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National Advisory Committee on Immunization (NACI)
January 2014
Update on the Use of Herpes Zoster Vaccine
Summary Table of Information Contained in this NACI Statement
The following table highlights key information for immunization providers from the full National Advisory Committee on Immunization (NACI) Statement: Update on the Use of Herpes Zoster Vaccine.
For readers interested in the full PDF version of the Update on the Use of Herpes Zoster Vaccine, the document is available for downloading or viewing on the Government of Canada Publications
Web site.
1. What
What is Herpes Zoster (HZ, shingles)?
HZ is a manifestation of reactivation of the varicella zoster virus (VZV). Herpes zoster infection is characterized by pain and a unilateral vesicular eruption, usually in a single dermatome. It arises from the reactivation of latent VZV from sensory ganglia present from previous chickenpox infection. Immunosuppressed persons are at increased risk for herpes zoster.
What is Herpes Zoster Vaccine (HZV)?
HZV is a live, attenuated virus vaccine containing a lyophilized preparation of the Oka/Merck strain of varicella-zoster virus. Additional information can be found in the Canadian Immunization Guide
2. Who
Who should be immunized?
HZV is recommended for the prevention of HZ and its complications in the following groups:
- Persons 60 years and older without contraindications;
- Individuals ≥50 years can be considered for immunization;
- Individuals on low dose immunosuppressive therapy and may be administered to individuals on anti-TNF biologics on a case by case basis after review with an expert in immunodeficiency;
- There is insufficient evidence to recommend for or against the administration of HZV in individuals with a history of HZ Ophthalmicus;
- There is insufficient evidence to recommend the use HZV in individuals with HIV, post-organ or hematopoietic stem cell transplant or in those receiving high dose corticosteroids, chemotherapy or immune suppressing medications listed in Table 1 of the Statement Update on the Use of Herpes Zoster Vaccine.
3. How
Dose and Schedule
A single dose of vaccine (entire contents of the reconstituted vial, 0.65 mL) should be administered subcutaneously.
- The vaccine can be given to those with or without a prior history of HZ.
- It is recommended that the vaccine be given at least one year following the last episode of HZ
- The need for revaccination has not yet been defined and duration of protection from HZ vaccination is unknown beyond 5 years.
Coadministration
HZ vaccine can be co-administered (using a different site) with pneumococcal vaccine.
4. Why
Evidence supports the use of HZ vaccine in immunocompetent individuals over age 50. There are also data to support the safety of vaccine in some immunocompromised groups. Complications of acute HZ are potentially severe and may include sight-threatening eye infections, central nervous system infection, nerve palsies including the Ramsay-Hunt Syndrome, neuromuscular disease including Guillain-Barré Syndrome, and secondary bacterial infections. The most frequent complication of acute HZ is post-herpetic neuralgia (PHN) which often has a major adverse impact on quality of life, especially in elderly persons. Treatment options for HZ and PHN are of limited effectiveness.
HZ vaccine reduces the incidence of HZ and post-herpetic neuralgia
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