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{{Short description|Vaccine to prevent shingles}}
{{tooshort|date=September 2009}}
{{Use dmy dates|date=July 2024}}
{{Drugbox
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| target = ] (chickenpox), ], ]
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A '''zoster vaccine''' is a ] that reduces the ] of ] (shingles), a disease caused by reactivation of the ], which is also responsible for ].<ref name=Gershon2015/> Shingles provokes a painful rash with blisters, and can be followed by chronic pain (]), as well as other complications. Older people are more often affected, as are people with weakened immune systems (]). Both shingles and postherpetic neuralgia can be prevented by vaccination.<ref name=Saguil2017/>
The '''varicella vaccine''' is a ] that protects against the viral disease commonly known as ], ], and ].


Two zoster vaccines have been approved for use in people over 50 years old.<ref name=Saguil2017>{{cite journal |vauthors=Saguil A, Kane S, Mercado M, Lauters R |title=Herpes zoster and postherpetic neuralgia: prevention and management |journal=American Family Physician |volume=96 |issue=10 |pages=656–663 |date=November 2017 |pmid=29431387 |doi= |url=https://www.aafp.org/afp/2017/1115/p656.html |access-date=19 February 2021 |archive-date=25 April 2021 |archive-url=https://web.archive.org/web/20210425043628/https://www.aafp.org/afp/2017/1115/p656.html |url-status=live }}</ref> '''Shingrix''' (]) is a ] vaccine which has been used in many countries since 2017.<ref name="pmid30361202" /> '''Zostavax''' (]), in use since 2006,<ref name="pmid35340552">{{cite journal | vauthors=Pan CX, Lee MS, Nambudiri VE | title=Global herpes zoster incidence, burden of disease, and vaccine availability: a narrative review | journal=] | volume=10 | year=2022 | doi = 10.1177/25151355221084535 | pmc=8941701 | pmid=35340552 }}</ref> is an ] which consists of a larger-than-normal dose of ].<ref name=Gershon2015>{{cite journal | vauthors = Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D, Grose C, Hambleton S, Kennedy PG, Oxman MN, Seward JF, Yamanishi K | title = Varicella zoster virus infection | journal = Nature Reviews. Disease Primers | volume = 1 | issue = | page = 15016 | date = July 2015 | pmid = 27188665 | pmc = 5381807 | doi = 10.1038/nrdp.2015.16 }}</ref> Unlike Shingrix, Zostavax is not suitable for people with immunosuppression or diseases that affect the immune system.<ref name=Saguil2017/> Zostavax was discontinued in the United States in November 2020.<ref name="cdc" />
==Dangers of chickenpox==
Chickenpox is most often a mild disease, especially for children. Prior to the introduction of vaccine in 1995 in the US (released in 1988 in Japan & Korea), there were around 4,000,000 cases per year in the U.S., mostly children, with typically 100 or fewer deaths. Though mostly children caught it, the majority of deaths (by as much as 80%) were among adults. Additionally, chickenpox involved the hospitalization of about 10,000 people each year.<!--
--><ref name="WHO-Varicella vaccine">{{cite web | author=The Vaccines and other Biologicals department | publisher=WHO | title=Varicella vaccine | url=http://www.who.int/vaccines/en/varicella.shtml | date=May 2003 | accessdate=2006-08-18 |archiveurl = http://web.archive.org/web/20060813125255/http://www.who.int/vaccines/en/varicella.shtml <!-- Bot retrieved archive --> |archivedate = 2006-08-13}} - which includes:<br>{{cite journal | title=Varicella vaccines: WHO position paper | journal=Weekly Epidemiological Record | year=1998 | volume=73 | pages=241–248 | url=http://www.who.int/wer/pdf/1998/wer7332.pdf | format=PDF | pmid=9715106 | issue=32}}</ref> It was a very common disease for children in the United States, and was often seen as a part of childhood.<ref>{{cite web|author=USA |url=http://www.helium.com/items/1036041-chicken-pox-the-quintessential-childhood-disease |title=Chicken pox: The quintessential childhood disease - by Shane Hampton |publisher=Helium |date= |accessdate=2011-02-08}}</ref>


Shingrix appears to prevent more cases of shingles than Zostavax, although side effects seem to be more frequent.<ref name="pmid30361202"/><ref name="Cochrane2019">{{cite journal |vauthors = Gagliardi AM, Andriolo BN, Torloni MR, Soares BG, de Oliveira Gomes J, Andriolo RB, Canteiro Cruz E |date=November 2019 |title=Vaccines for preventing herpes zoster in older adults |journal=The Cochrane Database of Systematic Reviews |volume=2019 |issue=11 |pages= |doi=10.1002/14651858.CD008858.pub4 |pmc=6836378 |pmid=31696946}}</ref>
During 2003 and the first half of 2004, the CDC reported eight deaths from varicella, six of whom were children or adolescents. These deaths and hospitalizations have substantially declined in the U.S. due to vaccination,<!--
--><ref name="Seward2002">{{cite journal | author=Seward JF, Watson BM, Peterson CL, ''et al.'' | title=Varicella disease after introduction of varicella vaccine in the United States, 1995&ndash;2000 | year=2002 | journal=JAMA | volume=287 | issue=5 | pages=606&ndash;11 | pmid=11829699 | url=http://jama.ama-assn.org/cgi/content/full/287/5/606 | accessdate=2006-05-01 | doi=10.1001/jama.287.5.606 }}</ref><!--
--><ref name="Nguyen2005">{{cite journal | author=Nguyen HQ, Jumaan AO, Seward JF | title=Decline in mortality due to varicella after implementation of varicella vaccination in the United States | journal=N Engl J Med | year=2005 | volume=352 | pages=450&ndash;8 | pmid=15689583 | url=http://content.nejm.org/cgi/content/abstract/352/5/450 | accessdate=2006-05-01 | doi=10.1056/NEJMoa042271 | issue=5 }}</ref><!--
--> though the rate of ] infection has increased for the same reason.<ref>{{cite journal |journal=Control Hosp. Epidemiol. |year=2008 |volume=29 |issue=12 |pages=1157–1163 |title=Herpes zoster-related hospitalizations and expenditures before and after introduction of the varicella vaccine in the United States |author= Patel MS, Gebremariam A, Davis MM |pmid=18999945 |doi=10.1086/591975}}</ref><ref>{{cite journal |journal=BMC Public Health |year=2005 |volume=5 |pages=68–68 |title= The incidence of varicella and herpes zoster in Massachusetts as measured by the Behavioral Risk Factor Surveillance System (BRFSS) during a period of increasing varicella vaccine coverage, 1998-2003 |author=Yih WK, Brooks DR, Lett SM, Jumaan AO, Zhang Z. Clements KM, Seward JF |pmid=15960856 |doi=10.1186/1471-2458-5-68 |pmc=1177968}}</ref><ref>{{cite journal |journal=Mayo Clin Proc.|year=2007 |volume=82 |issue=11 |pages=1341–1349 |title=A Population-Based Study of the Incidence and Complication Rates of Herpes Zoster Before Zoster Vaccine Introduction|author=Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS |pmid=17976353 |doi=10.4065/82.11.1341}}</ref> The vaccine has more recently been determined to be effective at preventing shingles (zoster) in persons 60 years of age and older, if administered regularly.<!--
--><ref name="Oxman2005">{{cite journal | author=Oxman MN, Levin MJ, Johnson GR, ''et al.'' | title=A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults | journal=] | year=2005 | volume=352 |pages=2271&ndash;84 | pmid=15930418 | doi=10.1056/NEJMoa051016 | issue=22}}</ref>


