Shingles/Herpes Zoster Vaccine Recommendations

For the recommendations of the Advisory Committee for Immunization Practices (ACIP), see Zoster (Shingles) ACIP Vaccine Recommendations.

Routine Vaccination of People 60 Years Old and Older

CDC recommends a single dose of herpes zoster vaccine for people 60 years old or older, whether or not the person reported a prior episode of zoster. People with chronic medical conditions may be vaccinated unless a contraindication or precaution exists for their condition. Zoster vaccine is a live virus vaccine. It can be administered concurrently with all other live and inactivated vaccines, including those routinely recommended for people 60 years old and older, such as influenza and pneumococcal vaccines.

When vaccinating people 60 years old or older, there is no need to screen for a history of varicella (chickenpox) infection or to conduct laboratory testing for serologic evidence of prior varicella infection. Even if a person reports that they have not had varicella, they can still receive the zoster vaccine. The Zostavax® zoster vaccine package insert [12 pages] makes no reference to varicella history, and almost all people 60 years old or older are immune to varicella. The Advisory Committee on Immunization Practices (ACIP) states that people born in the United States prior to 1980 are considered immune to varicella. If serologic evidence of varicella susceptibility becomes available to the healthcare provider, the patient should be offered varicella vaccine not zoster vaccine.

Zoster vaccine should be given regardless of a history of zoster. Zoster does recur, and there is no biological or epidemiological evidence to indicate that persons are at reduced risk for zoster for any period of time following a prior occurrence of the disease. There are no recognized safety concerns in giving the vaccine to people with prior history of zoster.

The general guideline for any vaccine is to wait until the acute stage of the illness is over and symptoms abate.

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Vaccination of People 50 through 59 Years Old

Zostavax vaccine is approved by FDA for people age 50 years and older. However, CDC does not recommend routine use of herpes zoster vaccine in people age 50 through 59 years. Healthcare providers considering the herpes zoster vaccine for certain persons in age ranges should discuss the risks and benefits of vaccination with their patients. Although the vaccine has short-term efficacy, there have been no long-term studies of vaccine protection in this age group. In adults vaccinated at age 60 years or older, vaccine efficacy wanes within the first 5 years after vaccination, and protection beyond 5 years is uncertain; therefore, adults receiving the vaccine before age 60 years might not be protected when their risks for herpes zoster and its complications are highest.

Also, healthcare providers may want to first consider whether the patients 50 to 59 years old would have poor tolerance to herpes zoster or post-herpetic neuralgia symptoms. For example, if the patient has

• preexisting chronic pain, severe depression, or other co-morbidities,
• intolerance to treatment medications due to hypersensitivity or interactions with other medications, or
• extenuating employment-related factors.

No data are available about the effectiveness of zoster vaccine in adults who become immunosuppressed after their vaccination.

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Contraindications and Precautions for Shingles Vaccination

Zoster vaccine should not be administered to:

• A person who has ever had a life-threatening or severe allergic reaction to gelatin, the antibiotic neomycin, or any other component of shingles vaccine.
• A person who has a weakened immune system because of:
  • HIV/AIDS or another disease that affects the immune system,
  • treatment with drugs that affect the immune system, such as steroids,
  • cancer treatment such as radiation or chemotherapy, or
  • cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma.
• Women who are or might be pregnant. Women should not become pregnant until at least 4 weeks after getting zoster vaccine.

Someone with a minor acute illness, such as a cold, may be vaccinated. But anyone with a moderate or severe acute illness should usually wait until they recover before getting the vaccine. This includes anyone with a temperature of 101.3°F or higher.

This information was taken directly from the Shingles Vaccine Information Statement (VIS) dated 10/06/2009.

To learn more about general vaccine contraindications and precautions, visit:

• Contraindications and Precautions for Adults Only
• Conditions Commonly Misperceived as Contraindications to Vaccination

For more information on herpes zoster and immunization, visit:

• Prevention of Herpes Zoster Recommendations of the Advisory Committee on Immunization Practices.  
  Pink Book's Chapter on General Recommendations on Immunization

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