What is the Varicella-Zoster Virus ?
Varicella-zoster virus (VZV) is a very infectious virus which can cause 2 distinct clinical diseases:
- Chicken Pox
Primary infection with varicella – zoster virus causes chickenpox, a common childhood infection. The virus may remain dormant in some of the dorsal root ganglion of nerves of the spinal cord. The virus can become reactivated after a period of time, maybe several decades and cause Shingles.
How can Stakelum’s Pharmacy help?
Because The Herpes Zoster Vaccine is not on the National Immunisation Programme all patients are required to pay for vaccine.
To book an appointment, please email us at firstname.lastname@example.org or call us on 086 555 3345.
Effects Of Varicella Zoster Virus
Varicella is typically a benign infection of childhood characterised by a generalised pruritic vesicular rash. A mild prodrome of fever and malaise may occur, more commonly in adults. The rash usually starts on the head and progresses to the trunk and extremities. The rash may involve mucous membranes (mouth, respiratory tract, vagina, conjunctiva and cornea). The rash progresses from macules to papules to vesicular lesions that crust over as they dry. Successive crops appear over several days. The number of lesions ranges from a few to hundreds. In children, the clinical course is generally mild with malaise, pruritus and fever for 2-3 days. Complications are uncommon in childhood and include superinfection (usually with Group A streptococcus), skin scarring, encephalitis, pneumonia, glomerulonephritis, myocarditis, hepatitis and coagulopathy.
The risk of complications is higher in infants aged < 1 year and in persons aged > 15 years, particularly pregnant women, smokers, and the immunocompromised. Diagnosis is primarily clinical. If necessary, diagnosis can be confirmed from a swab of vesicular fluid by culture or biopsy for electron microscopy. Serology is also available and can be used to demonstrate immunity. Recovery from varicella usually results in lifelong immunity. Recurrent disease is rare but is more likely in immunocompromised individuals
Herpes Zoster Vaccine
Herpes zoster vaccines are licensed for individuals aged ≥50 years to reduce the risk of developing zoster and postherpetic neuralgia. It is not necessary to determine whether patients have a history of varicella or zoster prior to vaccination because waning antibodies in previously exposed patients (particularly older adults) may lead to negative results despite past infection. There are two licensed zoster vaccines:
Zostavax®, live attenuated vaccine (designated zoster vaccine live [ZVL]. It is indicated for prevention of herpes zoster and herpes zoster-related postherpetic neuralgia (PHN) in individuals aged ≥50 years.
Shingrix®, non-live recombinant glycoprotein E vaccine (designated recombinant zoster vaccine [RZV]. It is indicated for prevention of herpes zoster (HZ) and post-herpetic neuralgia (PHN) in adults aged ≥50 years. It is currently not available in Ireland. An up to date list of licensed and marketed vaccines can be accessed on the HPRA website www.hpra.ie
The vaccines should be stored at +2○ to +8○ C and protected from light. After reconstitution the vaccine should be used immediately. Discard any vaccine unused after 30 minutes. Dose and route of administration Zostavax: the dose is 0.65ml IM or SC, preferably in the upper arm.
Recommendations (per the HSE)
Herpes zoster vaccination may be considered in those aged ≥50 years, due to the greater burden and severity of disease in this age group. The vaccine may be given to those who have had zoster. It is prudent to defer vaccination for 12 months after the zoster has resolved so that the vaccine can produce a more effective immune response. As the vaccine is not part of the national immunisation programme, individuals aged ≥50 years wishing to receive it should consult with their GP or pharmacist.
There are insufficient data to make definitive recommendations regarding zoster vaccination in immunocompromised persons aged ≥50 years. The approach to vaccination in immunocompromised patients depends upon when immunosuppression is planned, underlying condition, and the choice of vaccine.
Patients should ideally be vaccinated ≥4 weeks before the initiation of immunosuppressive therapy.
Patients receiving low-dose immunosuppressive therapy are likely to respond to vaccination but disseminated zoster with vaccine type virus may rarely occur.
Acute severe febrile illness– defer until recovery.
Pregnancy should be avoided for 1 month following vaccination.
Administration to individuals who are immunocompromised may result in disseminated VZV disease, including fatal outcomes. Patients who previously received immunosuppressive therapy should be carefully evaluated for reconstitution of their immune system prior to receiving ZVL.
The safety and efficacy of ZVL has not been established in adults infected with HIV with or without evidence of immunosuppression.
This vaccine should be given subcutaneously to individuals with severe thrombocytopoenia or any significant coagulation disorder, because they may bleed following IM injections.