PIC QUESTION OF THE WEEK: 9/15/08 Shortly after its approval in 2006, varicella zoster virus (VZV) vaccine (Zostavax) became an important tool in preventing reactivation of the latent virus and resultant condition known as shingles. The availability of this new vaccine generated a number of questions for the staff of the Pharmaceutical Information Center and some were reviewed in a previous issue of the PIC Question of the Week (1/14/08). An increase in usage has been stimulated by the Recommendations of the Advisory Committee on Immunization Practices (ACIP) published earlier this year (see CDC reference below). The following points briefly answer some of these earlier questions and introduce a few others that have recently been directed to the Center. •
• •
•
Should a patient with a history of shingles receive a dose of VZV vaccine? Second episodes of shingles are infrequent, but have been reported. The CDC recommends that all adults over 60 years, even those reportedly experiencing an earlier attack, be administered a dose of the vaccine. The ACIP has not recommended a specific time interval between an attack of shingles and subsequent administration of the vaccine. Is VZV vaccine indicated for individuals without a documented history of chickenpox? The CDC currently recommends use of the vaccine regardless of the history of chickenpox. What is the risk of transmitting this virus to an immunosuppressed household contact? The CDC does not suggest any additional precautions if the vaccine is administered to a person in close contact with an individual who is immunosuppressed. Transmission of the virus in these cases is rare, but more likely if the recipient of the vaccine develops a varicella-like rash. Even in these cases, the contact person does not require varicella immune globulin. In the rare event a contact develops varicella illness, standard anti-viral agents such as acyclovir, etc. should be effective. How long should a person receiving immunosuppressive corticosteroids (≥20 mg/day of prednisone or equivalent for ≥ two weeks) discontinue treatment before receiving VZV vaccine? The current recommendation is that these individuals wait two or more weeks after stopping corticosteroids before receiving the vaccine.
References: • •
Centers for Disease Control and Prevention. Prevention of herpes zoster: recommendation of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2008;57(RR-5):1-30. CDC. Herpes zoster-vaccine Q&As for providers. www.cdc.gov/vaccines/vpd-shingles/vac-faqs-hep.htm (Accessed September 7, 2008).
Photo by: bespam: used under Creative Commons License; http://www.flickr.com/photos/8207249@N08/1198410138/ (Accessed September 3, 2008)
Ashley M. Bartell and Alaina E. Fairley, Pharm.D. Candidates The PIC Question of the Week is a publication of the Pharmaceutical Information Center, Mylan School of Pharmacy, Duquesne University, Pittsburgh, PA 15282 (412.396.4600).