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{FLD:NCP HERPES ZOSTER GUIDANCE}
- History of anaphylactic reaction to any components of the vaccine,
including gelatin and neomycin.
- Immunosuppressed persons (AIDS with CD4+ T-lymphocyte values <200 per
mm or <15% ot total lymphocytes or other clinical manifestations of
HIV, leukemia, lymphomas, or other mailgnant neoplasms affecting the
bone marrow or lymphatic system.)
- Persons on immunosuppressive therapy, including high-dose
corticosteroids (>20 mg/day of prednisone or equivalent) lasting tow or
more weeks.
- Persons receiving recombinant human immune mediators and immune
modulators, especially the antitumor necrosis factor agents, such as
adalimumab, infliximab, etanercept, and certolizumab pegol.
- Persons taking chronic acyclovir, famciclovir, valacyclovir, or other
antiviral therapy that inhibits varicella zoster virus replication.
- Persons with clinical or laboratory evidence of other unspecified
{FLD:CDC ZOSTER VACCINE RECOMMENDATIONS}
cellular immunodeficiency.
- Active, untreatable tuberculosis
- Persons pregnant, or may be pregnant. Women should not become pregnant
until at least 4 weeks after getting the Herpes Zoster vaccine.
- Persons undergoing hematopoietic stem cell transplantation (HSCT). The
experience of HSCT recipients with VZV-containing vaccines (e.g., zoster
vaccine) is limited. Providers should assess the immune status of the
recipient on a case-by-case basis to determine the relevant risks.
PRECAUTIONS:
- Zoster vaccination of persons who have severe acute illness should be
postponed until recovery. Zoster vaccine can be administered to persons
who have mild acute illnesses with or without fever.
- Breastfeeding women
RECOMMENDATION: The CDC recommends all adults aged 60 and older receive a
- Patients receiving low-dose immunosuppressive medications.
- VHA clinicians should use clinical judgment for patients on low-dose
immunosuppressive therapy, including low-doses of
Methotrexate (<0.4 mg/Kg/week), Azathioprine (<3.0 mg/Kg/day), or
6-mercaptopurine 1.5 mg/Kg/day).
These doses are not considered sufficiently immunosuppressive to create
vaccine safety concerns and are not contraindications for administration
of zoster vaccine. However, clinicians should have and document a
conversation using shared decision making about potential benefits and
one-time dose of Herpes Zoster vaccine.
harms before ordering zoster immunization in patients on low-dose
immunosuppressive therapy.
CONTRAINDICATIONS:
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