Available Vaccines



Zoster or shingles, a dermatomal-vesicular infection, is caused by reactivation of latent varicella–zoster virus (VZV). Primary infection with VZV causes varicella. Zoster occurs following waning VZV cellular immunity and presents as a painful rash involving one or two adjacent dermatomes.

The rash is preceded by prodromal pain over the affected dermatome. It may be accompanied with headache, photophobia, malaise with fever being less common. Prodromal pain lasts three to four days but it can extend to a week. A maculopapular rash develops into clusters of vesicles. Characteristic rash appears as vesicles on an erythematous base.  New vesicles continue to appear over three to four days. The rash is usually accompanied by the same pain during prodrome but this acute phase pain can worsen, improve or appear for the first time. VZV can cause viremia. In immunocompromised persons, extensive viremia can lead to disseminated form of zoster.

Postherpetic neuralgia (PHN) is the most common complication of herpes zoster. It is diagnosed as pain persisting for an extended period after onset of zoster rash. Other complications include ophthalmic involvement, bacterial superinfections of the lesions, cranial and peripheral nerve palsies, meningoencephalitis, pneumonitis, hepatitis and acute retinal necrosis.


  • The zoster vaccine (ZVL, Zostavax®) is a lyophilised preparation of Oka/ Merck strain of VZV live, attenuated varicella virus (VZV). It is produced by Merck & Co. It contains hydrolysed porcine gelatine.

  • Zostavax® vaccine is more potent than the varicella vaccine because it contains varicella virus at a much higher titre. It is not to be used for the prevention of varicella.

  • The recombinant zoster vaccine (RZV, Shingrix®) is a 2-dose subunit vaccine given intramuscularly 2 to 6 months apart. It is indicated for prevention of HZ. It is not indicated for prevention of primary varicella infection. It consists of the major envelope glycoprotein E (gE) antigen component, which must be reconstituted at the time of use with the accompanying AS01 adjuvant suspension component to help enhance the immune response. It is produced by GSK Biologicals. This vaccine has been marketed since 2017. Although it is currently not available in Malaysia,  GSK has plans to introduce the vaccine to Malaysia.

Vaccines Available in Malaysia


ZVL, Zostavax® will not be available in Malaysia soon. In future, the recombinant zoster vaccine will be available.


Contraindications and Adverse Effects

  • Recombinant zoster vaccine should not be given to:
      1. Persons with a history of anaphylactic reaction to any of the vaccine components.

  • To date, the reported adverse events for zoster live vaccine received by the National Pharmaceutical Regulatory Agency (NPRA) include fever and varicella like rashes.

Target Groups in Malaysia

  • Recombinant zoster vaccine is recommended for persons who are 50 years and above with a history of varicella. Zoster vaccine may be given regardless of whether or not they have had prior herpes zoster (shingles) infection.

Implications for Healthcare Workers (HCWs)

Healthcare workers above 50 years should receive the vaccination as they are at higher risk of exposure to varicella-zoster virus and they may also be the source of varicella infection (chickenpox) to their patients.

Evidence for Effectiveness

  • Efficacy of the recombinant zoster vaccine (RZV) was evaluated in more than 30 000 participants. The efficacy for prevention of herpes zoster was 96.9% in persons aged 50-59 years, 97.4% in persons 60-69 years and 91.3% in participants aged >70 years. In 2017, ACIP recommended it for the use of immunocompetent adults aged 50 years and above.

    In an open-label concomitant administration of recombinant zoster vaccine with influenza vaccine study, there was no evidence of interference in immune response to both vaccines.


  1. Centers for Disease Control and Prevention. (2018) Recommendations of Advisory Committee on Immunization Practices for use of herpes zoster vaccines. MMWR,67,3,103-108
  2. Centers for Disease Control and Prevention. (2015) Pink Book. Epidemiology and Prevention of Vaccine Preventable Disease, 13th Edition
  3. Levin, M.J. (2018) Zoster vaccine. In Plotkin S.A., Orenstein W.A., Offit, P.A., Edwards K.M.(Eds) Vaccines. (7th Edition) Saunders Elsevier.
  4. MSD Local Product Circular Zostervax® 2014
  5. National Pharmaceutical Regulatory Agency (NPRA), Ministry of Health Malaysia. Senarai Produk Vaksin Berdaftar Dengan Pihak Berkuasa Kawalan Dadah. Updated 5 September 2019
  6. The Malaysian National Centre of Adverse Drug Reactions database. Accessed: 10 October 2019