Published: 7 September 2017

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Zostavax Vaccine for Shingles — Do Not Use in Immunocompromised Patients

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Prescriber Update 38(3): 41-42
September 2017

The Australian Therapeutic Goods Administration (TGA) recently received a report of a death in an individual following vaccination with Zostavax¹. The patient had a pre-existing compromised immune system. Healthcare professionals are reminded that Zostavax vaccination is contraindicated in immunocompromised patients due to the risk of disseminated herpes zoster infection².

Zostavax is a live, attenuated varicella-zoster virus vaccine that is indicated in individuals 50 years of age or older for:

• prevention of herpes zoster (shingles)
• prevention of postherpetic neuralgia
• reduction of acute and chronic zoster-associated pain².

Zostavax contains a higher titre of the live attenuated varicella vaccine, with nine to 14 times more virus than the childhood varicella vaccines (depending on the childhood varicella vaccine). Zostavax should not be administrated to children as it has the potential to cause harm in this population^2,3.

In the Shingles Prevention Study, the use of the zoster vaccine reduced the burden of illness due to herpes zoster in adults 60 years of age or older by 61.1%⁴. The incidence of post-herpetic neuralgia was also reduced by 66.5% in adults 60 years of age or older who received the vaccine⁴.

Zostavax is contraindicated for use in patients with primary and acquired immunodeficiency states due to conditions such as acute and chronic leukaemias, lymphoma, other conditions affecting the bone marrow or lymphatic system, immunosuppression due to HIV/AIDS, and cellular immune deficiencies².

In addition, Zostavax is contraindicated in patients on immunosuppressive therapy including high dose corticosteroids². However, Zostavax is not contraindicated in patients who are receiving topical/inhaled corticosteroids or low dose systemic corticosteroids, or in patients who are receiving corticosteroids as replacement therapy (eg, for adrenal insufficiency)². Further information on immunisation of individuals with diseases or therapy causing immunocompromise can be found in the Ministry of Health’s Immunisation Handbook⁵.

Healthcare professionals should assess the patient’s immunological status before vaccination. Any patient who is immunosuppressed or immunodeficient should not receive Zostavax.

Healthcare professionals are encouraged to report any suspected adverse reactions to vaccines or medicines to the Centre for Adverse Reactions Monitoring (CARM).

Information on how to report can be found on the Medsafe website (www.medsafe.govt.nz/safety/report-a-problem.asp) or the CARM website (https://nzphvc.otago.ac.nz/reporting/).

References

1. Therapeutic Goods Administration. 2017. Safety Advisory — Not to be Used in Patients with Compromised Immune Function. 7 March 2017. URL: tga.gov.au/alert/zostavax-vaccine# (accessed 12 July 2017)
2. Merck Sharp & Dohme (New Zealand) Limited. 2016. Zostavax Data Sheet. 18 April 2016. URL: medsafe.govt.nz/profs/Datasheet/z/zostavaxinj.pdf (accessed 12 July 2017).
3. Medsafe. 2015. Varicella Zoster Virus Vaccines — Medication Errors. Prescriber Update 36(3): 40. URL: ../Sep2015/VaricellaVaccines.htm (accessed 2 August 2017).
4. Oxman MN, Levin MJ, Johnson GR, et al. 2005. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. The New England Journal of Medicine 352: 2271–84.
5. Ministry of Health. 2017. Immunisation Handbook. Wellington: Ministry of Health. URL: www.health.govt.nz/system/files/documents/publications/immunisation-handbook-2017-may17-v2.html#_4.3.3_Secondary_(acquired) (accessed 2 August 2017)