All About Zostavax

The Medical College of Wisconsin's Deidre L. Faust, MD, answers questions about Zostavax, the shingles vaccine that has been available since 2006.

Question 1: I have had the extreme debilitating pain from shingles that you discussed in your recent column. I would like to do anything possible to prevent another episode of shingles, but I am concerned that the vaccine could cause a reactivation of shingles.

Is there any information about whether or not this could happen from the vaccine and has the vaccine been studied in people who have already had shingles?

A: The Shingles Prevention Study was a large-scale study (nearly 40,000 patients) done to look at the effectiveness of the shingles vaccine in preventing herpes zoster (the virus that causes chicken pox and shingles), its complications, and also potential risks associated with getting the vaccine. In the study, patients who received the vaccine had a significantly reduced risk of getting shingles and most importantly, also had a substantial reduction in the amount of complications related to shingles, particularly the pain.

While there were cases of shingles in the vaccinated group, the researchers were able to identify the virus that caused the outbreak. The virus was not the same virus that was given in the vaccine. Cases of shingles during the study were caused by reactivation of the already present herpes zoster virus likely obtained in childhood from chicken pox, not from the vaccine.

Furthermore, there were substantially fewer cases of shingles in the vaccinated group compared to the unvaccinated group and their pain after was substantially less than those in the unvaccinated group. The study, unfortunately, did not include patients like you who have had a prior episode of shingles.

There is currently an ongoing trial that is looking at the utility and safety of using the Zostavax vaccine in people who have already had shingles. Having said that, the Advisory Committee on Immunization Practices, the group that advises physicians on how to use vaccines, states that "a single dose of zoster vaccine is recommended for adults 60 years of age and older whether or not they report a prior episode of herpes zoster."

Hopefully, the study designed to look at the efficacy of the vaccine in people who have had shingles will be done soon and will shed further light on your question.

Question 2: You recently stated in your column that people who have had a severe reaction to neomycin should not have the shingles vaccine. I have had localized reactions to neosporin and my pharmacist told me not to use any medications with neomycin in them because of this. Does this mean I can not get the shingles vaccine?

A: The shingles vaccine is only contraindicated in anaphylactic reactions to neomycin. Anaphylaxis is a severe allergic reaction consisting usually of shortness of breath, throat or tongue swelling, flushing, and gastrointestinal distress.

Patients may have one or all of these symptoms when they are experiencing anaphylaxis. Localized reactions or contact dermatitis is not a contraindication to the shingles vaccine. I would make sure your doctor is aware of your reaction prior to administration as he or she may want to monitor you in the office a little longer after the immunization.

The most common side effect of the Zostavax vaccine is a localized skin reaction - redness around the site of injection. Do not be alarmed if this occurs after the vaccination, but be sure to report it to your doctor.

Deidre L. Faust, MD, is a Staff Physician (Internal Medicine) at the Medical College of Wisconsin's Plank Road Clinic. Her column appears in the Milwaukee Journal-Sentinel.

For more information on this topic, see the HealthLink article Age and the Shingles Vaccine.