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Zostavax® vaccine administration alert

27 February 2017

Use of shingles vaccine (Zostavax®) when contraindicated has resulted in a death in Australia. 

Do not administer Zostavax® to patients with severe immunocompromise.

Take a detailed medical and medication history prior to vaccination.

Conditions that would contraindicate zoster vaccination

Conditions that would contraindicate zoster vaccination include:

  • Anaphylaxis following a previous dose of any VZV-containing vaccine (either zoster or varicella vaccine), or anaphylaxis following any vaccine component (including gelatin or neomycin).
  • Pregnancy
  • Primary or acquired immunodeficiency
    • Current haematologic neoplasms: leukaemias, lymphomas, myelodysplastic syndromes
    • Post-transplant: solid organ (on immunosuppressive therapy)
    • Haematopoietic stem cell transplant (within 24 months)
    • Immunocompromised due to primary immunodeficiency
    • Symptomatic HIV or HIV with CD4 count of ≤200 per μL
    • Other significantly immunocompromising conditions
  • Immunosuppressive therapy (current or recent)
    • Chemotherapy or radiotherapy. Wait at least 6 months after the end of treatment and patients are demonstrated to be in remission.
    • Corticosteroids (short-term high dose, long-term lower dose). See table below:
    • All biologics and most disease-modifying anti-rheumatic drugs (DMARDs). See table below.

(This is not a complete list of all immunosuppressive medications. If on more than one agent or if any doubt do not administer Zostavax® and seek specialist advice about its use.)

Drug group Some examples Comments regarding Zostavax® use
Anti-TNF Etanercept, Infliximab, Adalimumab

Contraindicated.

Zostavax can be used 1 month prior to treatment initiation or 12 months post treatment cessation.

IL-1 inhibition Anakinra
Costimulation blockade Abatacept
B-cell depletion /inhibition Rituximab
Immunomodulators (antimetabolites) Azathioprine, Methotrexate, 6-Mercaptopurine Contraindicated if >3.0mg/kg/day azathioprine, or >0.4mg/kg/week methotrexate, or >1.5mg/kg/day 6-mercaptopurine.

Zostavax can be used 1 month prior to treatment initiation or 3 months post treatment cessation.
Corticosteriod Prednisolone Complex – see The Australian Immunisation Handbook section 3.3.3.
T-cell activation inhibition Tacrolimus, Cyclosporine

Contraindicated.Zostavax can be used 1 month prior to treatment initiation or 3 months post treatment cessation

 

Others Cyclophosphamide, Mycophenolate, Sulfasalazine

Urgently seek specialist advice if Zostavax® is given to a person with severe immunocompromise.

For more information

For more information see the The Australian Immunisation Handbook and for all enquires please contact the CDCB on 1300 232 272 (24 hours/7 days)

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