older regardless of whether they report a prior episode of herpes zoster. Although the vaccine is licensed by the Food and Drug Administration (FDA) for use among and can be administered to persons aged 50 years and older by private providers, ACIP recommends that vaccination begins at age 60.
  • Persons aged 60 years and older with chronic medical conditions may be vaccinated unless their condition constitutes a contraindication, such as pregnancy or severe immunodeficiency.

Contraindications

  •  History of anaphylactic reaction to gelatin, neomycin, or other vaccine components
  •  Immunosuppression, including that due to high-dose corticosteroid or other therapy

A person who has a weakened immune system because of:

    • HIV/AIDS or another disease that affects the immune system
    • cancer treatment such as radiation or chemotherapy
    • cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma
  • Women who are or might be pregnant

Precautions

  • Moderate or severe acute illness with or without fever
  • Receipt of specific antivirals (i.e., acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination, if possible; delay resumption of these antiviral drugs for 14 days after vaccination.

Special Consideration

  • This vaccine is not a substitute for varicella vaccine and should never be administered to children.
  • Not indicated for treatment of herpes zoster (shingles) or postherpetic neuralgia
  •  The duration of protection after vaccination is unknown.
  • Must be stored frozen at a temperature of 50F or colder
  • Must be used within 30 minutes of reconstitution or discarded; may not be refrozen after reconstitution
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