Sage Journals: Discover world-class research

Abstract

Spanish

French

OBJECTIVE

To determine whether concomitant administration of zoster vaccine and polysaccharide pneumococcal-23 vaccine (PPV23) provides sufficient protection against herpes zoster infections.

DATA SOURCES

Literature was retrieved through the Centers for Disease Control and Prevention (CDC) website, PubMed (inception-February 2013), and Scopus (inception-February 2013) using the key words herpes zoster, pneumococcal, vaccine, concomitant, simultaneous administration, Pneumovax, Zostavax, and barriers. In addition, reference citations from publications were used.

STUDY SELECTION AND DATA EXTRACTION

All English-language articles identified from the data sources were evaluated. Two studies evaluating concomitant and nonconcomitant administration of zoster vaccine and PPV23 were included.

DATA SYNTHESIS

Current product labeling recommends a 4-week interval between zoster vaccine and PPV23 administration; however, the Food and Drug Administration (FDA) and the CDC promote concomitant administration to prevent a missed opportunity to vaccinate. This has caused confusion among health care professionals regarding the appropriate timing of these vaccines. A randomized trial that evaluated the immunogenicity of zoster vaccine and PPV23 given together versus separated by at least 4 weeks demonstrated that the varicella zoster virus (VZV) antibody levels of concomitant versus nonconcomitant vaccination groups did not meet noninferiority requirements. However, a large retrospective cohort trial that compared the incidence of herpes zoster infections following concomitant versus nonconcomitant administration of PPV23 and zoster vaccine did not find a statistically significant between-group difference.

CONCLUSIONS

Concomitant administration of zoster vaccine and PPV23 is advocated by the CDC and FDA to improve immunization rates among vaccine-eligible individuals. Since there is no direct evidence that simultaneous administration of zoster vaccine and PPV23 puts patients at increased risk of developing herpes zoster, the vaccines should be given during the same office visit to avoid a missed opportunity to vaccinate against 2 serious diseases.

Get full access to this article

View all access options for this article.

References

1. MacIntyre

, Egerton

, McCaughey

, Concomitant administration of zoster and pneumococcal vaccines in adults ≥60 years old. Hum Vaccin 2010; 6: 894–902.

2. Huang

, Johnson

, Ray

, Healthcare utilization and cost of pneumococcal disease in the United States. Vaccine 2011; 29: 3398–412.

3. Centers for Disease Control and Prevention. Herpes zoster. www.cdc.gov/shingles/hcp/clinical-overview.html#complications (accessed 2013 Apr 7).

4. Targonski

, Poland

. Pneumococcal vaccination in adults: recommendations, trends, and prospects. Cleve Clin J Med 2007; 74: 401–6, 408–10, 413–4.

5. Product information. Pneumovax (pneumococcal vaccine). Whitehouse Station, NJ: Merck & Co, Inc., October 2011.

6. Centers for Disease Control and Prevention. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). www.cdc.gov/mmwr/preview/mmwrhtml/mm5934a3.htm (accessed 2013 Apr 7).

7. Oxman

, Levin

, Johnson

, A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 2005; 352: 2271–84.

8. Product information. Zostavax (zoster vaccine). Whitehouse Station, NJ: Merck & Co, Inc., June 2011.

9. FDA news release. FDA approves Zostavax vaccine to prevent shingles in individuals 50 to 59 years of age. www.fda.gov/newsevents/newsroom/pressannouncements/ucm248390.htm (accessed 2013 Apr 7).

10.

10. Centers for Disease Control and Prevention. Herpes zoster vaccination for health care professionals. www.cdc.gov/vaccines/vpd-vac/shingles/hcp-vaccination.htm (accessed 2013 Apr 7).

11.

11. Centers for Disease Control and Prevention. Adult vaccination coverage—United States 2010. www.cdc.gov/mmwr/preview/mmwrhtml/mm6104a2.htm (accessed 2013 Apr 7).

12.

12. Schaffner

. Update on vaccine-preventable diseases: are adults in your community protected? J Fam Pract 2008; 57 (suppl): S1–11.

13.

13. Centers for Disease Control and Prevention. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2011; 60 (RR-2): 6, 8–9, 38.

14.

14. Centers for Disease Control and Prevention. Guidelines for spacing the administration of live and killed antigens. http://wonder.cdc.gov/wonder/prevguid/p0000348/p0000348.asp#Table6 (accessed 2013 Apr 7).

15.

15. Vaccines, blood, & biologics. December 18, 2009, approval letter Zostavax. www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm195993.htm (accessed 2013 Apr 7).

16.

16. Tseng

, Smith

, Sy

, Evaluation of the incidence of herpes zoster after concomitant administration of zoster vaccine and polysaccharide pneumococcal vaccine. Vaccine 2011; 29: 3628–32.

17.

17. Food and Drug Administration. Zostavax (zoster vaccine live) suspension for subcutaneous injection. Detailed view: safety labeling changes approved by the FDA center for biologics evaluation and research (CBER)—March 2011 and January 2010 www.fda.gov/Safety/MedWatch/SafetyInformation/ucm200862.htm (accessed 2013 Apr 7).

18.

18. Baylor

. Perspective of the US Food and Drug Administration on concomitant administration of Zostavax and Pneumovax (letter). Vaccine 2011; 29: 8771. Author reply, 8772.

19.

19. Centers for Disease Control and Prevention. Herpes zoster vaccination for health care professionals. www.cdc.gov/vaccines/vpd-vac/shingles/hcp-vaccination.htm (accessed 2013 Apr 1).

20.

20. Levin

, Oxman

, Zhang

, Varicella-zoster virus-specific immune responses in elderly recipients of a herpes zoster vaccine. J Infect Dis 2008; 197: 825–35.

21.

21. Weinberg