Another vaccine, known as ], is used to prevent diseases caused by the same virus.<ref>{{cite web|url=https://www.cdc.gov/vaccines/vpd/shingles/hcp/zostavax/hcp-vax-recs.html|title=Herpes Zoster Vaccination|work=U.S. ] (CDC)|access-date=26 October 2021|date=31 July 2015|archive-date=26 October 2021|archive-url=https://web.archive.org/web/20211026095854/https://www.cdc.gov/vaccines/vpd/shingles/hcp/zostavax/hcp-vax-recs.html|url-status=live}}</ref>
==Vaccination worldwide==
{{TOC limit}}


== Medical uses ==
Japan was among the first countries to routinely vaccinate for chickenpox. Routine vaccination against varicella zoster virus is also performed in the ], and the incidence of chickenpox has been dramatically reduced there (from 4 million cases per year in the pre-vaccine era to approximately 400,000 cases per year as of 2005). In ] most countries do not currently vaccinate against varicella, though the vaccine is gaining wider acceptance. Australia, Canada, and other countries have now adopted recommendations for routine immunization of children and susceptible adults against chickenpox.
Zoster vaccination is used to prevent shingles and its complications, including postherpetic neuralgia.<ref name=Gershon2015/><ref name=Saguil2017/> It can be considered a ], given that it is used to treat a ] that has remained dormant ] since chicken pox infection earlier in life.<ref name=Gershon2015/> The available zoster vaccine is intended for use in people over the age of 50.<ref name=Saguil2017/> {{As of|2021}} it was not confirmed whether a ] was required,<ref name=gboi>{{Cite book|url=https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1012943/Green_book_of_immunisation_28a_Shingles.pdf|title=Green Book of immunisation|chapter=Chapter 28a: Shingles (herpes zoster)|page=8|date=23 August 2021|quote=The need for booster doses of either Shingrix and Zostavax has not yet been determined.|access-date=11 November 2021|archive-date=29 September 2021|archive-url=https://web.archive.org/web/20210929023322/https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1012943/Green_book_of_immunisation_28a_Shingles.pdf|url-status=live}}</ref><ref name="pmid30361202"/> but the ] (ACIP) in the United States recommends Shingrix for adults over the age of 50, including those who have already received Zostavax.<ref name=han/>


===Shingrix===
Vaccination is common in the United States, with 41 of the 50 states require immunization for children attending government-run schools. All 50 states offer a medical exemption, with 48 of those states also offering philosophical and/or religious exemptions. The vaccination is not routine in the United Kingdom. In the U.S. opinions that it should be dropped (individually or ]) are also sometimes voiced.
]
The ACIP voted that Shingrix is preferred over Zostavax for the prevention of zoster and related complications because data showed vaccine efficacy of more than 90% against shingles across all age groups. Unlike Zostavax, which is given as a single shot, Shingrix is given as two identical intramuscular doses, two to six months apart.<ref name=han>{{cite web|vauthors=Han DH|date=25 October 2017|title=ACIP: New Vaccine Recommendations for Shingles Prevention|url=https://www.empr.com/home/news/acip-new-vaccine-recommendations-for-shingles-prevention/|publisher=MPR|access-date=30 October 2017|archive-date=11 May 2021|archive-url=https://web.archive.org/web/20210511150500/https://www.empr.com/home/news/acip-new-vaccine-recommendations-for-shingles-prevention/|url-status=live}}</ref><ref name="pmid35340552" /><ref>{{cite web| publisher=walrus| title=Are Dose One And Dose Two Of Shingrix The Same?| vauthors = Staiger B | date=27 October 2019| url=https://walrus.com/questions/are-dose-one-and-dose-two-of-shingrix-the-same| access-date=5 February 2024| archive-date=5 February 2024| archive-url=https://web.archive.org/web/20240205211121/https://walrus.com/questions/are-dose-one-and-dose-two-of-shingrix-the-same| url-status=live}}</ref><!---citation for "identical"--->{{better reference needed|date=February 2023}} Shingrix provides high levels of immunity for at least 7 years after vaccination, but it is possible the vaccine may provide protection for much longer.<ref name="Shingrix-CDC" /><ref>{{cite journal | vauthors = Shah RA, Limmer AL, Nwannunu CE, Patel RR, Mui UN, Tyring SK | title = Shingrix for Herpes Zoster: A Review | journal = Skin Therapy Letter | volume = 24 | issue = 4 | pages = 5–7 | date = July 2019 | pmid = 31339679 }}</ref>


A large randomized clinical trial{{which?|date=March 2024}} showed Shingrix reduced the incidence of shingles 96.6% (relative risk reduction, RRR) in the 50–59 age group, and 91.3% (], RRR) in those over age 70.{{citation needed|date=March 2024}} The absolute decrease in risk (], ARR) of herpes zoster following immunization over three and a half years is 3.3% (3.54% down to 0.28%) while the decrease in the risk of postherpetic neuralgia is 0.3% (0.34% down to 0.06%).<ref name=TI2018>{{cite web |title= Shingrix: A New Vaccine for Shingles |url=https://www.ti.ubc.ca/2018/10/10/114-shingrix-a-new-vaccine-for-shingles/ |website=Therapeutics Initiative |access-date=14 October 2018 |date=11 October 2018 |archive-date=14 October 2018 |archive-url=https://web.archive.org/web/20181014130121/https://www.ti.ubc.ca/2018/10/10/114-shingrix-a-new-vaccine-for-shingles/ |url-status=live }}</ref><ref>{{cite web | url=https://www.ti.ubc.ca/2018/10/10/114-shingrix-a-new-vaccine-for-shingles/ | title=Therapeutics Initiative &#124; &#91;114&#93; Shingrix: A New Vaccine for Shingles }}</ref><ref>{{cite web | url=https://www.ti.ubc.ca/2018/10/10/114-shingrix-a-new-vaccine-for-shingles/#ref1 | title=Therapeutics Initiative &#124; &#91;114&#93; Shingrix: A New Vaccine for Shingles }}</ref>
Other countries, such as ] and the ], have targeted recommendations for the vaccine, e.g., for susceptible health care workers at risk of varicella exposure. In the UK, varicella antibodies are measured as part of the routine of prenatal care, and by 2005 all ] personnel had determined their immunity and been immunized if they were non-immune and have direct patient contact. Population-based immunization against varicella is not otherwise practiced in the UK. It is feared that there would be a greater number of cases of shingles in adults, until the vaccination was given to the entire population—because adults who have had chickenpox as a child are less likely to have shingles in later life if they have been exposed occasionally to the chickenpox virus (for example by their children). This is because the exposure acts as a booster vaccine.<ref>{{dead link|date=February 2011}}</ref><ref>{{cite web|url=http://www.hpa.org.uk/infections/topics_az/chickenpox/gen_info.htm |title=UK Health Protection Agency ('&#39;Prevention'&#39; section) |publisher=Hpa.org.uk |date= |accessdate=2011-02-08}}</ref>
The long-term duration of protection from varicella vaccine is unknown, but there are now persons vaccinated more than thirty years ago with no evidence of waning immunity, while others have become vulnerable in as few as 6 years. Assessments of duration of immunity are complicated in an environment where natural disease is still common, which typically leads to an overestimation of effectiveness, and we are only now entering an era in the U.S. where the long-term efficacy of varicella vaccine can be accurately gauged.<!--
--><ref name="Goldman2005">{{cite journal | author=Goldman GS | title=Universal varicella vaccination: efficacy trends and effect on herpes zoster | journal=Int J Toxicol| volume=24| issue=4 | year=2005 | pages=205&ndash;213 | pmid=16126614 | doi=10.1080/10915810591000659}}</ref>


