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Immunizations - Varicella-Zoster Virus (Shingles)

Description

An in-depth report on the purpose of immunizations and recommended schedules.

Alternative Names

Measles; Rubella; Tetanus; Vaccinations; Whooping cough

Varicella-Zoster Virus (Shingles):

Shingles is an infection caused by the varicella zoster virus, the same virus responsible for chickenpox. Once a person has chickenpox, the virus lies dormant in the body. It can emerge years later as shingles.

Shingles causes a painful, red, and sometimes blistery rash to form on the body or face. The disease can cause intense pain, called post herpetic neuralgia. Other symptoms include fever, headache, and chills. In rare cases, complications, such as pneumonia, blindness, and brain inflammation (encephalitis), can occur. Shingles is most common in adults over age 50.

Vaccines for Shingles

In May 2006, the U.S. Food and Drug Administration licensed the herpes zoster vaccine (Zostavax) for the prevention of shingles. The vaccine can reportedly cut the incidence of shingles in half for adults over age 60, but its effectiveness declines with increasing age.

Recommendations for the Vaccine in Adults. All adults age 60 or older should get a single dose of the herpes zoster vaccine, regardless of whether they have previously had shingles.

The following people should not receive the herpes zoster vaccine:

Anyone who has a weakened immune system due to HIV/AIDS or cancer of the lymph, bone, or blood, or due to treatments such as radiation or long-term corticosteroids
Women who are pregnant, or anyone who is in close contact with a pregnant woman who has not had chickenpox
Children -- they should receive only the chickenpox vaccine

Side Effects of the Herpes Zoster Vaccine

Redness, pain, and swelling. About a third of the people who get the vaccine have mild redness, soreness, swelling, or itching at the injection site.

Headache. About 1 in 70 people experience headache after receiving the vaccine.

There have been no serious side effects reported with the shingles vaccine.

Long-Term Protection

Research has found that the herpes zoster vaccine reduces the incidence of shingles by about 50%. The benefit is as high as 64% in people ages 60 - 69, but declines to 18% in the group of adults older than 80 years. In people who are vaccinated but still develop shingles, the vaccine reduces the duration of the pain involved with the disease.

Resources

www.immunize.org -- Immunization Action Coalition
www.cdc.gov/vaccines/ -- The National Immunization Program
www.fda.gov/cber/vaers/vaers.htm -- Vaccine Adverse Event Reporting System
www.hrsa.gov/vaccinecompensation/ -- National Vaccine Injury Compensation Program
www.immunizationinfo.org -- The National Network for Immunization Information
www.vaccine.chop.edu -- Vaccine Education Center, Children's Hospital of Philadelphia
www.vaccinesafety.edu -- Institute for Vaccine Safety, Johns Hopkins School of Public Health
www.whathealth.com -- National Partnership for Immunization
www.immunofacts.com -- Information on vaccinations
www.vaccines.org -- The Vaccine Page

References

American Academy of Pediatrics Committee on Infectious Diseases. Prevention and control of meningococcal disease: recommendations for use of meningococcal vaccines in pediatric patients. Pediatrics. 2005 Aug;116(2):496-505.

Centers for Disease Control and Prevention. Recommended Immunization Schedule for Ages 0 - 6 Years, United States, 2009.

Centers for Disease Control and Prevention. Recommended Immunization Schedule for Ages 7 - 18 Years, United States, 2009.

Centers for Disease Control and Prevention. Recommended Immunization Schedule for Adults, United States, 2009. Available online.

Centers for Disease Control and Prevention. Revised Recommendations of the Advisory Committee on Immunization Practices to Vaccinate All Persons Aged 11 - 18 Years with Meningococcal Conjugate Vaccine. Morbidity and Mortality Weekly Report. 2007:56(31);794-795.

Centers for Disease Control and Prevention. Notice to Readers: Recommendation from the Advisory Committee on Immunization Practices (ACIP) for Use of Quadrivalent Meningococcal Conjugate Vaccine (MCV4) in Children Aged 2 - 10 Years at Increased Risk for Invasive Meningococcal Disease. Morbidity and Mortality Weekly Report. 2007;56(48);1265-1266.

Centers for Disease Control and Prevention. Prevention of influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008. Morbidity and Mortality Weekly Report. 2008:57(No. RR-7).

Centers for Disease Control and Prevention. Update on Hib Vaccine Shortage. October 22, 2008. Available online.

Chaves SS, Gargiullo P, Zhang JX, Civen R, Guris D, Mascola L. Loss of vaccine-induced immunity to varicella over time. NEJM. March 15, 2007;356:1121-1129.

Garland SM, Hernandez-Avila M, Wheeler CM, Perez G, Harper DM, Leodolter S, et al. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. NEJM. May 10, 2007;356:1928-1943.

GlaxoSmithKline. Boostrix Prescribing Information. December, 2008.

Grijalva CG, Nuorti JP, Arbogast PG, Martin SW, Edwards KM, Griffin MR. Decline in pneumonia admissions after routine childhood immunisation with pneumococcal conjugate vaccine in the USA: a time-series analysis. Lancet. April 7, 2007;369:1179-1186.

Poehling KA, Szilagyi PG, Crijalva CG, Martin SW, LaFleur B, Mitchel E, et al. Reduction of frequent otitis media and pressure-equalizing tube insertions in children after introduction of pneumococcal conjugate vaccine. Pediatrics. April 4, 2007;119:707-715.

US Food and Drug Administration. FDA Approves Expanded Uses for Gardasil to Include Preventing Certain Vulvar and Vaginal Cancers. September 12, 2008.

US Food and Drug Administration. FDA Approves New Vaccine to Prevent Gastroenteritis Caused by Rotavirus. April 3, 2008.

US Food and Drug Administration. Zostavax Questions and Answers. Available online. Last Accessed 3/12/2009.

World Health Organization. Immunization surveillance, assessment and monitoring -- United States of America (the) reported cases. Last Updated: December 18, 2008. Available online.

Zuckerman JN. Protective efficacy, immunotherapeutic potential, and safety of hepatitis B vaccines. J Med Virol. 2006 Feb;78(2):169-77.

Reviewed last on: 3/23/2009
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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