Zostavax II: new refrigerator-stable zoster vaccine

Merck Canada is now producing Zostavax II, a refrigerator-stable version of the varicella zoster vaccine. The new vaccine formulation will be replacing the original Zostavax, which had to be kept frozen (at -15oC or colder) prior to use.Zostavax II is indicated for the prevention of herpes zoster (shingles) in individuals 50 years of age or older. Individuals should receive a single dose consisting of the entire contents of the reconstituted vial (approximately 0.65 mL) injected subcutaneously, preferably into the upper arm. The duration of protection and need for a booster dose is unknown; however, a single dose provides protection for at least four years.The manufacturer reports a slightly lower frequency of injection-site adverse reactions (e.g., erythema, pain, pruritus, rash, swelling) and a similar frequency of systemic adverse reactions (e.g., myalgia, dizziness, headache, pruritus) with the refrigerator-stable formulation compared with the frozen formulation.Zostavax II (zoster vaccine live, attenuated [Oka/Merck], refrigerator-stable) vaccine should be stored under refrigeration (2–8oC or colder). It is supplied as a powder that must be reconstituted to form a suspension prior to injection.The vaccine should be reconstituted (using the supplied diluent) immediately after removal from the refrigerator. It should be administered promptly after reconstitution and discarded if not used within 30 minutes. Reconstituted vaccine should not be frozen.The product monograph for Zostavax II indicates that it should not be given concomitantly with Pneumovax 23 (pneumococcal vaccine, polyvalent) because this can result in reduced immunogenicity of the zoster vaccine. However, the 2014 National Advisory Committee on Immunization (NACI) guidelines for use of zoster vaccine specifies that herpes zoster and pneumococcal vaccines can be co-administered at different injection sites.The 2014 NACI guidelines outline when zoster vaccine should be recommended (or considered) for the prevention of herpes zoster and its complications. The guidelines also address several contentious issues, including the recommended age range for administering zoster vaccine; immunization of immunocompromised hosts; zoster vaccination following a prior episode of herpes zoster; the recurrence or exacerbation of herpes zoster ophthalmicus following administration of zoster vaccine; and issues that require further study.ReferencesMerck Canada Inc. Zostavax II (zoster vaccine live, attenuated [Oka/Merck], refrigerator-stable) product monograph. Kirkland, QC; January 14, 2013. http://www.merck.ca/assets/en/pdf/products/ZOSTAVAX_II-PM_E.pdf (accessed May 8, 2014).National Advisory Committee on Immunization, Public Health Agency of Canada. Update on the use of herpes zoster vaccine. An Advisory Committee Statement. January 2014. http://publications.gc.ca/collections/collection_2014/aspc-phac/HP40-92-2014-eng.pdf (accessed May 8, 2014).

Zostavax II: new refrigerator-stable zoster vaccine

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