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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.     
02 Jan 14

Sample Q&A: The Disease

How do you know if you have shingles?
Often the first symptoms of shingles may be numbness, tingling, itching, or pain in one particular location on one side of the face or body. In the pre-eruption stage, diagnosis may be difficult, and the pain can be so severe that it may be mistaken for pleurisy, kidney stones, gallstones, appendicitis, or even a heart attack, depending on the location of the affected nerve. The virus infects the skin cells and creates a painful, red rash that resembles chickenpox. Doctors can distinguish shingles from chickenpox by the way the spots are distributed. The rash usually appears in a well-defined band on one side of the body, typically the torso; or on one side of the face, around the nose and eyes. The rash usually begins as clusters of small bumps that soon develop into fluid-filled blisters (vesicles). The blisters fill with pus, break open, and form crusty scabs. In about four or five weeks, the disease will have run its course, and the skin will begin healing. Even after the blisters have healed the site may remain painful to the slightest touch or breeze. It is usually a very painful rash, and typically people can't bear clothes touching the affected area.
Recommendations of the Advisory Committee on Immunization Practices (ACIP)
Merck 31 Aug 07
Information on Shingles and Postherpetic Neuralgia
Package Insert - Vaccine
Merck 31 Aug 07
Information on Shingles and Postherpetic Neuralgia
Zostavax 31 May 06
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