People who have received varicella vaccine when it was indicated can consider zoster vaccine

People who have received varicella vaccine (Varivax or Varilrix) when it was indicated (such as in childhood or as a catch-up vaccine) and are indicated to receive zoster vaccine (that is, are aged ≥50 years, or ≥18 years with immunocompromise) can consider zoster vaccine. A history of varicella infection can be incorrect or uncertain before vaccination.

Herpes zoster in people who have been vaccinated against varicella is rare, and can be due to reactivation of either wild-type virus or vaccine virus. The incidence of herpes zoster in people who have received varicella vaccine is up to 5 times lower than in unvaccinated people infected with wild-type varicella (48 per 100,000 person-years compared with 230 per 100,000 person-years, in a study of children aged <18 years).²¹ However, when herpes zoster does occur in varicella-vaccinated people, up to 45% of cases may be due to vaccine strain virus.^21,22

Studies of the safety and immunogenicity of Shingrix in people who have received varicella vaccine are limited. Studies have not specifically investigated whether Shingrix vaccination provides protection following breakthrough varicella infection, or against vaccine-type herpes zoster, however there are no theoretical safety concerns.

Data suggest that the risk of herpes zoster following varicella vaccination is greater in people who are immunocompromised than in immunocompetent people.²¹ Shingrix is therefore likely to have greater benefit for people who have previously received varicella vaccine who are immunocompromised.

Shingrix is funded through the NIP for non-Indigenous people aged ≥65 years, Aboriginal and Torres Strait Islander people aged ≥50 years and people aged ≥18 years with moderate or severe immunocompromising conditions that put them at the highest risk of herpes zoster.