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Varicella Zoster
varicella zoster blisters

Shingles is a disease caused by the varicella-zoster virus, which is the same virus that causes chickenpox. After chickenpox illness, the virus lies dormant in certain nerve tissue. As people age, it is possible for the virus to reappear in the form of shingles. Shingles is more common in people 50 years of age and older and in people who have weak immune systems. Up to 1 million cases of shingles occur each year in the United States.

A shingles rash usually appears on one side of the face or body and follows along the nerve root. The rash lasts from 2 to 4 weeks. The main symptom of shingles is pain, which can be quite severe and persist even after the rash is gone. Other symptoms include fever, headache, chills and upset stomach.

Treatment of shingles focuses on shortening the length of illness and pain relief. Antiviral medications, such as acyclovir, famciclovir, and valacyclovir, are used to help shorten the length of illness. Pain medications, including topical medications, are used to help relieve the pain associated with shingles.

About the Vaccine

There is only one shingles vaccine. It is a live, attenuated vaccine.

Shingles Vaccines Licensed for Use in the U.S.

Product: Zostavax® (Shingles)
Manufacturer: Merck & Co.
Year licensed: 2006
Product Insert

Indications Contraindications and precautions
  • People 50 years of age and older.
  • People who have had a severe allergic reaction to a shingles vaccine component.
  • People who are moderately or severely ill should wait until recovery before receiving any vaccine. Minor illnesses, such as a cold, are not a contraindication.
  • People who are immune compromised due to disease, treatment, or medication.
  • Women who are pregnant or planning pregnancy within 4 weeks.
  • Shingles vaccination is not recommended for persons of any age who have received varicella (chickenpox) vaccine.
  • People taking chronic acyclovir, famciclovir, or valacyclovir should discontinue these medications at least 24 hours before administration of zoster vaccine, if possible. These medications should not be used for at least 14 days after vaccination.
Vaccine Dose/Route Routine Administration Schedule
Zostavax Dose: 0.65 mL

Route: Subcutaneously
Single dose     
Shingles Vaccine Side Effects
  • Redness, soreness, swelling, or itching at the injection site (1 in 3 people).
  • Headache (1 in 70 people).
  • Severe allergic reaction (very rare).
Product Name Supplied Storage and Handling
Merck & Co.
0.65 mL single dose vial with diluent (1 and 10 sets per package). Zostavax should be stored frozen at a temperature of -15°C (+5°F) or colder until it is reconstituted for injection. Protect from light. Zostavax may be stored and/or transported at refrigerator temperature (2 to 8°C, 36 to 46°F) for up to 72 continuous hours prior to reconstitution. Reconstituted vaccine must be used within 30 minutes. Diluent can be stored in the refrigerator or at room temperature. Diluent should not be frozen.

Zostavax is a semi-hazy to translucent, off-white to pale yellow liquid.     
The webinar series will provide an overview of the principles of vaccination, general recommendations, immunization strategies for providers, and specific information about vaccine-preventable diseases and the vaccines that prevent them. This is a live, 15 week, online series.
02 Jan 14

Sample Q&A: The Disease

How serious is shingles, especially to the Armed Forces?

Most healthy individuals make an uneventful recovery. Although it's difficult to resist scratching the itchy rash, it is best to keep hands off, to prevent a bacterial infection that may require antibiotic treatment. After an infection, the skin may be left with significant scarring, which may be serious enough to require plastic surgery.

Another complication, Ramsay Hunt syndrome, occurs when the varicella-zoster virus spreads to the facial nerve, causing facial paralysis, intense ear pain and vesicles in the auditory canal and outer ear structures (auricle). The rash might appear on the outer ear, inside the ear canal, on the soft palate (part of the roof of the mouth), or around the mouth and on the face, neck, and scalp. The hearing loss, vertigo, and facial paralysis that may result are usually, but not always, temporary.

Occasionally, the rash will appear as a single spot or cluster of spots on the tip of the nose. This symptom is called Hutchinson's sign. The ophthalmic nerve is often involved and the eye may become affected, causing temporary or permanent blindness. If the eye is affected (ophthalmic herpes) or looks like it may become affected, an eye specialist (ophthalmologist) should be consulted.

Shingles is a serious threat to immunosuppressed individuals - for example, those with HIV infection, individuals who are receiving cancer treatments and those that have received organ transplants. In those whose immune systems are extremely weakened, the varicella zoster virus can also spread to the internal organs and affect the lungs, central nervous system and the brain, possibly leading to death.

Recommendations of the Advisory Committee on Immunization Practices (ACIP)
Merck 31 Aug 07
Information on Shingles and Postherpetic Neuralgia
Information Paper
Package Insert - Vaccine
Merck 31 Aug 07
Information on Shingles and Postherpetic Neuralgia
New shipping package for ZOSTAVAX from Merck Vaccines (replacing the use of dry ice with 6 refrigerant packs)
MMQC-11-1404 15 Jun 11
Vaccine Information Statement