Administering Zostavax

A new shingles vaccine called Shingrix was licensed by the U.S. Food and Drug Administration (FDA) in 2017. CDC recommends that healthy adults 50 years and older get two doses of Shingrix, 2 to 6 months apart. Shingrix provides strong protection against shingles and PHN. Shingrix is the preferred vaccine, over Zostavax.

Zostavax (zoster vaccine live) is administered subcutaneously as a single dose in the deltoid region. The vaccine should not be injected intramuscularly. However, it is not necessary to repeat vaccination if it is administered intramuscularly.

The vaccine should be administered immediately after reconstitution to minimize loss of potency. Any unused vaccine should be discarded if not used within 30 minutes.

Administration with Other Vaccines

To avoid introducing barriers to patients who are interested in two important vaccines, CDC continues to recommend that Zostavax and pneumococcal vaccine be administered at the same visit if the person is eligible for both. When both pneumococcal conjugate vaccine PCV13 and PPSV23 are recommended for an adult, PCV13 should always be administered first and may be administered at the same time as Zostavax.

Vaccine Administration Errors

Zostavax should not be used in children and should not be used in place of varicella (chickenpox) vaccine. Also, varicella vaccine should not be used in place of Zostavax. Administration of Zostavax to a child who was supposed to be vaccinated with varicella vaccine is a serious vaccine administration error. The event should be documented and procedures put in place to prevent this from happening again. This event should be reported to the Vaccine Adverse Event Reporting System (VAERS) by phone 800-822-7967 or through the websiteexternal icon. VAERS is maintained jointly by CDC and the Food and Drug Administration.

If a dose of herpes zoster (shingles) vaccine was given accidentally in place of varicella vaccine (Varivax®) for a child or an adult, then that dose of herpes zoster vaccine should be counted the same as a single valid dose of varicella vaccine. That’s because the level of protection against varicella would probably be at least the same from herpes zoster vaccine as for the conventional dose of varicella vaccine. If the erroneous dose was administered in lieu of the first dose of varicella vaccine, following such an error, a second dose of varicella vaccine is still required.

If you accidentally administered varicella vaccine to an adult when Zostavax was indicated, no specific safety concerns exist, but the dose should not be considered valid. You should administer a dose of Zostavax to the patient during that same visit. If the error is not immediately detected, you should administer a dose of Zostavax as soon as possible, but not within 28 days of the varicella vaccine dose to prevent potential interference of 2 doses of live attenuated virus. The event should be documented and procedures put in place to prevent this from happening again.

Page last reviewed: January 25, 2018