Zostavax is the only zoster vaccine currently registered in Australia. Zostavax is a live attenuated vaccine developed from the same strain as the chicken pox (varicella zoster virus) vaccine but it is around fourteen times stronger.6
The registered varicella vaccines are not indicated for preventing Herpes Zoster in older people and Zostavax is not indicated for use in younger people who have not been previously immunised or infected with the varicella zoster virus.
Zostavax is not indicated during an acute shingles episode nor for the treatment of PHN (post-herpetic neuralgia).
Protection from vaccination declines with age and time since last vaccination however a booster is not recommended at this stage.7
The Shingles Prevention Study (SPS), a single, large, randomised, double-blind placebo controlled trial was conducted among 38 546 adults aged ≥ 60 years. SPS showed that Zostavax reduced:
• Herpes Zoster by 51.3%
• PHN by 66.5% and the
• Burden of illness by 61.1% over a median of more than 3 years follow up.8
A single 0.65ml dose is required to be given by subcutaneous injection only.
Zoster vaccine is only registered for use in adults ≥ 50 years of age.
Who should be vaccinated?
All adults 60 years and older who have not previously received a dose.
Household contacts (≥ 50 years of age) of a person who is, or who is expected to become immunocompromised.
In particular, persons with chronic conditions, such as splenectomy, diabetes, rheumatoid arthritis, inflammatory bowel disease, dermatologic conditions, cardiorespiratory conditions or kidney disease who are not immunocompromised since these people may have more serious complications from shingles.9
Free for all adults aged 70 years through the National Immunisation Program (NIP).
A single catch up dose will be funded under the NIP for adults between 71-79 years of age until October 2021.
Vaccination of other age groups (e.g. those aged 50-69 or 80 years and over) is available on prescription and can be purchased by patients.
Why is Zostavax funded for 70-79 year olds?
Immunisation is most cost effective in this age group because:
• The likelihood of people developing shingles and PHN is considerably higher than in younger people
• Although vaccine efficacy is lower against shingles compared to younger people, the efficacy against PHN is 67%
From SPS, vaccine efficacy in people aged over 80 years was lower and not statistically significant however the number of participants aged over 80 years was low.
Who should not receive the zoster vaccine?
People who are severely immunocompromised through:
• Primary or acquired immunodeficiency:
-Haematologic neoplasms: leukaemias, lymphomas myelodysplastic syndromes
-Post-transplant: solid organ (on immunosuppressive therapy), haematopoietic stem cell transplant (within 24 months)
-Immunocompromised due to primary or acquired (HIV/AIDS) immunodeficiency
-Other significantly immunocompromising conditions
• Immunosuppressive therapy (current or recent)
-Chemotherapy or radiotherapy
-High-dose corticosteroids (≥20 mg of prednisone per day, or equivalent) for ≥14 days
-All biologics and most disease-modifying anti-rheumatic drugs (DMARDs). Patients taking low doses of specific DMARDs can be safely vaccinated. Refer to the Australian Immunisation Handbook for more details
Previous anaphylaxis to the vaccine (either Zostavax or varicella vaccine) or its components
Before vaccinating people with Zostavax
Obtain medical history prior to vaccination with zoster vaccine, check contraindications of zoster vaccine in immunocompromised individuals
In persons who are or have recently been immunocompromised, the safety of administering zoster vaccine should always be considered on a case-by-case basis. If there is uncertainty around the level of immunocompromise and when vaccine administration may be safe, vaccination should be withheld and expert advice sought from the treating physician and/or an immunisation specialist.
Co-administration with other vaccines
Can I give zoster vaccine on the same day as other vaccines?
Yes, all inactivated or live vaccines (including any of the available pneumococcal vaccines) may be co-administered with zoster vaccine (using separate syringes and injection sites). If zoster vaccine is not given on the same day as other live viral vaccines (e.g. MMR, yellow fever) separate administration by 4 weeks. (refer to 4.24.4 Vaccine of the Australian Immunisation Handbook).
If a rash has been present for less than 72 hours, antiviral treatment reduces acute pain, duration of the rash, viral shedding and ophthalmic complications. Whether antiviral therapy reduces the incidence of post-herpetic neuralgia is contentious.
Antiviral treatment is indicated for immunocompetent patients who present within 72 hours of the onset of the rash, and for all immunocompromised patients regardless of the duration of the rash.
Use famciclovir or valaciclovir or aciclovir.
There is evidence that famciclovir and valaciclovir are more effective than aciclovir in reducing pain in patients with herpes zoster.10
References for clinical information:
6. Australian Technical Advisory Group on Immunisation (ATAGI). The Australian immunisation handbook 10th ed (2017 update). Canberra: Australian Government Department of Health, 2017.
7. Zoster vaccine for Australian adults/NCIRS Fact sheet: August 2017.
8. Oxman MN, Levin MJ, Johnson GR, et al, A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. New England Journal of Medicine 2005;352:2271-84.
9. Zoster vaccine: Frequently asked questions/NCIRS Fact sheet: August 2017.
10. Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2014.
Page published: 8 March 2017
Last updated: 23 October 2017