The Therapeutic Goods Administration (TGA) has reminded health professionals that Zostavax vaccine should not be used in immunocompromised patients due to the risk of disseminated disease from the virus.
The TGA alert follows the death of a person with pre-existing compromised immune function who received the live, attenuated varicella-zoster virus vaccine.
Zostavax has a much higher potency than childhood varicella vaccines – about 14 times more virus – in order to boost an immune response in the elderly.
It is not recommended in people with a compromised immune system due to disease or treatment, including high-dose corticosteroids, disease modifying anti-rheumatic drugs (DMARDs), chemotherapy or radiotherapy.
The Australian Immunisation Handbook advises the vaccine can be given to patients receiving certain low dose, non-biological DMARDs such as methotrexate <0.4 mg/kg per week, azathioprine ≤3.0 mg/kg per day or mercaptopurine ≤1.5 mg/kg per day, either on their own or in combination with low-dose corticosteroids.