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