===Zostavax===
The vaccine is exceedingly safe: approximately 5% of children who receive the vaccine develop a fever or rash, but as of 1 May 2006, there have been no deaths yet attributable to the vaccine despite more than 40 million doses being administered.<!--
]
--><ref name="Wise2000">{{cite journal | author=Wise RP, Salive ME, Braun MM, ''et al.'' | title=Postlicensure safety surveillance for varicella vaccine | journal=JAMA | year=2000 | volume=284 | issue=10 | pages=1271&ndash;9 | pmid=10979114 | doi=10.1001/jama.284.10.1271 }}</ref>
The Zostavax vaccine (both single dose and two-dose regime) is likely effective at protecting people from herpes zoster disease for a duration of up to three years.<ref name=":0">{{cite journal | vauthors = de Oliveira Gomes J, Gagliardi AM, Andriolo BN, Torloni MR, Andriolo RB, Puga ME, Canteiro Cruz E | title = Vaccines for preventing herpes zoster in older adults | journal = The Cochrane Database of Systematic Reviews | volume = 2023 | issue = 10 | pages = CD008858 | date = October 2023 | pmid = 37781954 | pmc = 10542961 | doi = 10.1002/14651858.CD008858.pub5 | collaboration = Cochrane Acute Respiratory Infections Group }}</ref> The degree of longer term protection (beyond 4 years from the initial vaccination) is not clear. The need for re-vaccination after the first full vaccine schedule is complete remains to be confirmed.<ref name=":0" />
Cases of vaccine-related chickenpox have been reported in patients with a weakened immune system,<!--
--><ref name="Wise2000"/><ref name="Quinlivan">{{cite journal | author=Quinlivan MA, Gershon AA, Nichols RA, La Russa P, Steinberg SP, Breuer J | title=Vaccine Oka Varicella-zoster virus genotypes are monomorphic in single vesicles and polymorphic in respiratory tract secretions | year=2006 | journal=J Infect Dis | volume=193 | issue=7 | pages=927&ndash;30 | pmid=16518753 | doi=10.1086/500835 }}</ref><!--
--> but no deaths.


Zostavax was shown to reduce the incidence of shingles by 51% in a study of 38,000 adults aged 60 and older who received the vaccine. The vaccine also reduced by 67% the number of cases of ] (PHN) and reduced the severity and duration of pain and discomfort associated with shingles, by 61%.<ref name=Mitka2006>{{cite journal| vauthors=Mitka M | title=FDA approves shingles vaccine: herpes zoster vaccine targets older adults| journal=]| date=July 2006| volume=296| issue=2| pages=157–158| pmid=16835412| doi=10.1001/jama.296.2.157 }}</ref><ref>{{cite press release| url=https://www.pharmaceuticalonline.com/doc/fda-licenses-new-vaccine-to-reduce-older-amer-0001| title=FDA Licenses New Vaccine to Reduce Older Americans' Risk of Shingles| access-date=31 October 2009| date=26 May 2006| publisher=U.S. ] (FDA)| archive-date=12 November 2017| archive-url=https://web.archive.org/web/20171112131752/https://www.pharmaceuticalonline.com/doc/fda-licenses-new-vaccine-to-reduce-older-amer-0001| url-status=live}}</ref><ref name="Zostavax FDA label">{{cite web | title=Zostavax – zoster vaccine live injection, powder, lyophilized, for suspension Sterile Diluent – sterile water injection | website=DailyMed | date=26 September 2019 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=30a0464e-e012-4c16-bc05-88f07e412203 | access-date=6 September 2020 | archive-date=25 September 2020 | archive-url=https://web.archive.org/web/20200925014237/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=30a0464e-e012-4c16-bc05-88f07e412203 | url-status=live }}</ref> The FDA originally recommended it for individuals 60 years of age or older who are not severely allergic to any of its components and who meet the following requirements:<ref>{{cite web|url=https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm132880.htm |title=Patient Information about Zostavax |access-date=31 October 2009 |date=May 2006 |publisher=U.S. ] (FDA) |archive-url=https://web.archive.org/web/20090619154705/https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm132880.htm |archive-date=19 June 2009 }}</ref><ref>{{cite web| url=https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm176335.htm| archive-url=https://web.archive.org/web/20090827043729/http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm176335.htm| archive-date=27 August 2009| title=Patient Information about Zostavax (Text) 12/2008| access-date=31 October 2009| date=December 2008| publisher=U.S. ] (FDA)}}</ref>
The literature contains several reports of adverse reactions following varicella vaccination,<!--
* do not have a weakened immune system due to ] or another disease or medications (such as ], ] and ]) that affect the immune system;
--><ref name="Long list">For example:
* do not have a history of cancer affecting the bone marrow or lymphatic system, such as ] or ]; and
*{{cite journal | author=Ravkina LI, Matsevich GR | title=Morphological changes in the central nervous system in post-vaccinal encephalomyelitis developing after chickenpox vaccination in children | journal=Zh Nevropatol Psikhiatr Im S S Korsakova | year=1970 | volume=70 | issue=10 | pages=1465&ndash;71 | pmid=4395233 }}
* do not have active, untreated ].
*{{cite journal | author=Sunaga Y, Hikima A, Ostuka T, Morikawa A | title=Acute cerebellar ataxia with abnormal MRI lesions after varicella vaccination | journal=Pediatr Neurol | year=1995 | volume=13 | issue=4 | pages=340&ndash;2 | pmid=8771172 | doi=10.1016/0887-8994(95)00194-8 }}
*{{cite journal | author=Singer S, Johnson CE, Mohr R, Holowecky C | title=Urticaria following varicella vaccine associated with gelatin allergy | journal=Vaccine | year=1995 | volume=17 | issue=4 | pages=327&ndash;9 | pmid=9987170 | doi=10.1016/S0264-410X(98)00209-6}}
*{{cite journal | author=Gerecitano J, Friedman-Kien A, Chazen GD | title=Allergic reaction to varicella vaccine | journal=Ann Intern Med | year=1997 | volume=126 | issue=10 | pages=833&ndash;4 | pmid=9148672}}
*{{cite journal | author=Sakaguchi M, Yamanaka T, Ikeda K, Sano Y, Fujita H, Miura T, Inouye S | title=IgE-mediated systemic reactions to gelatin included in the varicella vaccine | journal=J Allergy Clin Immonol | year=1997 | volume=99 | issue=2 | pages=263&ndash;4 | pmid=9042057 | doi=10.1016/S0091-6749(97)70108-8 }}
*{{cite journal | author=Naruse H, Miwata H, Ozaki T, Asano Y, Namazue J, Yamanishi K | title=Varicella infection complicated with meningitis after immunization | journal=Acta Paediatr Jpn | year=1993 | volume=35 | issue=4 | pages=345&ndash;7 | pmid=8397466 }}
*{{cite journal | author=Lee SY, Komp DM, Andiman W | title=Thrombocytopenic Purpura following varicella-zoster vaccination | journal=Am J Pediatr Hematol Oncol | year=1986 | volume=8 | issue=1 | pages=78&ndash;80 | pmid=3013041 | doi=10.1097/00043426-198608010-00016 }}
*{{cite journal | author=Wrensch M, Weinberg A, Wiencke J, Miike R, Barger G, Kelsey K | title=Prevalence of antibodies to four herpesviruses among adults with glioma and controls | journal=Am J Epidem | year=2001 | volume=154 | issue=2 | pages=161&ndash;5 | pmid=11447050 | doi=10.1093/aje/154.2.161}}
*{{cite journal | author=Naseri A, Good WV, Cunningham ET Jr | title=Herpes zoster virus sclerokeratitis and anterior uveitis in a child following varicella vaccination | journal=Am J Ophthalmol | year=2003 | volume=135 | issue=3 | pages=415&ndash;7 | pmid=12614776 | doi=10.1016/S0002-9394(02)01957-8}}
*{{cite journal | author=Esmaeli-Gutstein B, Winkelman JZ | title=Uveitis associated with varicella virus vaccine | journal=Am J Ophthalmol | year=1999 | volume=127 | issue=6 | pages=733&ndash;4 | pmid=10372892 | doi=10.1016/S0002-9394(99)00059-8}}
*{{cite journal | author=Schwab J, Ryan M | title=Varicella zoster virus meningitis in a previously immunized child | journal=Pediatrics | year=2004 | volume=114 | issue=2 | pages=e273&ndash;4 | pmid=15286270 | doi=10.1542/peds.114.2.e273}}
*{{cite journal | author=Bronstein DE, Cotliar J, Votava-Smith JK, Powell MZ, Miller MJ, Cherry JD | title=Recurrent papular urticaria after varicella immunization in a 15-month-old girl | journal=Pediatr Infect Dis J | year=2005 | volume=24 | issue=3 | pages=269&ndash;70 | pmid=15750467 | doi=10.1097/01.inf.0000154330.47509.42}}
*{{cite journal | author=Binder NR, Holland GN, Hosea S, Silverberg ML | title=Herpes zoster ophthalmicus in an otherwise-healthy child | journal=J Aapos | year=2005 | volume=9 | issue=6 | pages=597&ndash;8 | pmid=16414532 |doi=10.1016/j.jaapos.2005.06.009}}</ref><!--
--> including vaccine-strain zoster in children and adults.<!--
--><ref name="Matsubara1995">{{cite journal | author=Matsubara K, Nigami H, Harigaya H, Baba K | title=Herpes zoster in a normal child after varicella vaccination | journal=Acta Paediatr Jpn | year=1995 | volume=37 | issue=5 | pages=648&ndash;50 | pmid=8533598}}</ref><!--
--><ref name="Hammerschlag1989">{{cite journal | author=Hammerschlag MR, Gershon AA, Steinberg SP, Clarke L, Gelb LD | title=Herpes zoster in an adult recipient of live attenuated varicella vaccine | journal=J Infect Dis | year=1989 | volume=160 | issue=3 | pages=535&ndash;7 | pmid=2547882 }}</ref>
A mean of 2,350 reports per year are attributed to varicella vaccine based on 20,004 cases reported to the Vaccine Adverse Event Reporting System (VAERS) database from May, 1995 through December, 2003. Minor events are known to be under-reported to VAERS.


