ACIP: New Recommendations for Herpes Zoster Vaccine Administration

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Recombinant zoster vaccine is preferred over live zoster vaccine for the prevention of herpes zoster and related complications.
Recombinant zoster vaccine is preferred over live zoster vaccine for the prevention of herpes zoster and related complications.

The Advisory Committee on Immunization Practices (ACIP) has updated its recommendations on the use of herpes zoster vaccines, supplementing its original 2008 Prevention of Herpes Zoster Recommendations of ACIP report, which outlines recombinant zoster vaccine (RZV) and zoster vaccine live (ZVL) use in adults.

Recommendations

The ACIP has made the following recommendations:

  1. RZV is recommended for the prevention of herpes zoster and related complications for immunocompetent adults age ≥50.
  2. RZV is also recommended for immunocompetent adults who have previously received the ZVL vaccine.
  3. RZV is preferred over ZVL for the prevention of herpes zoster and related complications.

The ACIP also recommends that adults with a history of herpes zoster should receive RZV, although the vaccination should be delayed if the patient is experiencing an episode of herpes zoster.

Adults with chronic renal failure, diabetes, rheumatoid arthritis, and chronic pulmonary disease should receive RZV.

A Centers for Disease Control and Prevention (CDC) analysis evaluating the cost-effectiveness of both vaccines and under most assumptions, RZV prevented herpes zoster at a lower overall cost than ZVL.

Contraindications

Individuals with a history of severe allergic reaction such as anaphylaxis should be administered RZV.

Precautions

RZV is not a treatment for herpes zoster and should not be administered during an active episode.

The ACIP cannot recommend RZV use in pregnant or lactating women as there is no available data evaluating the safety of RZV in this population.

Reference

Dooling KL, Guo A, Patel M, et al. Recommendations of the advisory committee on immunization practices for use of herpes zoster vaccines.  MMWR Morb Mortal Wkly Rep. 2018;67:103-108.

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