Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

Herpes zoster, commonly referred to as shingles, is a painful condition caused by the reactivation of the latent varicella-zoster virus (VZV) within the sensory ganglia.1 Shingles is characterized by clusters of blisters that develop on one side of the body in a bandlike pattern and can cause severe pain that may last for weeks, months, or years.2 The Centers for Disease Control and Prevention (CDC) reports that 1 in 3 individuals will develop herpes zoster in his or her lifetime, accounting for >1 million cases annually.1,2

Risk Increases with Age

The incidence and severity of herpes zoster increases with advancing age, starting at around age 50, and more than 50% of all individuals who will develop herpes zoster are >60 years of age.1-3 In addition, >50% of all persons living up to 85 years of age have had or will develop shingles.2

Complications attributed to herpes zoster occur in almost 50% of older persons with the condition.3,4 The most frequent debilitating complication, which also increases with advancing age, is postherpetic neuralgia, a neuropathic pain syndrome that persists or develops after the dermatomal rash has healed.1,4-6 Examples of other complications include conjunctivitis, uveitis, episcleritis, scleritis, retinitis, choroiditis, and optic neuritis.1 Although no clearly defined causes for the reactivation of the VZV are known (other than increasing age), patients who are immunocompromised are at risk for reactivation.7

The CDC's Advisory Committee on Immunization Practice announced on May 15 its recommendation that individuals =60 years of age be vaccinated against herpes zoster.1,2 This recommendation replaces the provisional recommendation made by the CDC in 2006.2

In June 2005, Oxman et al reported in the New England Journal of Medicine that the use of the zoster vaccine decreased the burden of illness due to herpes zoster by 61.1%; decreased the incidence of postherpetic neuralgia by 66.5%; and reduced the incidence of herpes zoster by 51.3%.3 In addition, the study concluded that the zoster vaccine reduced the morbidity associated with herpes zoster and postherpetic neuralgia among older adults.3

Zoster Vaccine

Zostavax (Merck & Co Inc), which was approved by the FDA on May 25, 2006, is the only available vaccine to prevent herpes zoster. It is available as a lyophilized preparation of live, attenuated VZV.8 Zostavax is indicated for the prevention of herpes zoster in individuals ≥60 years of age, including individuals who have reported a previous episode of zoster or who have chronic medical conditions, such as chronic renal failure, diabetes, rheumatoid arthritis, or chronic pulmonary disease, unless those conditions or other comorbid conditions are contraindicated for its use.1,8 Zostavax is not indicated for the treatment of herpes zoster or postherpetic neuralgia.

The use of Zostavax is contraindicated in individuals with a history of anaphylactic/anaphylactoid reaction to gelatin, neomycin, or any other component of the vaccine; individuals with a history of primary or acquired immunodeficiency states; or those on immunosuppressive therapy.8 Vaccination should be deferred in individuals with active untreated tuberculosis. It also is contraindicated in children, women of childbearing age, and should never be administered to pregnant females.8

For more information on herpes zoster and the zoster vaccine, go to the Centers for Disease Control and Prevention Web site at

The vaccine should be stored frozen and reconstituted immediately upon removal from the freezer. The diluent supplied by the manufacturer can be stored at room or refrigerated temperature. Prior to administration, the vaccine should be reconstituted with the diluent supplied by the manufacturer and should be administered immediately to minimize loss of potency. The vaccine should be discarded if not used within 30 minutes of reconstitution.

Zostavax should be administered as a single 0.65-mL dose subcutaneously in the deltoid region of the upper arm. The most common adverse reactions are associated with site injection reactions, such as erythema, pain, tenderness, swelling, pruritus, hematoma, and warmth.8 Examples of systemic reactions reported include headache, fever, rhinitis, diarrhea, flu syndrome, respiratory infection, and asthenia.8


  1. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report Web site. Prevention of Herpes Zoster. Recommendations of the Advisory Committee on Immunization Practices (ACIP). Accessed on May 28, 2008
  2. .
  3. Centers for Disease Control and Prevention Web site. CDC Recommends Shingles Vaccine. Accessed on May 28, 2008.
  4. Oxman, MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005;352(22):2271-2284.
  5. Oxman, MN. Clinical Manifestations of Herpes Zoster. In: Arvin AM, Gershon AA, eds. Varicella?Zoster Virus: Virology and Clinical Management. Cambridge, England: Cambridge University Press, 2000:246-275.
  6. Donahue JG, Choo PW, Manson JE, Platt R. The incidence of herpes zoster. Arch Intern Med. 1995;155:1605-1609.
  7. Dworkin RH, Portenoy RK. Pain and its persistence in herpes zoster. Pain. 1996;67:241-251.
  8. Herpes Zoster. In: Beers M, ed. The Merck Manual of Diagnosis and Therapy.18th Edition. Rahway, NJ: Merck Publishing; 2006:1609-1610.
  9. Zostavax [package insert]. Rahway, NJ: Merck & Co, Inc.