In 2006, the US ] (ACIP) recommended that the live vaccine be given to all adults age 60 and over, including those who have had a previous episode of shingles,<ref name="CDC">{{cite press release| url=https://www.cdc.gov/media/pressrel/r061026.htm| title=CDC's Advisory Committee Recommends "Shingles" Vaccination| date=26 October 2006| publisher=U.S. ] (CDC)| access-date=31 October 2009| archive-date=5 November 2009| archive-url=https://web.archive.org/web/20091105120851/http://www.cdc.gov/media/pressrel/r061026.htm| url-status=live}}</ref> and those who do not recall having had chickenpox, since more than 99% of Americans ages 40 and older have had chickenpox.<ref name=Shingrix-CDC/>
==Administration==
This vaccine is a shot given in the ]. It is recommended for all children under 13 and for everyone 13 or older who has never had chickenpox.


Two doses are always recommended. In the first case a first dose is administered at 12 to 15 months and a second dose at age 4-6 years. For people older than 13 the two doses are administered 4 to 8 weeks apart. <ref>{{cite web|url=http://www.vaccineinformation.org/varicel/qandavax.asp|title=Who should get this vaccine?|date=|accessdate=May 5,2010}}</ref>

The varicella vaccine is not recommended for seriously ill people, ], people who have experienced a serious allergic reaction to the varicella vaccine in the past, people who are allergic to ], people allergic to ], people suffering from an immune system disease, such as ], people receiving high doses of ], people receiving treatment for ] with ], ] or ], as well as people who have received ] or ] during the past 5 months. <ref>{{cite web|url=http://familydoctor.org/online/famdocen/home/healthy/vaccines/193.html|title=Who should not receive the varicella vaccine?|date=|accessdate=May 5,2010}}</ref>


==Side effects== ==Side effects==
===Shingrix===
Serious side effects are very rare, however in rare occasions, some severe reactions have been reported such as ], ], and ]. <ref>{{cite web|url=http://www.nlm.nih.gov/medlineplus/ency/article/007065.htm|title=Risks and Side Effects|date=|accessdate=May 5,2010}}</ref>
Temporary side effects from the Shingrix shots are likely and can be severe enough in one out of six people to affect normal daily activities for up to three days.<ref name=Shingrix-CDC/> Mild to moderate pain at the injection site is common, and some may have redness or swelling.<ref name=Shingrix-CDC/> Side effects include fatigue, muscle pain, headache, shivering, fever, and nausea.<ref name=Shingrix-CDC/> Symptoms usually resolve in two to three days.<ref name="Shingrix-CDC">{{Cite web |date=24 May 2022 |title=Shingles Vaccination: What Everyone Should Know |url=https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html |access-date=1 January 2023 |publisher=U.S. ] (CDC) |archive-date=20 April 2018 |archive-url=https://web.archive.org/web/20180420202420/https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html |url-status=live }}</ref> Side effects with Shingrix are greater than those with Zostavax and occur more frequently in individuals aged 50 to 69 years compared with those 70 years and older.<ref name="pmid30361202">{{cite journal |vauthors=Tricco AC, Zarin W, Cardoso R, Veroniki AA, Khan PA, Nincic V, Ghassemi M, Warren R, Sharpe JP, Page AV, Straus SE |title=Efficacy, effectiveness, and safety of herpes zoster vaccines in adults aged 50 and older: systematic review and network meta-analysis |journal=BMJ |volume=363 |date=October 2018 |pages=k4029 |doi=10.1136/bmj.k4029|pmid=30361202 |pmc=6201212 }}</ref><ref name="Shingrix FDA label">{{cite web | title=Shingrix- zoster vaccine recombinant, adjuvanted kit | website=DailyMed | date=4 October 2019 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0280849d-5c78-4a9d-8941-4eab429f6bd8 | access-date=6 September 2020 | archive-date=25 September 2020 | archive-url=https://web.archive.org/web/20200925081742/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0280849d-5c78-4a9d-8941-4eab429f6bd8 | url-status=live }}</ref>


===Zostavax===
The possible mild side effects include redness, ], and ] at the injection site, as well as ]. A few people may develop a mild ] which usually appears around the shot's area. <ref>{{cite web|url=http://www.vaccineinformation.org/varicel/qandavax.asp|title=What side effects have been reported with this vaccine?|date=|accessdate=May 5,2010}}</ref>
The live vaccine (Zostavax) is very safe; one to a few percent of people develop a mild form of chickenpox, often with about five or six blisters around the injection site, and without fever. The blisters are harmless and temporary.<ref name="Milvax" /><ref>{{cite web| url= https://www.webmd.com/vaccines/features/shingles-vaccine-for-adults| title= Shingles Vaccine: Expert Q&A| vauthors= Harris S| date= 18 January 2011|website=WebMD| access-date= 4 January 2014 |archive-date= 3 January 2014| archive-url= https://web.archive.org/web/20140103114546/http://www.webmd.com/vaccines/features/shingles-vaccine-for-adults| url-status= live}}</ref> In one study 64% of the Zostavax group and 14% of the controls had some adverse reaction. However, the rates of serious adverse events were comparable between the Zostavax group (0.6%) and those receiving the placebo (0.5%).<ref>{{cite web | url=https://www.rxlist.com/zostavax-side-effects-drug-center.htm | title=Zostavax Side Effects Center | vauthors=Cunha JP | publisher=RxList | access-date=4 January 2014 | archive-date=5 January 2014 | archive-url=https://web.archive.org/web/20140105003948/http://www.rxlist.com/zostavax-side-effects-drug-center.htm | url-status=live }}</ref> A study including children with ] found that the risk of getting shingles after vaccination is much lower than the risk of getting shingles for children with natural chicken pox in their history. Data from healthy children and adults point in the same direction.<ref name="Milvax" />


