Varicella Zoster

Question 1

What type of vaccine is the varicella zoster vaccine?

Answer 1

Live attenuated VZV

Question 2

What is the difference between the varicella zoster vaccines (Varilrix® and Varivax®) and the herpes zoster vaccine (Zostavax®)?

Answer 2

The Zostavax® vaccine has a significantly higher antigen content than the chickenpox vaccines and is used to provide protection against herpes zoster (shingles)

Question 3

What is the aim of immunisation against varicella?

Answer 3

To protect individuals who are at most risk of serious illness from exposure by vaccinating specific individuals who are in regular or close contact with those at risk

Question 4

For whom is the varicella-zoster vaccine recommended?

Answer 4

1. Non-immune or varicella-zoster antibody-negative healthcare workers who have patient contact (including cleaners, catering staff, and receptionists)
2. Non-immune lab staff who may be exposed
3. Non-immune healthy susceptible contacts of immunocompromised patients where continuing close contact is unavoidable

**NOT routinely offered to the general public

Question 5

Can individuals with a definite history of chickenpox or shingles be considered immune?

Answer 5

Yes; however, for individuals born and raised overseas, a history of chickenpox is less reliable and routine testing should be considered

Question 6

What is the schedule for primary immunisation against varicella zoster?

Answer 6

Children aged 1 year and over AND adults should receive 2 doses of VZV vaccine at least 4-8 weeks apart

Vaccination should be postponed in acutely unwell individuals until they have fully recovered, unless protection is urgently required

Question 7

What side effects may be seen following the VZV vaccine? (3)

Answer 7

1. Within 1 month of vaccination, some individuals may develop a localised rash at the injection site or a generalised rash (papular or vesicular); may be infectious
2. Latent infection
3. Reactivation causing shingles in some individuals (risk is substantially lower than with wild chickenpox)

** Healthcare workers who develop a post-vaccine rash should consult their occupational health department for assessment before commencing work

Question 8

Can the VZV vaccine be given to immunocompromised or immunosuppressed individuals?

Answer 8

Not recommended (live vaccine)

Question 9

How is post-exposure prophylaxis of VZV managed in pregnant women and immunosuppressed individuals?

Answer 9

Varicella infection in immunosuppressed individuals and pregnant women can lead to severe and even life-threatening varicella disease. Post-exposure prophylaxis is recommended to attenuate disease and to reduce the risk of complications

Post-exposure prophylaxis involves the use of VZ immunoglobulin for the most vulnerable groups or aciclovir (unlicensed) or valaciclovir (unlicensed)

Individuals who develop chickenpox despite PEP require treatment with an antiviral

Question 10

For which individuals is VZ immunoglobulin (VZIG) recommended? (3)

Answer 10

For individuals who

• had a significant exposure to chickenpox or shingles AND
• have a clinical condition that increases the risk of severe chickenpox AND
• do not have antibodies to VZV

*this includes pregnant women who are exposed to VZV after 20 weeks

Question 11

Is chickenpox a notifiable disease?

Answer 11

Only in Northern Ireland

Question 12

What is the aim of the national shingles vaccination program?

Answer 12

To lower the incidence and severity of shingles in older people, in whom the risk and severity of disease and of subsequent post herpetic neuralgia is higher

Question 13

To which subset of adults is the singles VZV vaccine offered?

Answer 13

Although the shingles varicella-zoster vaccine is licensed for use in individuals aged 50 years and over, immunisation should only be offered to individuals aged 70–79 years as part of the national immunisation program.

This is because the burden of shingles disease is generally not as severe in individuals aged 50–69 years, and because of the limited vaccine effectiveness in older individuals.

Question 14

What is the vaccination regimen for the shingles VZV vaccine?

Answer 14

Individuals should be offered a single dose

This aims to boost immunity in individuals with pre-existing VZV immunity and prevent the development of shingles in later years

No need for a booster dose

Question 15

How should VZV vaccination be managed in patients taking antivirals?

Answer 15

Administration of the vaccine should be delayed until 48 hours after cessation of treatment

Question 16

What role does the shingles vaccine have in the treatment of shingles or post-herpetic-neuralgia?

Answer 16

None; not recommended for treatment BUT can be given to those with a previous history of shingles

Question 17

Can immunosuppressed individuals be given the shingles vaccine?

Answer 17

Decision should be based on clinical risk assessment; seek specialist advice for those who require protection

Question 18

Can the VZV vaccine be given during pregnancy?

Answer 18

Not recommended AND pregnancy should be avoided for 1 month after the last dose of the chickenpox VZV vaccine

All exposure to VZV vaccine from 3 months before conception to any time during pregnancy should be reported to the Immunisation Department of Public Health England