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# 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

- Class: [Viral vaccines](https://durgical.com/en/pharmacology/classes/viral-vaccines/)
- Target: Varicella-zoster virus glycoprotein E (gE)
- ATC code: J07BK03

Also called: Recombinant zoster vaccine (RZV), Herpes zoster subunit vaccine, Live zoster vaccine (ZVL, J07BK02, no longer made in the US)

◆**Varicella-zoster virus glycoprotein E (gE)**Zoster vaccine (recombinant)

ⓘ 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.

**Target in 3D:** Varicella-zoster virus glycoprotein E (gE). PDB structure 8V5Q (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/8V5Q) · Drag to rotate · pinch to zoom

## 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) →](https://durgical.com/en/conditions/herpes-zoster/)
- 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

### Serious (rare, important)

- Guillain-Barré syndrome: an association was found, but benefits outweigh risks
- Anaphylaxis (rare)

## 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.

## Memory aid

"gE for Grown-up Elders": recombinant gE, not live, sore arm expected, finish both doses.

## 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.

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## Related drugs

- [Varicella vaccine](https://durgical.com/en/pharmacology/varicella-vaccine/)

## Related conditions

- [Herpes zoster (shingles)](https://durgical.com/en/conditions/herpes-zoster/)

[← Back to the class: Viral vaccines](https://durgical.com/en/pharmacology/classes/viral-vaccines/)

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](https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-23-zoster.html) (Centers for Disease Control and Prevention, 2021); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=J07BK&showdescription=no) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/zoster-vaccine/