Zostavax is not used in people with compromised immune function.<ref>{{cite press release | title=Zostavax vaccine | website=Therapeutic Goods Administration (TGA) | date=7 March 2017 | url=https://www.tga.gov.au/alert/zostavax-vaccine | access-date=11 July 2020 | archive-date=12 July 2020 | archive-url=https://web.archive.org/web/20200712022958/https://www.tga.gov.au/alert/zostavax-vaccine | url-status=live }}</ref><ref>{{cite press release | title=Zostavax vaccine | website=Therapeutic Goods Administration (TGA) | date=6 July 2020 | url=https://www.tga.gov.au/alert/zostavax-vaccine-0 | access-date=11 July 2020 | archive-date=11 July 2020 | archive-url=https://web.archive.org/web/20200711234357/https://www.tga.gov.au/alert/zostavax-vaccine-0 | url-status=live }}</ref>
There is a risk to develop ] (shingles) following vaccination. However, this risk is less than after infection with the varicella virus. Most of the cases reported have been mild and have not been associated with serious complications. <ref>{{cite web|url=http://www.vaccineinformation.org/varicel/qandavax.asp|title=Vaccine Information for the public and health professionals|date=|accessdate=May 5,2010}}</ref>


==Effectiveness== == Composition ==
===Shingrix===
Shingrix is a suspension for intramuscular injection consisting of a ]d recombinant varicella zoster virus ] E antigen that is reconstituted at the time of use with AS01<sub>B</sub> suspension as an ]. The antigen is a purified truncated form of the glycoprotein, expressed in ]s. The AS01<sub>B</sub> adjuvant suspension is composed of 3-''O''-desacyl-4'-monophosphoryl ] (MPL) from '']'' (Minnesota strain) and a ] molecule (]) purified from '']'' (soap bark tree) extract, combined in a ] formulation consisting of ] (DOPC) and cholesterol in ] solution.<ref>{{cite web | url = https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/BloodVaccinesandOtherBiologics/VaccinesandRelatedBiologicalProductsAdvisoryCommittee/UCM575190.pdf | title = FDA Shingrix Briefing Document | publisher = U.S. ] (FDA) | access-date = 28 October 2017 | archive-date = 2 November 2017 | archive-url = https://web.archive.org/web/20171102233317/https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/BloodVaccinesandOtherBiologics/VaccinesandRelatedBiologicalProductsAdvisoryCommittee/UCM575190.pdf | url-status = live }}</ref>


===Zostavax===
According to the ], clinical trials have demonstrated that varicella vaccine is 70% to 90% effective for preventing varicella and more than 95% effective for preventing severe varicella. <ref>{{cite web|url=http://aappolicy.aappublications.org/cgi/content/full/pediatrics;105/1/136|title=Can the vaccine cause herpes zoster (shingles)?|date=|accessdate=May 5,2010}}</ref>
Zostavax contains live ] varicella-zoster virus.<ref name="Milvax">{{cite web|url=https://www.merckvaccines.com/Products/Zostavax|title=About Zostavax|date=May 2018|publisher=Merck Sharp & Dohme Corp|access-date=16 November 2018|archive-date=17 November 2018|archive-url=https://web.archive.org/web/20181117022240/https://www.merckvaccines.com/Products/Zostavax}}</ref><ref name="cdc">{{cite web|url=https://www.cdc.gov/vaccines/vpd/shingles/public/zostavax/index.html|title=What everyone should know about Zostavax|publisher=U.S. ] (CDC)|date=18 June 2018|access-date=16 November 2018|archive-date=17 November 2018|archive-url=https://web.archive.org/web/20181117063215/https://www.cdc.gov/vaccines/vpd/shingles/public/zostavax/index.html|url-status=live}}</ref> It is injected subcutaneously (under the skin) in the upper arm.<ref>{{cite web |url= https://www.medicinenet.com/zoster_vaccine_live__shingles_vaccine/article.htm |title= Shingles Vaccine (Zoster Shingles Vaccine Live, Zostavax) |publisher= Medicinenet.com |access-date= 29 April 2018 |archive-date= 12 November 2017 |archive-url= https://web.archive.org/web/20171112132202/https://www.medicinenet.com/zoster_vaccine_live__shingles_vaccine/article.htm |url-status= live }}</ref> The live vaccine is produced using the ] line of ] ].<ref name="Zostavax FDA label" /> This has raised religious and ethical concerns for some potential users, since that cell line was derived from an ].<ref>{{cite web|url=https://micro.magnet.fsu.edu/primer/techniques/fluorescence/gallery/cells/mrc5/mrc5cells.html|title=Human Fetal Lung Fibroblast Cells (MRC-5 Line)|publisher=Florida State University|vauthors=Davidson MW|date=13 November 2015|access-date=6 September 2020|archive-date=27 April 2021|archive-url=https://web.archive.org/web/20210427073549/https://micro.magnet.fsu.edu/primer/techniques/fluorescence/gallery/cells/mrc5/mrc5cells.html|url-status=live}}</ref>


==Cost effectiveness==
Furthermore, follow-up evaluations took place in the United States of children immunized that revealed protection for at least 11 years. Also, studies were conducted in ] which indicated protection for at least 20 years. <ref>{{cite web|url=http://aappolicy.aappublications.org/cgi/content/full/pediatrics;105/1/136 |title=Duration of immunity|date=|accessdate=May 5,2010}}</ref>
A 2007 study found that the live vaccine is likely to be cost-effective in the US, projecting an annual savings of {{US$|82}} to {{US$|103}} million in healthcare costs with cost-effectiveness ratios ranging from {{US$|16,229}} to {{US$|27,609}} per ] gained.<ref>{{cite journal | vauthors = Pellissier JM, Brisson M, Levin MJ | title = Evaluation of the cost-effectiveness in the United States of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults | journal = Vaccine | volume = 25 | issue = 49 | pages = 8326–8337 | date = November 2007 | pmid = 17980938 | doi = 10.1016/j.vaccine.2007.09.066 }}</ref> In 2007, the live vaccine was officially recommended in the US for healthy adults aged 60 and over, but is no longer given out in the United States {{as of|2020|lc=y}}, given the superiority of Shingrix.<ref name="MMWR_57(05)">{{cite journal | vauthors = Harpaz R, Ortega-Sanchez IR, Seward JF | title = Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP) | journal = MMWR. Recommendations and Reports | volume = 57 | issue = RR-5 | pages = 1–30; quiz CE2–4 | date = June 2008 | pmid = 18528318 | url = https://www.cdc.gov/mmwr/PDF/rr/rr5705.pdf | access-date = 6 September 2020 | archive-date = 8 June 2021 | archive-url = https://web.archive.org/web/20210608232821/http://www.cdc.gov/mmwr/pdf/rr/rr5705.pdf | url-status = live }}</ref><ref name="pmid17947396">{{cite journal | author = Advisory Committee on Immunization Practices | title = Recommended adult immunization schedule: United States, October 2007-September 2008 | journal = Annals of Internal Medicine | volume = 147 | issue = 10 | pages = 725–729 | date = November 2007 | pmid = 17947396 | doi = 10.7326/0003-4819-147-10-200711200-00187 | s2cid = 31630647 }}</ref><ref>{{cite journal | vauthors = Dooling KL, Guo A, Patel M, Lee GM, Moore K, Belongia EA, Harpaz R | title = Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 67 | issue = 3 | pages = 103–108 | date = January 2018 | pmid = 29370152 | pmc = 5812314 | doi = 10.15585/mmwr.mm6703a5 | doi-access = free | url = https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6703a5-H.pdf | access-date = 10 June 2023 | archive-date = 29 August 2021 | archive-url = https://web.archive.org/web/20210829055010/https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6703a5-H.pdf | url-status = live }}</ref>


