Zostavax® vaccination against shingles

Introduction – What is a Zostavax® vaccination?

The Zostavax® vaccination is a vaccine approved in 2006 and available in Germany since 2013. It is intended to prevent the development of a girdle-rose (Herpes Zoster infection). In Germany, vaccination against Varicella zoster (chickenpox) in children has been recommended since 2004.

The Zostavax® vaccination is aimed at the group of people over 60 years of age. Basically, vaccination is given against the same pathogen as for chickenpox. Interestingly, the immunity against an infection with Varizella zoster does not persist after a vaccination or a past infection, but decreases again over the years.

It has been found that the titer (concentration) of protective antibodies decreases after the age of 50. Because of this, a reinfection (new infection) with Varizella zoster is possible and a herpes zoster (girdle-rose) can occur if the titer (concentration) falls below a certain value. The vaccination with Zostavax is intended to counteract this waste, the protective antibodies, and thus protect against a new infection in old age and prevent girdle-roses.

Indications for a Zostavax® vaccination

The indication for a vaccination with Zostavax® is to prevent the occurrence of shingles (herpes zoster) and the sequelae (post-herpetic neuralgia). This occurs in people over 50 years of age with increased risk. In total, between 25% and 30% of all people suffer from shingles during their lifetime.

Since (as explained in the introduction) the protective titer, i.e. the concentration of antibodies, decreases after the age of 50, there is an indication for a vaccination with Zostavax® for people over 50. The indication is therefore prevention. If there is active girdle-rose, the vaccination must not be used.

An absolute contraindication to the use of Zostavax® vaccination is the existence of a congenital or acquired weakness of the immune system. These can be diseases of the bone marrow and lymphatic system. They also include chronic infections, such as HIV or tuberculosis.

In addition, patients receiving higher doses of cortisone should not be vaccinated with Zostavax. In the group of immunocompromised patients, vaccination with a subunit vaccine may be possible. These are inactivated vaccines – this means that only certain parts of the pathogen (antigens) are still present in the vaccine.

The vaccine Shingrix® has been approved for this purpose since October 2017. Furthermore, there is no approval for Zostavax vaccination during pregnancy and lactation. Patients suspected or known to be allergic to partial components of vaccines should only be vaccinated after a more detailed clarification – if necessary also with the manufacturer. In addition, vaccination should not be carried out during an acute herpes zoster infection or shingles.