Varicella Zoster Virus Vaccine

What is Varicella Zoster Virus Vaccine

Varicella-zoster virus vaccine, live is a lyophilized preparation of the Oka/Merck strain of live, attenuated varicella-zoster virus.

The vaccine is available as two different subcutaneous formulations (Varivax containing >= 1,350 plaque-forming units/dose and Zostavax containing >= 19,400 PFU/dose). These vaccines are approved for different indications, and are not interchangable.

Varivax is used to provide active immunity against the varicella (chickenpox) virus in susceptible adults and children >= 12 months old. Health care workers who do not have serologic evidence of immunity to varicella are recommended to be immunized with this vaccine.

Practitioner concerns that adults vaccinated as children could develop severe varicella infection complications if immunity provided by the vaccine is not long-lasting has limited use of Varivax.

However, clinical data have proved that the vaccine is effective for over 10 years in preventing varicella infection in healthy individuals; when breakthrough infections do occur, illness is typically mild.

Universal vaccination of children in the U.S. is expected to significantly reduce hospitalizations and deaths associated with varicella infection. In fact, the number of deaths from varicella either as the underlying or contributing cause in all age groups fell from 418 during 1995—1998 to 145 during 1999—2001. During 1999—2001, deaths associated with varicella fell to or below 0.15 per 1 million for all racial groups.

Strikingly, of children 1—4 years of age, the number of varicella-related deaths per 1 million fell from 0.77 during 1995—1998 to 0.07 during 1999—2001.

Varivax was tested and developed for 21 years prior to its final FDA approval on March 17, 1995. Varivax is part of the Vaccines for Children program in the U.S. for uninsured children.

Zostavax is approved by the FDA for prevention of herpes zoster (shingles) in adults at least 50 years of age.

Herpes zoster (a vesicular rash) and postherpetic neuralgia (a neuropathic pain syndrome which accompanies the vesicular rash) occurs after reactivation of the varicella-zoster virus; therefore, adults >= 50 years of age who either have had natural varicella infection (chickenpox) or have received Varivax should be vaccinated with Zostavax.

The CDC recommends that all adults >= 60 years of age and without a contraindication receive a single dose of the vaccine. Although use in patients with a previous history of herpes zoster has not been studied, the CDC recommends a single dose regardless of whether the adult reports a previous episode of herpes zoster.

Zostavax is not indicated treatment of varicella infection, herpes zoster, nor postherpetic neuralgia. Zostavax was approved by the FDA in May 2006, and is available free of charge through a new patient assistance program for low-income adults

Brand Names

  • Varivax
  • Zostavax

Indications

  • herpes zoster (shingles) infection prophylaxis
  • varicella (chickenpox) infection prophylaxis

Side Effects

  1. abdominal pain
  2. anaphylactic shock
  3. anaphylactoid reactions
  4. angioedema
  5. anorexia
  6. aplastic anemia
  7. arthralgia
  8. aseptic meningitis
  9. asthenia
  10. ataxia
  11. chills
  12. constipation
  13. cough
  14. diarrhea
  15. edema
  16. erythema
  17. erythema multiforme
  18. fatigue
  19. fever
  20. Guillain-Barre syndrome
  21. headache
  22. hematoma
  23. infection
  24. influenza
  25. injection site reaction
  26. insomnia
  27. irritability
  28. lymphadenopathy
  29. malaise
  30. meningitis
  31. myalgia
  32. myelitis
  33. nausea
  34. paresthesias
  35. pharyngitis
  36. pneumonitis
  37. pruritus
  38. purpura
  39. rash
  40. rhinitis
  41. seizures
  42. Stevens-Johnson syndrome
  43. stroke
  44. thrombocytopenia
  45. urticaria
  46. vesicular rash
  47. vomiting

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • acquired immunodeficiency syndrome (AIDS)
  • agammaglobulinemia
  • bone marrow suppression
  • breast-feeding
  • chemotherapy
  • children
  • corticosteroid therapy
  • fever
  • gelatin hypersensitivity
  • human immunodeficiency virus (HIV) infection
  • hypogammaglobulinemia
  • IgA deficiency
  • immunosuppression
  • infants
  • intramuscular administration
  • intravenous administration
  • leukemia
  • lymphoma
  • neomycin hypersensitivity
  • neonates
  • neoplastic disease
  • pregnancy
  • radiation therapy
  • respiratory infection
  • severe combined immunodeficiency (SCID)
  • tuberculosis

