Title page
Contents
About Public Health England 2
Executive summary 5
Background 6
The shingles vaccination programme 6
Programme delivery 7
Shingles infection 8
Shingles vaccine 8
Vaccine excipients 9
Vaccine efficacy 9
Vaccine supply 10
Vaccine storage 10
Vaccine eligibility for the national programme 11
Individuals outside of the national programme 11
Contraindications and special considerations for receiving Zostavax 12
Special considerations for vaccination of eligible individuals in clinical risk groups 14
Malignancy 14
Haematological disorders including haemopoietic stem cell transplants 15
Solid Organ Transplants 15
Chronic inflammatory disorders on immunosuppressive or immunomodulating therapies e.g. rheumatoid arthritis, inflammatory bowel disease, psoriasis, glomerulonephritis 15
Patients with Rheumatoid Arthritis (RA) 16
Patients with Inflammatory Bowel Disease 16
Patients with dermatological conditions 17
Patients with renal conditions such as glomerulonephritis or reduced renal function 17
Patients anticipating immunosuppressive therapy 18
HIV infection 18
Cellular immune deficiencies other than HIV infection 19
Patients with an absent or dysfunctional spleen 19
Vaccination of individuals receiving palliative care (cancer diagnosis) 20
Patients receiving antiviral agents (oral or intravenous) 20
Adverse reactions commonly associated with the administration of Zostavax 20
Development of a vesicular rash after receiving Zostavax 20
Vaccination of individuals with no previous history of chickenpox infection 21
Vaccination of individuals with a current chickenpox infection 21
Vaccination of eligible individuals with a previous history of shingles infection 22
Vaccination of individuals less than 70 years of age with a previous history of shingles infection (including recurrent shingles infections) 22
Vaccination of individuals with a current shingles infection 22
Vaccination of individuals with post herpatic neuralgia or residual nerve pain 22
Vaccination of individuals that have previously received Zostavax 23
Vaccine administration 23
Shingles vaccine reconstitution 23
Prescribing route for vaccine administration 23
Inadvertent administration of Zostavax 24
Inadvertent oral administration of Zostavax vaccine 24
Administration of Zostavax during pregnancy 24
Inadvertent administration of Zostavax to a child 25
Inadvertent administration of Zostavax to immunosuppressed individuals 26
Inadvertent administration of varicella vaccine (Varivax or Varilrix) to an adult instead of Zostavax 26
Inadvertent administration of Zostavax instead of Varivax or Varilrix 27
Administering Zostavax at the same time as other vaccines 27
Administering Zostavax at the same time as 23 valent pneumococcal polysaccharide vaccine 27
Gelatin content of Zostavax 28
Vaccine acceptability for the Jewish and Muslim communities 28
Appendix 1. Members of the expert working group 30