Recommendations for Herpes Zoster Vaccination: Consensus Report from the Portuguese Society of Internal Medicine and the Portuguese Association of General and Family Medicine
DOI:
https://doi.org/10.24950/rspmi.1886Keywords:
Aged, Herpes Zoster, Herpes Zoster Vaccine, Neuralgia, VaccinationAbstract
Herpes zoster (HZ), or shingles, is caused by the reactivation of the latent varicella zoster virus. It is a high-incidence disease, associated with great morbidity, which might create or worsen a patient’s frailty condition, thus reinforcing the importance of vaccination. Among the risk factors for HZ infection and postherpetic neuralgia (PHN), its major complication, are age, immunosuppression and the presence ofchronic conditions. Vaccination is an efficacious strategy to prevent HZ and PHN. In Portugal, there are two available HZ vaccines: the live attenuated vaccine and the recombinant vaccine, which demonstrated a high efficacy against HZ and its complications, particularly in the populations with higher risk, immunosuppressed and with immunosenescence for whom live attenuated vaccine is contraindicated. Notwithstanding, the HZ vaccine is not included in the National Vaccination Program and there are not specific national recommendations for immunization. Hence, the Portuguese Society of Internal Medicine and the Portuguese Association of General and Family Medicine elaborated a consensus report establishing guidelines for HZ vaccination.
Vaccination against HZ is recommended for all adults aged 50 years and over, as well as for adults aged between 18 and 49 years at high risk for HZ, namely patients with
comorbidities or immunosuppression. Immunocompetent
adults should be preferentially immunized with the recombinant vaccine, although they might receive the live attenuated vaccine in punctual situations; immunocompromised adults should only be immunized with the recombinant vaccine. The vaccination of individuals with a previous HZ episode is recommended, and individuals with prior immunization with the live attenuated vaccine should receive the recombinant vaccine. Promoting patient’s literacy when prescribing HZ vaccine is highly relevant, and the physician should have an active role in raising awareness about the importance of shingles vaccination.
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