Zostavax live attenuated vaccine for shingles

Zostavax is a live attenuated shingles vaccine that is given to prevent shingles Herpes zoster. This vaccine is by Merck.

It is a lyophilized preparation of the Oka/Merck strain of live, attenuated varicella-zoster virus (VZV). 

Zostavax, when reconstituted as directed, is a sterile suspension for subcutaneous administration. 

Each 0.65-mL dose contains a minimum of 19,400 PFU (plaque-forming units) of Oka/Merck strain of VZV.

Each dose contains 31.16 mg of sucrose, 15.58 mg of hydrolyzed porcine gelatin, 3.99 mg of sodium chloride, 0.62 mg of monosodium L-glutamate, 0.57 mg of sodium phosphate dibasic, 0.10 mg of potassium phosphate monobasic, 0.10 mg of potassium chloride; residual components of MRC-5 cells including DNA and protein; and trace quantities of neomycin and bovine calf serum. 

The product contains no preservatives.

Oka/Merck strain of VZV> 19400 PFU
sucrose31.16 mg
Hydrolyzed porcine gelatine15.58 mg
Sodium chloride3.99 mg
Potassium phosphate monobasic0.10 mg
Monosodium L-glutamate0.62 mg
Sodium phosphate dibasic0.57 mg
Potassium chloride0.10 mg
NeomycinBovine calf serumMRC 5 cells including proteins and DNA
Trace amounts

This vaccine is not intended for prevention of primary chickenpox. 


Zostavax Vaccine is discontinued from some markets and is to be replaced with Shingrix vaccine in coming time.

How is the Zostavax vaccine available?

Zostavax is supplied as a pack of single vial of lyophilized powder in a vial and a single vial of diluent 0.65 ml.

Also a pack of 10 vials of lyophilized powder and 10 vials of diluent 0.65 ml is available.

At what age to get the Zostavax vaccine?

Zostavax is a live attenuated vaccine for prevention of shingles.

Give this vaccine for adults above age 50 years of age.

How to give the Zostavax vaccine?

Zostavax vaccine is for subcutaneous injection.

Follow all the safety injection precautions for giving injections.

First take the diluent in a sterile syringe which does not contain preservatives and antiseptics or other drugs.

Then push the diluent in vial with lyophilized powder without forming foam.

Agitate gently and suck back the mixture in the syringe.

Do not apply antiseptics and spirit to vial.

Use the vaccine within 30 minutes of reconstitution or it should be discarded.

The antiseptic or spirit applied to skin before injection should vaporize completely before giving injection.

Inject the dose by subcutaneous route.

Give it a shoulder deltoid region.

Do not inject intramuscular or intravenous.

Disposable items used should be discarded as per local biomedical waste management protocols to protect your environment.

How to store Zostavax vaccine?

Store zostavax vaccine as per recommendations of supplier or manufacturer.

Store this vaccine at temperature minus 50 degree Celsius to minus 15 degree Celsius.

It is stored frozen.

Maintain the temperature range using a strict cold chain.

Maintain the cold chain all all stages from manufacturer to the end user.

The vaccine can be stored at 2-8 degree Celsius upto 72 hours.

If the vaccine is stored at 2-8 degree Celsius and not used, discard it.

If the temperature recommendations were not followed, discard the vaccine.

While discarding local biomedical waste management protocols should be followed to protect environmental damage.

How Does the Zostavax Vaccine work?

Zostavax is a live attenuated vaccine.

When it is injected, the live virus in it infects you. It multiplies inside you like an actual disease causing virus.

This virus though live but attenuated cannot cause disease.

Your immunity recognizes this virus and develops an immune mechanism against it.

So when real infection occurs this developed immune system can fight back effectively.

Thus we can prevent Herpes zoster from occurring.

Safety of vaccine with other vaccines:

Zostavax Vaccine should not be mixed with the same syringe with other vaccines or drugs.

It was noted that the Pneumovax 23 vaccine given together interferes with development of immunity against Zostavax. 

These both vaccines should be given at least 4 weeks apart.

The effect of concomitant use of drugs which are effective against VZV has not yet been evaluated yet.

What are the side effects of the Zostavax  vaccine?

With this vaccine following are common side effects. These all side effects though occur generally are mild and can be managed at home and do not usually need admission. They usually occur in the first 5 days after vaccination.

  • Pain, swelling, redness: Injection site pain, swelling and redness can occur within a few hours of giving this vaccine. It can be reduced with cold compression and medicine like paracetamol in adequate doses.
  • Headache: Headache can occur after vaccination. It is generally mild to moderate grade and subsides with sponging and paracetamol.
  • Fever: Fever may occur within a few hours of giving this vaccine. It can be managed with or without medicines as needed symptomatically.
  • Muscle pain: Limb pain muscle pain and fatigue are known side effects after vaccination. It usually subsides on its own. The intensity of side effects can be decreased with paracetamol.
  • Diarrhea, loss of appetite, nausea: Some patients may experience side effects like nausea and decreased appetite and diarrhea. They are usually ild and subside by their own.
  • Flu like symptoms: Flu like symptoms like cold, stuffy running nose and cough may occur after vaccination.
  • Varicella like rashes: Some patients may experience chickenpox like rashes on skin after this vaccination. They may occur upto 42 days after vaccination. Usually they are less in number and subsides on its own.
  • Anaphylaxis: Like all other vaccines and drugs this vaccine may cause anaphylaxis and severe allergic reactions. They are extremely rare to occur.

To whom Zostavax Vaccine should not be given?

In following cases this vaccine should not be given:

  • Do not give this vaccine if the patient is known to be allergic to any of its components.
  • Do not give this vaccine if the patient had got an allergic or anaphylactic reaction at the time of the previous dose.
  • In pregnancy and breastfeeding mothers.
  • Those who are immunosuppressed should not take this vaccine.
  • Do not give this vaccine if the patient has symptoms of stage 3 or stage 4 of HIV AIds.
  • Avoid this vaccine if the patient is on drugs causing immunosuppression.
  • This vaccine should not be used in children and adolescents for prevention of chickenpox.
  • Deferral should be considered in acute illness (for example, in the presence of fever) or in patients with active untreated tuberculosis. 

Warnings and caution with Zostavax Vaccine

  • This vaccine prevents shingles but does not treat it.
  • This vaccine may not protect all those who have received vaccination.
  • Efficacy of this vaccine after 4 years of dose and long term protection is not yet evaluated.
  • Need of additional doses and booster is not yet known.
  • Do not use this vaccine in pregnancy, lactating mothers and immunosuppressed individuals.
  • Like any other vaccine, give this vaccine with readiness to manage anaphylaxis reaction.
  • Do not use this vaccine in children and teens to prevent chickenpox.


This article is for information purpose only. Take your doctor’s opinions before using it or meet us in person.

<span class="has-inline-color has-luminous-vivid-orange-color">Dr Yatin Bhole MBBS DCh DNB</span>
Dr Yatin Bhole MBBS DCh DNB

This article was written by Dr Yatin Bhole who is practicing Pediatrician at Bhole Children Clinic, Ravet. This post is for general information and before applying it on yourself, you should meet your doctor or meet us in person.

Sharing Is Caring:

Leave a Reply