Herpes zoster (shingles)
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Oral health training for primary health care workers.
Herpes zoster, also known as shingles, results from reactivation of latent varicella-zoster virus (VZV). Following primary infection, which causes varicella (chickenpox), VZV remains dormant lifelong in sensory nerve ganglia and can reactivate later in life.
Herpes zoster can occur at any age but is most commonly a disease of older adults, with incidence beginning to rise from 50 years of age. The most common serious complication is post-herpetic neuralgia, persistent pain that can strongly affect physical, psychological, social and functional well-being. Disease and complications are more frequent and often more severe in people who are immunocompromised.
Herpes zoster vaccines
The currently only widely available herpes zoster vaccine is the recombinant zoster vaccine, first licensed in 2017. Additional herpes zoster vaccines are licensed for use in the domestic markets.
WHO’s recommendations for the use
- WHO recommends the use of herpes zoster vaccines to prevent herpes zoster in older adults in countries where the disease is considered an important public health problem.
- Countries should consider herpes zoster vaccination within a life-course approach to immunization and as part of programmes that support healthy ageing.
- The decision to introduce vaccination, determine a target age group from 50 years of age and select an implementation strategy should be guided by national and subnational disease burden, affordability, cost-effectiveness, vaccine impact modelling and programme delivery considerations.
- Vaccination may be offered irrespective of a previous history of varicella or varicella vaccination.
- As RZV is currently the only widely available product, the recommendations focus on this vaccine.
Vaccine schedule
- Two doses of RZV should be administered by intramuscular injection. The second dose should be given 2–6 months after the first dose.
- The second dose is essential for optimal protection, even if it is delayed for a year or more.
- Booster doses are not currently recommended.
Specific populations and additional considerations
- Countries could consider two doses of RZV for people older than 18 years with immunocompromising conditions who are at increased risk of herpes zoster.
- For immunocompromised people who would benefit from a shorter schedule, including before imminent immunosuppression, the second dose may be administered from one month after the first dose.
- RZV may be administered to people living with HIV, including people with advanced HIV disease; vaccination will be most effective after three months of effective antiretroviral therapy.
- RZV may be considered following a previous episode of herpes zoster. Both doses should be administered after symptoms have completely resolved.
- Countries should consider RZV vaccination for people previously vaccinated with a live-attenuated zoster vaccine.
Co-administration and contraindications
- RZV can be co-administered with other vaccines. Vaccines administered during the same visit should be given at different anatomical sites.
- A contraindication to RZV is hypersensitivity to a previous dose or to any vaccine component.
WHO position paper