See the Australian Immunisation Handbook for more details.

Shingles vaccine (Zostavax) screening for contraindications

Patient name:

 

                        
Date of birth:                       
Practice record number:                       

Questions

This section can be completed by the health care provider, patient or guardian.

For patients/guardians, if you are unsure about an answer, leave it blank and discuss with your health care provider.

1

Have you ever had a shingles vaccine before? Yes/No

When:

2

Do you feel unwell today? Yes/No

Details:

3

Have you had shingles or post-herpetic neuralgia (nerve pain after shingles) in the past year? Yes/No

Details: 

4

Have you had a serious allergic reaction (anaphylaxis) to a previous dose of shingles or varicella (chickenpox) vaccine, or any vaccine components, including neomycin or gelatin? Yes/No

Details:

5

Have you ever had cancer, leukaemia, lymphoma, an organ transplant, a bone marrow transplant, stem cell therapy, or another health condition that weakens your immune system, including blood disorders, graft versus host disease or HIV/AIDS? Yes/No

Details:

6

In the past 12 months, have you been on any treatment for rheumatoid arthritis, multiple sclerosis, psoriasis, polymyositis, sarcoidosis, inflammatory bowel disease or other inflammatory conditions? Yes/No

Details:

7

In the past 12 months, have you taken medicine that weakens your immune system, such as oral prednisolone or other steroids, anti-cancer drugs, biologic therapy, radiotherapy or chemotherapy? Yes/No

Details:

8

Have you been treated recently with oral antiviral medication such as aciclovir for conditions such as herpes? Yes/No

Details:

Outcome

This section is to be completed by the health care provider only. Put an X next to the row that applies.

No contraindications to Zostavax vaccination

  • Discussed side effects of vaccination
  • Obtained informed consent for vaccination
  • Advised patient that if a chickenpox-like rash develops 2 to 4 weeks after vaccination:
    • seek medical attention
    • tell the medical practitioner they have recently had zoster vaccine
Zostavax is contraindicated

Zostavax should be delayed (mark which option applies):

  • until recovered from acute illness
  • until treatment is complete and for ___months afterwards
  • until current episode of shingles has resolved and for at least 1 year afterwards

Level of immunocompromise uncertain — not for vaccination at this time

  • Check serology for past varicella-zoster virus infection
  • Assess immune status (eg medication history from other providers, laboratory investigations)
  • Review recent specialist/other reports of patient health status if available
  • Consult treating physician and/or immunisation specialist

Provider name:     

Date:

Notes for health care providers

Zostavax® (shingles) vaccine is a live attenuated vaccine. It has a risk of causing disseminated varicella zoster disease in people who are immunocompromised. 

If you have any doubt about whether a person is suitable to receive the vaccine, do not vaccinate, and seek further advice. 

1.    Have you ever had a shingles vaccine before?

Zostavax® is not recommended for people who have already received a shingles vaccine. Currently in Australia, Zostavax® is recommended as a single dose only and is provided free for people aged 70 years under the National Immunisation Program. There is also a 5-year catch-up program for people aged 71–79 years until 31 October 2021. 

2.    Do you feel unwell today?

For people who are acutely unwell with fever or systemic symptoms, delay vaccinating until they have fully recovered. This is to avoid confusing the diagnosis of any acute illness by attributing signs or symptoms to adverse effects of the vaccine. 

Minor illness without fever or systemic symptoms is not a valid reason to postpone immunisation. 

3.    Have you had shingles or post-herpetic neuralgia (nerve pain after shingles) in the past year?

Zostavax® is not recommended for the treatment of shingles or post-herpetic neuralgia (PHN). People with shingles or PHN should wait until symptoms have stopped before being considered for vaccination. 

If the person has had shingles in the past year and they have a fully functioning immune system (i.e. they do not have any of the conditions listed on the following pages), delay vaccination for 1 year. People who have 2 or more episodes of shingles in 1 year should have investigations for an underlying cause of immune suppression before vaccination.

4.    Have you had a serious allergic reaction (anaphylaxis) to a previous dose of shingles or varicella (chickenpox) vaccine, or any vaccine components, including neomycin or gelatin?

Anaphylaxis following vaccination is rare. Do not vaccinate a person who has had a confirmed anaphylactic reaction to a previous dose of shingles or varicella vaccine, or any of the vaccine components, including neomycin or gelatin.

5.    Have you ever had cancer, leukaemia, lymphoma, an organ transplant, a bone marrow transplant, stem cell therapy, or another health condition that weakens your immune system, including blood disorders, graft versus host disease or HIV/AIDS?

6.    In the past 12 months, have you been on any treatment for rheumatoid arthritis, multiple sclerosis, psoriasis, polymyositis, sarcoidosis, inflammatory bowel disease or other inflammatory conditions?

7.    In the past 12 months, have you taken medicine that weakens your immune system, such as oral prednisolone or other steroids, anti-cancer drugs, biologic therapy, radiotherapy or chemotherapy?

The decision to administer Zostavax® to immunosuppressed people should be based on a detailed clinical risk assessment. This is because Zostavax® is a live attenuated vaccine with a 14-fold higher amount of varicella-zoster virus than monovalent varicella (chickenpox) vaccines (eg Varilrix, Varivax). 

If the person is under specialist care, and it is not possible to obtain full information about their treatment history, do not vaccinate, and seek advice from the specialist or an immunologist/haematologist. 

If you have concerns about the nature of therapies (including biologics) or the degree of immunosuppression, do not vaccinate, and seek advice from the relevant specialist.

Zostavax® is not contraindicated for use in people who are receiving topical or inhaled corticosteroids, or corticosteroid replacement therapy.

Immunocompromising conditions that contraindicate Zostavax®

Primary or acquired immunodeficiency

  • Haematological neoplasms — leukaemia, lymphoma, myelodysplastic syndromes, including people under follow-up for chronic lymphoproliferative disorders, and people who are currently not receiving treatment or who have never received treatment
  • Post-transplant — solid organ transplant recipients who are on immunosuppressive therapy or have used immunosuppressive therapy within the past 6 months, people who have had a haematopoietic stem cell transplant within the past 24 months (or longer if they have immunosuppression or graft versus host disease) 
  • Symptomatic HIV infection or AIDS
  • Other significantly immunocompromising conditions

Immunosuppressive therapy (current or recent — see table on next page

  • Chemotherapy or radiotherapy
  • Corticosteroids (high dose) 
  • All biologics and most disease-modifying anti-rheumatic drugs (DMARDs) 

8.    Have you been treated recently with oral antiviral medication such as aciclovir for conditions such as herpes?

Zostavax® may have lower effectiveness if given while a person is being treated with oral or intravenous antivirals (such as aciclovir) or within 24 hours of such treatment. Delay vaccination until after this time. If the person is on long-term therapy, consider stopping treatment, vaccinating 24 hours later, and resuming antiviral treatment 14 days later.

The use of topical aciclovir is not a contraindication to vaccination.

More information

Contact your state or territory immunisation service.

Adapted from Health Protection Scotland, and National Centre for Immunisation Research & Surveillance fact sheets:  

Last updated: 
13 January 2021
Last reviewed: 
13 January 2021

Definitions

AIDS
acquired immunodeficiency syndrome
PHN
post-herpetic neuralgia