The herpes zoster vaccine is used to prevent shingles, a painful, blistering rash caused by reactivation of the varicella zoster virus (the same virus responsible for chickenpox) later in life. The recombinant, adjuvanted version is the preferred vaccine type in current use. It is administered by a healthcare professional. 

Shingles can affect anyone who has had chickenpox, and most adults have. In India, studies show that more than 90% of people carry the virus in their body by the age of 40. 

• Age: The risk rises with age, especially after 50. Older adults are also more likely to develop postherpetic neuralgia (PHN), the long-lasting nerve pain that can follow shingles, and the pain tends to be more severe.

• Weak immunity: Adults with a weak immune system, such as people with cancer, HIV, an organ transplant, or on immunosuppressive medicines, are at higher risk of shingles and its complications. This applies from age 18.

• Long-term conditions: People with diabetes, heart disease, or kidney disease may also be at higher risk.

• Children and younger adults: Shingles is less common in them, and the vaccine is not approved for people younger than 18.

Therapeutic Class: Vaccine (immunizing biological product) for shingles prevention.

Pharmacological Class: Recombinant subunit vaccine with an adjuvant (AS01B), containing varicella zoster virus glycoprotein E (gE) antigen.

Drug Family: Recombinant, adjuvanted vaccines.

ATC Classification: J07BK03 (Varicella zoster vaccine, recombinant).

Approved:

• Prevention of herpes zoster (shingles) in adults aged 50 years and older.

• Prevention of shingles in adults aged 18 years and older who are, or will be, at higher risk because of a weak immune system caused by a disease or its treatment (approved by the US FDA and the European Medicines Agency; check the label of the brand sold in India).

• Prevention of postherpetic neuralgia (PHN), the long-lasting nerve pain that can follow shingles, by preventing shingles itself.

Commonly used for:

• Routine vaccination of adults aged 50 years and older.

• Vaccination of adults with long-term conditions or weak immunity, as advised by their doctor.

• Vaccination of people who have already had shingles, chickenpox, or the older live shingles vaccine.

Off-label use (only under medical guidance):

• No routine off-label therapeutic use. The vaccine is preventive. It does not treat active shingles or existing nerve pain.

• It is not used to prevent chickenpox.

• Intramuscular injection: a single dose is 0.5 mL.

• Each dose contains 50 mcg of recombinant varicella zoster virus glycoprotein E (gE) antigen with the AS01B adjuvant.

• Supplied either as two vials (a powder and an adjuvant liquid that are mixed just before use) or as a ready-to-use prefilled syringe, depending on the country and presentation.

• Store in a refrigerator at 2 to 8 degrees C. Do not freeze. Protect from light.

The vaccine contains one protein (glycoprotein E) from the varicella zoster virus, combined with an adjuvant (AS01B) that strengthens the immune response. It does not contain live virus, so it cannot cause shingles or chickenpox. The risk of shingles rises as the body's immunity against this virus declines with age or because of illness or treatment. The vaccine boosts this immunity, which helps the body keep the dormant virus from reactivating.

Routine schedule:

• Adults 50 years and older: 2 doses of 0.5 mL, with the second dose given 2 to 6 months after the first.

• Adults with a weak immune system, or who will have one soon: 2 doses, and the second dose can be given 1 to 2 months after the first if a shorter schedule is needed.

• There is no maximum age for vaccination.

• Route: Intramuscular injection, preferably into the upper arm (deltoid muscle).

• After earlier shingles or earlier vaccines: People who have had shingles can be vaccinated after the rash has cleared. People who had the older live shingles vaccine can also receive this vaccine. The doctor will advise on timing.

• Missed dose: Receive the second dose as soon as possible. The series usually does not need to be restarted. Ask your doctor.

• Overdose: An overdose is unlikely because the vaccine is given by a healthcare professional as a single measured dose. Seek medical advice if an extra dose is accidentally given.
  

Common:

• Sore arm with mild or moderate pain (very common), redness, and swelling at the injection site.

• Tiredness.

• Muscle pain.

• Headache.

• Shivering and fever.

• Stomach pain or nausea.

These effects usually go away on their own in 2 to 3 days. They can be strong enough to interfere with daily activities for a short time. You should still get the second dose even if you had these reactions after the first dose.

