Zoster vaccine and immunosuppression

The Therapeutic Goods Administration (TGA) has issued a safety advisory regarding the use of Zostavax® in people with compromised immune function. Zostavax® is a live, attenuated varicella-zoster vaccine indicated for the prevention of herpes zoster in people aged 50 years and older. This vaccine is contraindicated in people with primary and acquired immunodeficiency states as well as those receiving immunosuppressive therapy. However, the product information emphasises that it is not contraindicated in people receiving topical or inhaled corticosteroids, low-dose systemic corticosteroids, or corticosteroid replacement therapy.

The TGA warning follows a new report of death due to disseminated varicella-zoster virus (Oka vaccine strain) infection. This patient was taking hydroxychloroquine and low-dose prednisolone when they received the zoster vaccine, in line with clinical recommendations. The TGA reminds healthcare professionals that this potentially life-threatening condition can occur in patients on low-dose immunosuppressive therapy and highlights the importance of a risk-based assessment prior to Zostavax® administration.

The Australian Immunisation Handbook can be referred to for further information regarding zoster vaccine use in people taking immunosuppressive therapy and the value of serological testing.