In Canada the cost of Shingrix is about {{CA$|300}} for the two doses.<ref name="TI2018" /> This likely represents a more cost effective intervention than the live vaccine given its lower cost and increased effectiveness.<ref>{{cite journal | vauthors = Le P, Rothberg MB | title = Cost-effectiveness of the Adjuvanted Herpes Zoster Subunit Vaccine in Older Adults | journal = JAMA Internal Medicine | volume = 178 | issue = 2 | pages = 248–258 | date = February 2018 | pmid = 29297049 | pmc = 5838796 | doi = 10.1001/jamainternmed.2017.7431 }}</ref>
People who do not develop enough protection when they get the vaccine may develop a mild case of the disease when in close contact with a person with chickenpox. In these cases, people show very little sign of illness. This has been the case of children who get the vaccine in their ] and later have contact with children with chickenpox. Some of these children may develop a mild chickenpox also known as breakthrough disease. <ref>{{cite web|url=http://www.hoptechno.com/chickenpox-vac.htm |title=Varicella Vaccine (Chickenpox)|date=|accessdate=May 5,2010}}</ref>


== Controversy == ==History==
=== European Union ===
Mortality due to primary varicella has declined significantly in countries which make wide use of the varicella vaccine.<!--
--><ref name="Seward2002"/><!--
--><ref name="Wise2000"/>
Zoster (shingles) most often occurs in the elderly. Multiple studies have not observed any effect on zoster incidence. This may be because infants and children immunized in varicella vaccination programs have not yet reached the age where zoster typically occurs. It is likewise too early to observe the effect on ] (PHN).


In 2006, the ] (EMA) issued a marketing authorization for the zoster vaccine to ] for routine vaccination in individuals aged 60 and over.<ref>{{cite web | url=https://www.ema.europa.eu/en/documents/overview/zostavax-epar-summary-public_en.pdf | title=Zostavax EPAR | date=July 2006 | access-date=27 March 2011 | publisher=] (EMA) | archive-date=5 July 2019 | archive-url=https://web.archive.org/web/20190705162552/https://www.ema.europa.eu/en/documents/overview/zostavax-epar-summary-public_en.pdf | url-status=live }}</ref><ref name="Zostavax EPAR" /> In 2007, the EMA updated the marketing authorization for routine vaccination in individuals aged 50 and over.<ref>{{cite web| url=https://www.ema.europa.eu/en/documents/scientific-discussion-variation/zostavax-h-c-674-ii-0003-epar-scientific-discussion-variation_en.pdf| title=Zostavax-H-C-674-II-03 Scientific Discussion| date=21 June 2007| access-date=27 March 2011| archive-date=5 July 2019| archive-url=https://web.archive.org/web/20190705162622/https://www.ema.europa.eu/en/documents/scientific-discussion-variation/zostavax-h-c-674-ii-0003-epar-scientific-discussion-variation_en.pdf| url-status=live}}</ref><ref name="Zostavax EPAR">{{cite web | title=Zostavax EPAR | website=] (EMA) | date=17 September 2018 | url=https://www.ema.europa.eu/en/medicines/human/EPAR/zostavax | access-date=31 July 2020 | archive-date=5 August 2020 | archive-url=https://web.archive.org/web/20200805022553/https://www.ema.europa.eu/en/medicines/human/EPAR/zostavax | url-status=live }}</ref>
It has been claimed that adult shingles may increase after introduction of varicella vaccine.<!--
--><ref name="Yih2005">{{cite journal | author=Yih WK, Brooks DR, Lett SM, Jumaan AO, Zhang Z, Clements KM, Seward JF | title=The incidence of varicella and herpes zoster in Massachusetts as measured by the Behavioral Risk Factor Surveillance System (BRFSS) during a period of increasing varicella vaccination coverage, 1998-2003 | journal=BMC Public Health | volume=5| issue=1 | year=2005 | pages=68–68 | pmid=15960856 | doi=10.1186/1471-2458-5-68 | pmc=1177968}}</ref><!--
--><ref name="HerpesDoctor-506-Jack">{{cite web | author=Jack | title=Chickenpox Vaccine Linked with Shingles Epidemic | url=http://www.herpesdoctor.com/node/506 | publisher=HerpesDoctor | date=2005 | accessdate=2006-08-18}}</ref>
Preliminary evidence that this has occurred is available from data collected from the Antelope Valley Varicella Surveillance Project (VASP) which began surveillance of shingles in 2000. VASP case reports indicate there was a statistically significant increase in adult shingles cases reported to the Antelope Valley Varicella Active Surviellance Project (VASP) from 2000 to 2003. The 56.1% increase from 237 cases in 2000 to 370 cases in 2002 yields a rate ratio of 1.4 (95% C.I. 1.2-1.7). Increases in cases of shingles reported to VASP occurred in every age category (except 70+) from 2000 to 2001. VASP also reported that verified cases of shingles among adults aged 50 years and older increased 27.5% from 2006 to 2007. (Annual Summary, 2001, 2002, 2003, 2006, 2007 Antelope Valley Varicella Active Surveillance Project, Los Angeles County Department of Health Services; Centers for Disease Control and Prevention (CDC) Cooperative Agreement No. U66/CCU911165-10; Mascola L, et al.) <!--
--><ref name="Brisson2002">{{cite journal | author=Brisson M, Gay NJ, Edmunds WJ, Andrews NJ | title=Exposure to varicella boosts immunity to Herpes-zoster: implications for mass vaccination against varicella | journal=Vaccine | year=2002 | volume=20 | pages=2500&ndash;7 | pmid=12057605 | doi=10.1016/S0264-410X(02)00180-9 | issue=19-20}}</ref>


Shingrix was approved for medical use in the European Union in March 2018, with an indication for the prevention of herpes zoster (HZ) and post-herpetic neuralgia (PHN) in adults 50 years of age or older.<ref name="Shingrix EPAR">{{cite web | title=Shingrix EPAR | website=] (EMA) | date=17 September 2018 | url=https://www.ema.europa.eu/en/medicines/human/EPAR/shingrix | access-date=31 July 2020 | archive-date=4 August 2018 | archive-url=https://web.archive.org/web/20180804190847/http://www.ema.europa.eu/ema/index.jsp?curl=pages%2Fmedicines%2Fhuman%2Fmedicines%2F004336%2Fhuman_med_002240.jsp&mid=WC0b01ac058001d124 | url-status=live }} Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.</ref>
Additional controversy has arisen because cell lines derived from aborted fetal tissue were used in its development, and thus violates the ethics and beliefs of people who oppose the use of aborted fetal tissue in medical research.<ref>{{cite web|url=http://web.archive.org/web/20070212172520/http://www.cdc.gov/nip/vacsafe/concerns/gen/humancell.htm |title=NIP: Vacsafe/Concerns/Gen/Human Cell Cultures in Manufacturing Vaccines |publisher=Web.archive.org |date= |accessdate=2011-02-08}}</ref>


