Varicella-zoster vaccine

How it works

The attenuated Oka-strain virus induces humoral and cell-mediated immunity against varicella-zoster virus, boosting protection and reducing the risk of viral reactivation.

Prescribing in practice

• As a live vaccine it is contraindicated in pregnancy and in significant immunosuppression, where a non-live recombinant zoster vaccine should be considered instead.
• Pregnancy should be avoided for the recommended period after vaccination, and close contact with susceptible immunocompromised individuals managed if a rash develops.
• Salicylates should be avoided for a period after varicella vaccination in children because of a theoretical risk of Reye's syndrome.

Monitoring

No routine laboratory monitoring is required; observe for injection-site reactions and any post-vaccination varicelliform rash.

Counselling the patient

• A mild rash or injection-site soreness can occur and usually settles by itself.
• Avoid becoming pregnant for the advised period after the vaccine.
• Seek advice if a widespread rash develops, particularly if you are in contact with pregnant or immunocompromised people.

Evidence & guidelines

Use is supported by UK immunisation guidance (the Green Book), which distinguishes the live vaccine from the non-live recombinant zoster vaccine for at-risk groups.