New CDA Position Statement on Herpes Zoster Vaccine

August 2014
New CDA Position Statement on Herpes Zoster Vaccine
CDA National Office
Available online: http://www.dermatology.ca/media/position-statements/
CDA Pharmacy & Therapeutics Committee Position Statement on
the Herpes Zoster Vaccine
The herpes zoster infection is a painful blistering eruption usually affecting a single dermatome,
and arises from the reactivation of latent Varicella Zoster Virus (VZV) in sensory ganglia as a result of
a previous chickenpox infection. The most frequent complication is post-herpetic neuralgia (PHN),
which typically has a major adverse impact on quality of life, especially in elderly persons. It is
characterized by prolonged (usually > 90 days) often debilitating, neurogenic pain following the
acute zoster infection. This complication occurs in approximately 20% all adults, but at in least
one-third of octogenarians. Treatment options are of limited effectiveness. Other complications of
acute zoster are potentially include sight threatening eye infections, central nervous system
infection, nerve palsies including the Ramsay-Hunt Syndrome, neuromuscular disease including
Guillain-Barre Syndrome, and secondary bacterial infections.
A vaccine that may limit the occurrence of herpes zoster is currently available in Canada. It is a live
attenuated vaccine that is indicated for the prevention of herpes zoster in adults over the age of 50
years. In the pivotal efficacy trial, the vaccine reduced the incidence of Herpes Zoster by 51.3% in
the study population of 38,546 adults greater than 60 years of age. In addition the incidence of
post-herpetic neuralgia was significantly reduced by 66.5%. As subsequent study in 22,439 subjects
50-60 years of age the vaccine demonstrated a 69.8% reduction in Herpes Zoster and 73% less
zoster-associated pain in this population.
This vaccine is mercury (thimerosal) free. Because it is a live attenuated virus, it should be avoided
by immunocompromised individuals or those taking immune modifying medications (“biologics”).
While studies showed no increase in serious adverse events have been reported as compared with
placebo with this vaccine, local injection site reactions shortly after receiving the vaccine (including
chicken-pox like rashes around the injection site) and have been reported. While there have been
no reports anyone getting chickenpox from a person who has received this vaccine, if reactions do
occur, it is recommended to cover them up until they resolve.
It is recommended that you discuss with your primary physician or your dermatologist whether the
Herpes Zoster vaccine is right for you.
Respectfully submitted by Sam Hanna, MD, DABD
Chair, CDA Pharmacy & Therapeutics Committee
April 2014
Approved by CDA Board of Directors
June 25, 2014
Editorial Board/
Conseil de rédaction
National Editor/
Regional Editors /
Rédacteurs régionaux
Benjamin Barankin, MD
Robert Jackson, MD
Ottawa, ON
Paul Kuzel, MD
Edmonton, AB
G. Daniel Schachter, MD
Rédacteur en chef
Toronto, ON
Charles W. Lynde, MD
Markham, ON
Marc Boucier, MD
Moncton, NB
Executive Director /
Directeure générale
Peter R. Hull, MD
Saskatoon, SK
Chantal Courchesne
Ottawa, ON
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Ian Landells, MD
St. John’s, NL
Catherine McCuaig, MD
Montréal, QC
Toronto, MD
Victoria Taraska, MD
Winnipeg, MB
Catherine Zip, MD
Calgary, AB
Kathleen Moses, MD
Ottawa, ON
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CHANTAL COURCHESNE
EXECUITVE DIRECTOR / DIRECTEURE GÉNÉRALE
425-1385 rue, Bank Street, Ottawa, ON K1H 8N4
Tel: (613) 738-1748 / 1-800-267-3376 | Fax: (613) 738-4695
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