===Duration of immunity=== === United Kingdom ===
Some vaccinated children have been found to lose their protective antibody in as little as five to eight years.<ref>{{cite journal |author=Chaves SS, Gargiullo P, Zhang JX, ''et al.'' |title=Loss of vaccine-induced immunity to varicella over time |journal=N. Engl. J. Med. |volume=356 |issue=11 |pages=1121–9 |year=2007 |month=March |pmid=17360990 |doi=10.1056/NEJMoa064040 |url=}}</ref> However, according to the ]: "After observation of study populations for periods of up to 20 years in Japan and 10 years in the United States, more than 90% of immunocompetent persons who were vaccinated as children were still protected from varicella." However, since only one out of five Japanese children were vaccinated, the annual exposure of these vaccinees to children with natural chickenpox boosted the vaccinees' immune system. In the United States, where universal varicella vaccination has been practiced, the majority of children no longer receive exogenous (outside) boosting, thus, their cell-mediated immunity to VZV (varicella zoster virus) wanes--necessitating booster chickenpox vaccinations.<!--
--><ref name="WHO-Varicella vaccine"/>
Some persons exposed to the virus after vaccine can experience milder cases of chicken pox (and usually then harbor both the attenuated vaccine or oka strain as well as the wild type or natural chickenpox strain which are both subject to reactivation as shingles).<!--
--><ref name="CDCP-diseaseFAQs">{{cite web | work=Varicella Disease (Chickenpox) | title=General questions about the disease | url=http://www.cdc.gov/nip/diseases/varicella/faqs-gen-disease.htm | date=December 20, 2001 | publisher=CDCP | accessdate=2006-08-18}}</ref>


From 2013, the UK ] (NHS) started offering shingles vaccination to elderly people. People aged either 70 or 79 on 1 September 2013, were offered the vaccine. People aged 71 to 78 on that date would only have an opportunity to have the shingles vaccine after reaching the age of 79.<ref>{{cite web|title=Shingles Vaccination (16 July 2013, archived)|website=NHS UK|url=https://www.nhs.uk/Conditions/vaccinations/Pages/shingles-vaccination.aspx|archive-url=https://web.archive.org/web/20140602024601/https://www.nhs.uk/Conditions/vaccinations/Pages/shingles-vaccination.aspx|archive-date=2 June 2014|url-status=live}}</ref> The original intention was for people aged ''between'' 70 and 79 to be vaccinated, but the NHS later said that the vaccination program was being staggered as it would be impractical to vaccinate everyone in their 70s in a single year.<ref>{{cite web|title=Who can have the shingles vaccine? (16 July 2013, archived)|website=NHS UK|url=https://www.nhs.uk/Conditions/vaccinations/Pages/who-can-have-the-shingles-vaccine.aspx|archive-url=https://web.archive.org/web/20140410102402/https://www.nhs.uk/Conditions/vaccinations/Pages/who-can-have-the-shingles-vaccine.aspx|archive-date=10 April 2014|url-status=live}}</ref>
Catching "wild" chickenpox as a child has been thought to commonly result in lifelong immunity. Indeed, parents have deliberately ensured this in the past with "pox parties" (see below). Historically, exposure of adults to contagious children has boosted their immunity, reducing the risk of shingles.<ref name="HerpesDoctor-506-Jack"/>


In 2021, vaccination against shingles is available on the NHS to people aged 70 to 79.<ref name="NHS Shingles 2021" /> Vaccination is with single-dose Zostavax, except for people for whom Zostavax is deemed unsuitable, for example, with a condition that affects the immune system, for whom two-dose Shingrix vaccine is recommended.<ref name="NHS Shingles 2021" /> The NHS stated "The shingles vaccine is not available on the NHS to anyone aged 80 or over because it seems to be less effective in this age group".<ref name="NHS Shingles 2021">{{cite web | title=Shingles vaccine overview | website=] (NHS) | date=31 August 2021 | url=https://www.nhs.uk/conditions/vaccinations/shingles-vaccination/ | access-date=26 November 2021 | archive-date=2 June 2014 | archive-url=https://web.archive.org/web/20140602024601/https://www.nhs.uk/Conditions/vaccinations/Pages/shingles-vaccination.aspx | url-status=live }}</ref> Since 2023, the shingles vaccines is being offered to healthy people turning 65.<ref>{{Cite web |title=Why you may have to wait for your shingles vaccine |url=https://www.gov.uk/government/publications/shingles-vaccination-why-you-are-being-asked-to-wait/why-you-may-have-to-wait-for-your-shingles-vaccine |access-date=14 April 2024 |website=GOV.UK |language=en}}</ref>
<!-- immunocompromise is a different topic really -->
The CDC and corresponding national organisations are carefully observing the failure rate which may be high compared with other modern vaccines - large outbreaks of chickenpox having occurred at schools which required their children to be vaccinated.<!--
--><ref>{{dead link|date=February 2011}}</ref><!--
--><ref>{{cite journal |author=Tugwell BD, Lee LE, Gillette H, Lorber EM, Hedberg K, Cieslak PR |title=Chickenpox outbreak in a highly vaccinated school population |journal=Pediatrics |volume=113 |issue=3 Pt 1 |pages=455–9 |year=2004 |month=March |pmid=14993534 |doi=10.1542/peds.113.3.455 |url=}}</ref><!--
--><ref>http://www.al.com/news/huntsvilletimes/index.ssf?/base/news/113464189674151.xml&coll=1</ref><!--
--><ref>{{dead link|date=February 2011}}</ref><!--
--><ref>{{cite web|author=By HealthiNation |url=http://health.yahoo.com/ency/healthwise/hw208205 |title=Yahoo! Health |publisher=Health.yahoo.com |date= |accessdate=2011-02-08}}</ref>


===Immunocompromise=== ===United States===
Zostavax was developed by ] and approved and licensed by the US ] (FDA) in May 2006,<ref name=Mitka2006/> In 2011, the FDA approved the live vaccine for use in individuals 50 to 59 years of age.<ref name="Zostavax FDA label" /><ref>{{cite press release |date = 24 March 2011 |title = FDA approves Zostavax vaccine to prevent shingles in individuals 50 to 59 years of age |url = https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm248390.htm |publisher = U.S. ] (FDA) |access-date = 27 March 2011 |archive-url = https://web.archive.org/web/20110327063156/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm248390.htm |archive-date = 27 March 2011 }}</ref> Shingrix is a zoster vaccine developed by ] that was approved in the United States in October 2017.<ref>{{cite web |url = https://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM581750.pdf |title = BBL approval |date = 20 October 2017 |access-date = 29 April 2018 |publisher = U.S. ] (FDA) |archive-date = 1 November 2017 |archive-url = https://web.archive.org/web/20171101133001/https://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM581750.pdf |url-status = live }}</ref> Shingrix, which provides strong protection against shingles and PHN, was preferred over Zostavax before Zostavax was discontinued.<ref name=CDC2019Sym>{{cite web|title=Shingles (Herpes Zoster) Vaccination |url=https://www.cdc.gov/shingles/vaccination.html|publisher=U.S. ] (CDC) |archive-url=https://web.archive.org/web/20181207192225/https://www.cdc.gov/shingles/vaccination.html|archive-date=7 December 2018}}</ref>
The mortality rate in immunocompromised patients with disseminated herpes zoster is 5-15%, with most deaths from ]. Vaccines are less effective among these high-risk patients, as well as being more dangerous because they contain attenuated live virus (see last footnote). In a study performed on children with an ], 30% had lost the antibody after five years, and 8% had already caught wild chickenpox in that five year period.<!--
--><ref>{{cite journal | author = Pirofski L, Casadevall A | title = Use of licensed vaccines for active immunization of the immunocompromised host. | journal = Clin Microbiol Rev | volume = 11 | issue = 1 | pages = 1–26 | date=1 January 1998| pmid = 9457426 | url=http://cmr.asm.org/cgi/content/full/11/1/1?view=long&pmid=9457426 | pmc = 121373 }}</ref>