Serious:

• Severe allergic reactions (rare).

• Fainting after vaccination.

• Guillain-Barre syndrome, a serious nerve disorder (very rare), reported mainly within 6 weeks after vaccination.

Emergency symptoms: Seek immediate medical attention if you develop:

• Hives or severe rash.

• Swelling of the face, lips, or throat.

• Difficulty breathing.

• Fast heartbeat, dizziness, or weakness.

• New weakness, numbness, or tingling in the legs or arms, or trouble walking, in the weeks after the injection.

Recovery advice: Remain seated or lying down for about 15 minutes after vaccination, especially if you have a history of fainting. For pain or fever, you can use paracetamol or ibuprofen as advised by your doctor. The pain after the vaccine is usually milder than the pain of shingles.

• Allergy: Do not use if there was a severe allergic reaction to any ingredient of the vaccine or to a previous dose.

• Active shingles: Vaccination is postponed while you have a shingles rash. Get vaccinated after the rash has cleared.

• Illness: A mild illness such as a cold is not a reason to delay. If you have a moderate or severe illness, with or without fever, wait until you recover.

• Guillain-Barre syndrome: Tell your doctor if you have ever had this condition. A small increase in risk has been seen in the 6 weeks after vaccination in people aged 65 and older.

• Pregnancy: Data are insufficient. Vaccination is usually postponed during pregnancy. Discuss with your doctor.

• Breastfeeding: It is not known whether the vaccine passes into breast milk. Discuss with your doctor.

• Weak immunity: The vaccine is non-live, so it can be given to people with a weak immune system. The response may be lower than in healthy adults. The doctor may use a shorter schedule.

• Long-term conditions: Adults with conditions such as diabetes, heart disease, or kidney disease have a higher risk of shingles and can generally be vaccinated. The doctor will advise.

• Elderly: There is no maximum age. Reactions are generally less frequent in people aged 70 years and older than in those aged 50 to 69 years.

• Children: Not approved for people younger than 18 years. The vaccine does not prevent chickenpox.

• Limits of protection: No vaccine protects everyone. See a doctor early if a painful, blistering rash appears.

• Medicines that weaken the immune system (such as steroids, chemotherapy, and some biologic medicines) may reduce the response to the vaccine.

• The vaccine can be given at the same visit as the seasonal flu vaccine, pneumococcal vaccines, and the tetanus, diphtheria and pertussis (Tdap) vaccine, using different injection sites. Studies showed no meaningful interference in the immune response.

• Fever and shivering may be a little more common when it is given together with the 23-valent pneumococcal polysaccharide vaccine.

• Inform your healthcare provider about all medicines and vaccines you are receiving before vaccination.

• Observe for about 15 minutes after vaccination for fainting or allergic reactions.

• Complete both doses on time for optimal protection. Keep a record of the vaccine name, batch number, and dates.

• Watch for new weakness, numbness, or tingling in the arms or legs in the 6 weeks after vaccination, and contact a doctor immediately if it occurs.

• Contact your doctor if side effects are not improving after 2 to 3 days or are getting worse.

• The vaccine does not give complete protection. Seek early medical care for a painful, blistering rash, as early treatment helps.

• Zoster vaccine live (older live attenuated shingles vaccine, Zostavax). It is no longer available in the United States. People who received it earlier are still advised to receive the recombinant vaccine.

• Varicella (chickenpox) vaccine is a different vaccine that prevents chickenpox in people who have never had it. It is not a substitute for the shingles vaccine.

The herpes zoster vaccine is generally given as a standalone preventive vaccine. It may be given at the same visit as the flu vaccine, pneumococcal vaccines, or the Tdap vaccine, using separate injection sites. Vaccines must never be mixed in the same syringe.

• Shingles Vaccines.

• Herpes Zoster Prevention.

• Preventive Vaccines.

• Adult and Senior Vaccination.

• Recombinant Vaccines.

1. https://www.cdc.gov/shingles/vaccines/index.html

2. https://www.cdc.gov/vaccines/hcp/current-vis/shingles.html

3. https://www.fda.gov/media/108597/download

4. https://www.ema.europa.eu/en/medicines/human/EPAR/shingrix

The information on this page is for educational purposes only and is not a substitute for medical advice. Please consult your doctor to know if this treatment is appropriate for your condition.