Zoster vaccine (recombinant) !
Recombinant glycoprotein E with the AS01B adjuvant. It is not live and prevents shingles and postherpetic neuralgia in older adults.
Updated 2026-11-01
Also called: Recombinant zoster vaccine (RZV), Herpes zoster subunit vaccine, Live zoster vaccine (ZVL, J07BK02, no longer made in the US)
The figure shows the gE domain of varicella-zoster virus bound to a human antibody fragment; gE is the antigen of the recombinant zoster vaccine.
Mechanism of action
After chickenpox the virus stays latent in sensory ganglia. With age or weaker immunity, T-cell control fades and the virus reactivates along a dermatome as shingles. Glycoprotein E plus a strong adjuvant boosts gE-specific T cells and antibodies, restoring control. Because it is not live, it cannot cause varicella and can be used in people with low-dose immunosuppression.
- Latent VZV in sensory ganglia reactivates when T-cell control fades
- Recombinant gE with AS01B adjuvant is injected
- gE-specific T cells and antibodies are boosted
- Reactivation and postherpetic neuralgia become less likely
Pharmacokinetics
- Onset and duration
- Two-dose series; efficacy against postherpetic neuralgia 91.2% in adults aged 50 or older (CDC)
Indications
- Prevention of herpes zoster in older adults Herpes zoster (shingles) →
- Prevention of postherpetic neuralgia, the most frequent complication
Adverse effects
Common
- Pain at the injection site (very frequent)
- Myalgia and fatigue
- Systemic reactions more marked after the second dose
Contraindications
- Severe allergic reaction to a previous dose or a component
Key interactions
- Previous live zoster vaccine
- People who received the live vaccine still receive the recombinant series
- Low-dose immunosuppressive therapy
- Not a barrier: the recombinant vaccine is not live
What is monitored
- Local and systemic reactions after each dose
- Second dose completed
Administration and safety
- Intramuscular route
- Do not confuse it with varicella vaccine
- Record the batch and product
Nursing care
- Warn that a sore arm, myalgia and tiredness are common after each dose
- A previous episode of shingles is not a reason to skip it
- Remind the person to complete the second dose
Pregnancy and breastfeeding
No data in pregnancy; vaccination can be delayed until after pregnancy.
Test yourself
Think of the answer, then tap the question to see it.
Where does varicella-zoster virus stay latent?
In sensory ganglia; it reactivates along a dermatome as shingles.
Why can the recombinant zoster vaccine be given with low-dose immunosuppression?
It contains only glycoprotein E and an adjuvant, not live virus.
What is the most frequent complication of zoster?
Postherpetic neuralgia.
Related drugs
Related conditions
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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Chapter 23: Zoster | Pink Book | CDC (Centers for Disease Control and Prevention, 2021); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.