Interactions

  • Abatacept
  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Acyclovir
  • Adalimumab
  • Aldesleukin, IL-2
  • Alefacept
  • Alemtuzumab
  • Alkylating agents
  • Alpha interferons
  • Altretamine
  • Aminosalicylate sodium, Aminosalicylic acid
  • Anakinra
  • Anthracyclines
  • Antimetabolites
  • Antithymocyte Globulin
  • Antitumor antibiotics
  • Aspirin, ASA
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
  • Aspirin, ASA; Dipyridamole
  • Aspirin, ASA; Omeprazole
  • Aspirin, ASA; Oxycodone
  • Aspirin, ASA; Pravastatin
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Axicabtagene Ciloleucel
  • Azathioprine
  • Baricitinib
  • Basiliximab
  • Belatacept
  • Belimumab
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Bexarotene
  • Bismuth Subsalicylate
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Blinatumomab
  • Brodalumab
  • Busulfan
  • Canakinumab
  • Carmustine, BCNU
  • Certolizumab pegol
  • Chlorambucil
  • Choline Salicylate; Magnesium Salicylate
  • Cisplatin
  • Clofarabine
  • Cortisone
  • Crotalidae Polyvalent Immune Fab, Ovine
  • Cyclophosphamide
  • Cyclosporine
  • Cytarabine, ARA-C
  • Cytomegalovirus Immune Globulin, CMV-IGIV
  • Dacarbazine, DTIC
  • Daclizumab
  • Deflazacort
  • Dexamethasone
  • Digoxin Immune Fab
  • Docetaxel
  • Dupilumab
  • Efalizumab
  • Emapalumab
  • Estramustine
  • Etanercept
  • Everolimus
  • Famciclovir
  • Fingolimod
  • Floxuridine
  • Fludrocortisone
  • Fluorouracil, 5-FU
  • Folate analogs
  • Golimumab
  • Guselkumab
  • Hepatitis B Immune Globulin, HBIG
  • Hyaluronidase, Recombinant; Immune Globulin
  • Hydrocortisone
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Ifosfamide
  • Imatinib
  • Immune Globulin IV, IVIG, IGIV
  • Infliximab
  • Interferon Gamma-1b
  • Ixabepilone
  • Ixekizumab
  • Leflunomide
  • Lenalidomide
  • Lomustine, CCNU
  • Magnesium Salicylate
  • Mechlorethamine, Nitrogen Mustard
  • Melphalan
  • Methylprednisolone
  • Mitoxantrone
  • Muromonab-CD3
  • Mycophenolate
  • Natalizumab
  • Nelarabine
  • Nilotinib
  • Obinutuzumab
  • Ocrelizumab
  • Ofatumumab
  • Ozanimod
  • Paclitaxel
  • Prednisolone
  • Prednisone
  • Procarbazine
  • Purine analogs
  • Rabies Immune Globulin, human RIG
  • Respiratory Syncytial Virus Immune Globulin, RSV-IGIV
  • Rh0 [D] Immune Globulin
  • Rilonacept
  • Risankizumab
  • Rituximab
  • Rituximab; Hyaluronidase
  • Salicylates
  • Salsalate
  • Sarilumab
  • Secukinumab
  • Siltuximab
  • Siponimod
  • Sirolimus
  • Streptozocin
  • Tacrolimus
  • Temozolomide
  • Temsirolimus
  • Teriflunomide
  • Tetanus Immune Globulin, Human, TIG
  • Thiotepa
  • Tildrakizumab
  • Tisagenlecleucel
  • Tocilizumab
  • Tofacitinib
  • Tositumomab
  • Triamcinolone
  • Ustekinumab
  • Valacyclovir
  • Vedolizumab
  • Venetoclax
  • Vinblastine
  • Vincristine
  • Vincristine Liposomal
  • Vinorelbine
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