Indications for vaccination:
Individuals ≥ 50 years of age need to be vaccinated against herpes zoster to reduce the risk of developing herpes zoster and postherpetic neuralgia. Herpes zoster vaccination is not indicated for the treatment of herpes zoster or post-herpetic neuralgia. There are some precautions and contraindications for vaccination, especially those with impaired immune function.
It is not necessary to determine if the patient has a history of varicella or herpes zoster before vaccination, as antibodies to previously exposed patients (especially the elderly) will become lower and lower, although the infection may have been negative in the past. In addition, the reliability of self-reported herpes zoster history is often questionable. Of the individuals who have lived in the United States for 30 years, more than 96% have serological evidence of previous varicella, and most individuals who claim to have had no varicella have VZV antibodies. In addition, in individuals with normal immune function, individuals who have never been exposed to VZV are inadvertently vaccinated with zoster vaccine live (ZVL).
Vaccine selection There are currently 2 types of herpes zoster vaccine:
Inactive recombinant glycoprotein E vaccine [specifically referred to as recombinant zoster vaccine (RZV); trade name is Shingrix]. RZV contains VZV glycoprotein E and an adjuvant (AS01B).
● Live attenuated vaccine (specifically ZVL; trade name is Zostavax). ZVL contains 18,700 (to the expiration date) - 60,000 viral plaque forming units, far exceeding the Oka/Merck varicella vaccine used to prevent chickenpox, which has only about 1350 plaque forming units.
We recommend that most patients with normal immune function be vaccinated with RZV instead of ZVL.
Based on evidence that RZV is more potent, we generally prefer to use RZV, especially for individuals aged 60-89. In addition, there are fewer problems with RZV immunity. Although there is no long-term data on RZV, the protective effect has lasted for 4 years