The Medical Letter on Drugs and Therapeutics
Herpes Zoster Vaccine (Zostavax)
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A live attenuated varicella-zoster vaccine (Zostavax – Merck) has been approved by the FDA for prevention of herpes zoster (HZ; zoster; shingles) in persons ≥60 years old. Each dose of Zostavax contains about 14 times as much varicella-zoster virus (VZV) as Varivax, which has been used in the US since 1995 to vaccinate against varicella (chicken pox).

HERPES ZOSTER — Following primary infection (varicella), VZV persists in a latent form in sensory ganglia. VZV-specific cell-mediated immunity (VZV-CMI), which develops in response to varicella infection, prevents the latent virus from reactivating and multiplying to cause herpes zoster. When VZV-CMI falls below a critical threshold, as it does in older persons and immunosuppressed patients, latent VZV can reactivate, multiply and spread within the ganglion, causing neuronal necrosis, intense inflammation and often severe neuralgia. Postherpetic ... more      

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Title: Herpes Zoster Vaccine (Zostavax)
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