In June 2020, Merck discontinued the sale of Zostavax in the US. Vaccine doses already held by practitioners could still be administered up to the expiration date (none expired later than November 2020).<ref>{{cite web | title = Product Discontinuation Notice: Zostavax (Zoster Vaccine Live)| url = https://www.merckvaccines.com/wp-content/uploads/sites/8/2020/06/US-CIN-00033.pdf | archive-url = https://web.archive.org/web/20200818193428/https://www.merckvaccines.com/wp-content/uploads/sites/8/2020/06/US-CIN-00033.pdf | archive-date = 18 August 2020 }}</ref><ref name="cdc" />
==Pox parties==
{{Main|Pox party}}
A "pox party" is a party held by parents for the purpose of infecting their children with childhood diseases. Similar ideas have applied to other diseases, e.g. ], but are now discouraged by doctors and health services due to the risk of serious injury or death (even in children, as described above) from acquiring the disease. The reasoning behind such parties is that guests exposed to the ] virus will contract the disease and develop strong and persistent ] at an age before disaster is likely, particularly from chickenpox or ]. The first reference to such a practice is the letter of ] to ] describing parties held in Istanbul for the purpose of ]&mdash;an effective technique for gaining immunity to ].<ref>{{dead link|date=February 2011}}</ref> Lady Montagu imported variolation to England.


The US ] (CDC) recommends that healthy adults 50 years and older get two doses of Shingrix, at least two months apart. Initial clinical trials only tested a gap of less than six months between doses, but unexpected popularity and resulting shortages caused further testing to validate wider spacing of the two doses.<ref>{{cite news |title=Don't panic if you're put on a waiting list for the new shingles vaccine |url=https://www.washingtonpost.com/national/health-science/dont-panic-if-youre-put-on-a-waiting-list-for-the-new-shingles-vaccine/2018/07/24/248d972e-8e8d-11e8-8322-b5482bf5e0f5_story.html |newspaper=The Washington Post |date=29 July 2018 |access-date=24 January 2020 |vauthors=Cimons M |quote=The Centers for Disease Control and Prevention, which issues vaccine recommendations, says patients who wait longer than six months needn't worry, but they should get that second dose as soon as possible. Be sure not to skip it, because two doses convey the maximum immunity, more than 90%. |archive-date=5 August 2019 |archive-url=https://web.archive.org/web/20190805210246/https://www.washingtonpost.com/national/health-science/dont-panic-if-youre-put-on-a-waiting-list-for-the-new-shingles-vaccine/2018/07/24/248d972e-8e8d-11e8-8322-b5482bf5e0f5_story.html |url-status=live }}</ref><ref>{{cite web |title=Frequently Asked Questions About Shingrix |url=https://www.cdc.gov/vaccines/vpd/shingles/hcp/shingrix/faqs.html |publisher=U.S. ] (CDC) |date=26 March 2018 |access-date=23 January 2020 |quote=You and patients should make every effort to ensure that two doses are administered within the recommended 2–6 month interval. If more than 6 months have elapsed since the first dose, administer the second dose as soon as possible. Do not restart the vaccine series... |archive-date=1 May 2021 |archive-url=https://web.archive.org/web/20210501204759/https://www.cdc.gov/vaccines/vpd/shingles/hcp/shingrix/faqs.html |url-status=live }}</ref> Adults 19 years and older who are ] because of disease or therapy are also recommended to receive two doses of Shingrix.<ref name="Shingrix-CDC" />
==See also==

*]
The zoster vaccine is covered by ]. In 2019, more than 90% of Medicare Part D vaccine spending was for the zoster vaccine. 5.8 million vaccine doses were administered to Part D beneficiaries that year at a cost of $857 million.<ref>{{Cite book|url=https://www.medpac.gov/document/june-2021-report-to-the-congress-medicare-and-the-health-care-delivery-system/|title=Report to the Congress: Medicare and the Health Care Delivery System|publisher=Medicare Payment Advisory Commission|date=June 2021|page=254|access-date=15 June 2022|archive-date=24 May 2022|archive-url=https://web.archive.org/web/20220524175108/https://www.medpac.gov/document/june-2021-report-to-the-congress-medicare-and-the-health-care-delivery-system/|url-status=live}}</ref>

== Research ==
There is emerging evidence that the shingles vaccine may protect against ].<ref>{{cite news | vauthors = George J |title=Dementia Risk Drops With Shingles Vaccine — Recombinant shingles vaccine tied to 164 additional days without dementia diagnosis |url=https://www.medpagetoday.com/neurology/dementia/111252 |publisher=MED Page Today |date=26 July 2024}}</ref> A 2024 study of over 200,000 older US adults found that the recombinant shingles vaccine was linked to a larger reduction in dementia compared to the live shingles vaccine.<ref name=":1">{{cite journal | vauthors = Taquet M, Dercon Q, Todd JA, Harrison PJ | title = The recombinant shingles vaccine is associated with lower risk of dementia | journal = Nature Medicine | page = 1 | date = July 2024 | pmid = 39053634 | doi = 10.1038/s41591-024-03201-5 | doi-access = free | pmc = 11485228 }}</ref> Over a six-year follow-up, those who received the recombinant vaccine had a 17% increase in time without a dementia diagnosis compared to those who received the live vaccine.<ref name=":1" />


==References== ==References==
{{Reflist|2}} {{Reflist}}


==Further reading==
{{vaccines}}
{{refbegin}}
{{Varicella zoster}}
* {{cite journal | vauthors=((World Health Organization)) | year=2014 | title=Varicella and herpes zoster vaccines: WHO position paper, June 2014 | journal=Weekly Epidemiological Record | volume=89 | issue=25 | pages=265–287 | hdl=10665/242227 | url=https://www.who.int/immunization/position_papers/WHO_pp_varicella_herpes_zoster_june2014_summary.pdf?ua=1 | pmid=24983077 | access-date=20 December 2019 | archive-date=28 July 2021 | archive-url=https://web.archive.org/web/20210728105047/http://www.who.int/immunization/position_papers/WHO_pp_varicella_herpes_zoster_june2014_summary.pdf?ua=1 | url-status=live }}
* {{cite book | publisher = U.S. ] (CDC) | title = Epidemiology and Prevention of Vaccine-Preventable Diseases | veditors = Hall E, Wodi AP, Hamborsky J, Morelli V, Schillie S | edition = 14th | location = Washington D.C. | year = 2021 | chapter = Chapter 23: Zoster | chapter-url = https://www.cdc.gov/vaccines/pubs/pinkbook/herpes-zoster.html | url = https://www.cdc.gov/vaccines/pubs/pinkbook/index.html | access-date = 9 January 2020 | archive-date = 30 December 2016 | archive-url = https://web.archive.org/web/20161230001534/https://www.cdc.gov/vaccines/pubs/pinkbook/index.html | url-status = live }}
{{refend}}


==External links==
{{DEFAULTSORT:Varicella Vaccine}}
* U.S. ] (FDA)
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* U.S. ] (FDA)
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* {{cite web | title=Shingrix Vaccine Information Statement | website=U.S. ] (CDC) | date=19 May 2023 | url=https://www.cdc.gov/vaccines/hcp/vis/vis-statements/shingles-recombinant.html}}
* {{Cite web|url=https://www.fda.gov/vaccines-blood-biologics/vaccines/zostavax-herpes-zoster-vaccine-questions-and-answers |title=Zostavax (Herpes Zoster Vaccine) Questions and Answers |website=Questions about Vaccines |date=18 February 2021 |publisher=U.S. ] (FDA)}}


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