Zostavax: The Shingle Vaccine

As seen in Consultant Connection November 2012 Issue
By: Cody Siebenaller, ONU, PharmD Candidate, ICP Clinical Pharmacy Student
 
Shingles is a painful infection that is commonly seen among the elderly. It initially presents initially with pain down one side of the body or face. This pain progresses into a red rash that develops into blisters. The blisters proceed to break open and dry into a crust, which usually falls off in two to three weeks. The shingles virus generally infects one nerve. Shingles is caused by the varicella-zoster virus, the same virus that causes chicken pox in children and young adults. Because shingles is caused by a virus, typical antibiotics used against bacterial infections will be of no benefit to treat the outbreak. The only treatments available are antivirals such as acyclovir or valacyclovir. The pain associated with shingles is caused by inflammation of the nerves and it is not muscular or skeletal in nature. Because of this, typical pain relievers, including over the counter medications and narcotic pain relievers may not be effective. Gabapentin is sometimes prescribed for the pain associated with shingles because it relieves nerve associated pain.
 
While inital outbreak of shingles is painful and debilitating, the most serious result is the possibly of postherpetic neuralgia. Postherpetic neuralgia is a condition in which the pain associated with the shingles outbreak continues after the rash and blisters have resolved. This pain can range from mild discomfort to severe and debilitating pain. Treatment usually consists of gabapentin. This is more common in the elderly, which is why shingles prevention is important as opposed to treating patients once they have already developed the disease.
 
Zostavax is the brand name for the vaccine used to prevent the occurrence of shingles. It is indicated for the prevention of shingles in patients over the age of 50. The Centers for Disease Control (CDC) currently recommends all patients over the age of 60, who have not yet received the zoster vaccine and who are not contraindicated for it use, should receive Zostavax. Patients who would be considered contraindicated include, those who have a decrease immune system, patients receiving immunosuppressant therapy including high dose steroids, or any other patients whose immune system is compromised, such as patients with HIV or leukemia. Zostavax needs to only be administered one time in patients over 60 years of age. It is injected subcutaneously in the upper deltoid region of the arm. Zostavax should be stored between -58°F to 5°F, meaning it should be kept in the freezer. Zostavax is provided as a powder, meaning it must be reconstituted. The diluent provided should be stored at either room temperature or in the refrigerator. To reconstitute Zostavax, all of the diluent should be brought into a syringe and then injected into the vial of powdered vaccine. The vaccine should then be gently mixed, not shaken, until all the vaccine has been dissolved. The vaccine can then be administered to the patient.
 
In conclusion, Shingles is an infection caused by the same virus that causes chicken pox. In the elderly it can cause painful postherpetic neuralgia that can be severe and debilitating. Because of this all patients over the age of 60 who are not contraindicated for that administration of Zostavax, should receive the vaccine.
 
References
1. “Recommended Adult Immunization Schedule — United States, 2012.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 03 Feb. 2012. Web. 10 Sept. 2012. <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6104a9.htm>.
2. Board, A.D.A.M. Editorial. Shingles. U.S. National Library of Medicine, 18 Nov. 0000. Web. 10 Sept. 2012. <http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001861/>
3. Lexi-Comp, Inc. (Lexi-DrugsTM ). Zostavax. Lexi-Comp, Inc.; September 10, 2012
4. Lexi-Comp, Inc. (Lexi-DrugsTM ). acyclovir. Lexi-Comp, Inc.; September 10, 2012

5. Lexi-Comp, Inc. (Lexi-DrugsTM ). gabapentin. Lexi-Comp, Inc.; September 10, 2012

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