Status:
Resolved
Health advisory:
170002
Date Issued:
03 Mar 2017
Issued by:
Professor Charles Guest, Chief Health Officer, Victoria
Issued to:
Health professionals, Aged Care facilities, Victorian public

Key messages

  • The shingles vaccine Zostavax® has been provided free for 70-79 year olds since November 2016.
  • Zostavax® is contraindicated in patients who are immunocompromised.
  • Administration, where contraindicated, has resulted in a death in Australia.
  • Do not administer Zostavax® to patients who are immunocompromised.
  • If someone is on a combination of medications or if there is any doubt whether Zostavax® is safe for your patient, defer vaccination and seek specialist advice.
  • If in doubt seek advice from a specialist or the Department of Health & Human Services Immunisation Section on telephone: 1300 882 008.

What is the issue?

Zostavax® contains live attenuated varicella-zoster virus, containing 14 times more virus than childhood varicella vaccines. Administration to people who are immunocompromised is associated with risk of disseminated disease from the vaccine virus. This occurs when a disease spreads from its initial point of origin in the body into other areas.

Who is at risk?

In addition to being contraindicated for those with previous anaphylaxis to the vaccine or its components, it is vital all GPs are aware of the following contraindications, which include, but is not limited to:

  • Haematological or generalised malignancies (including those not on treatment): e.g. lymphoma, acute or chronic leukaemia, Hodgkin's disease
  • Solid organ or bone marrow transplant recipients (with exceptions as advised by specialists)
  • HIV/AIDS (with exceptions as advised by specialist) or other congenital/acquired immunodeficiencies
  • Current or recent high-dose systemic immunosuppressive therapy: e.g. chemotherapy, radiation therapy, oral corticosteroids, disease modifying anti-rheumatic drugs.

Prevention / treatment

If an immunocompromised person is inadvertently given Zostavax®:

  • Urgently contact the treating specialist or infectious disease specialist for advice on use of antivirals.
  • Alternatively, call the Victorian Department of Health & Human Services Immunisation Section on telephone: 1300 882 008, Monday to Friday 9am to 12pm midday and 2pm to 3pm.

More information

Guide to safe doses of immunosuppressive therapy for Zostavax® administration:

Mechanism of Action

Examples

Safe Dose*

Comments

Anti-TNF

Etanercept, Infliximab, Adalimumab

NONE

Immunise 1 month prior to treatment initiation OR 12 months post treatment cessation

IL-1 inhibition

Anakinra

NONE

Co-stimulation blockade

Abatacept

NONE

B-cell Depletion/Inhibition

Rituximab

NONE

Immunomodulators (Antimetabolites)

Azathioprine

6-Mercaptopurine

Methotrexate

≤3.0 mg/kg/day

≤1.5 mg/kg/day

≤0.4 mg/kg/week

If on higher dose, immunise 1 month prior to treatment initiation OR 3 months post cessation

Refer to Immunisation handbook and NCIRS factsheet (below)

Corticosteroids

Prednisone

Complex

T-cell activation inhibition

Tacrolimus, Cyclosporine

NONE

Immunise 1 month prior to treatment initiation OR 3 months post cessation

Others

Cyclophosphamide, Mycophenolate, Sulfasalazine

NONE

* See the current online Australian Immunisation Handbook, Chapters 3.3.3 and 4.24

Clinical information

  • National Centre for Immunisation Research & Surveillance (NCIRS) Zoster fact sheet
  • National Centre for Immunisation Research & Surveillance (NCIRS) Herpes fact sheet
  • SAEFVIC - the Victorian vaccine safety service on telephone 1300 882 924 (option 1)

Consumer information

Shingles information at the Better Health Channel