Herpes Zoster Vaccine

Herpes zoster, commonly known as shingles, is caused by the varicella-zoster virus (VZV), the same virus that causes chickenpox. After the initial infection, the virus remains dormant in nerve ganglia even after recovery. When immunity declines, the dormant virus can reactivate, travel along a nerve to the skin surface, and cause a rash. The rash is often blistering and distributed in a band-like pattern, depending on the affected nerve.

Patients may initially experience abnormal skin sensations, pain, or fever, followed by a rash that may be accompanied by numbness and neuropathic pain. Shingles occurs more often in older adults and people with weaker immunity. Accordingly, cancer patients—whether they are currently receiving treatment or have completed treatment—are a high-risk group, and their risk of complications such as post-herpetic neuralgia is higher than that of the general population.

Vaccination can effectively reduce both the incidence of shingles and the risk of severe disease, and is therefore an important preventive strategy. This page explains the benefits of vaccination, recommended timing, and precautions for patients and families.

Approximately 97% of adults in Hong Kong have previously been infected with varicella-zoster virus. Cancer itself, as well as treatments such as chemotherapy and radiotherapy, can increase the risk of shingles. Among cancer patients receiving chemotherapy, the risk has been reported to be around 25 times higher than in the general population, especially during the first two years after a cancer diagnosis, and the risk remains significantly elevated thereafter. Some studies have also suggested that people with shingles may have a higher subsequent risk of cancer.

1.Symptoms may last longer, involve a wider area, and carry a higher risk of serious complications such as viremia, pneumonia, hepatitis, encephalitis, and recurrence.

2.The risk of post-herpetic neuralgia is further increased in immunocompromised cancer patients; pain may persist for years and in some cases may not fully resolve.

3.Shingles may delay cancer treatment until the patient has recovered.

Treatment for shingles generally requires antiviral medication within the first 72 hours after the rash appears. However, antiviral therapy does not effectively prevent post-herpetic neuralgia. Multiple pain medicines are often needed for neuralgia after shingles, and symptom control is frequently unsatisfactory. Vaccination is the most effective preventive measure.

1.Non-live recombinant vaccine (recombinant zoster vaccine): contains recombinant VZV antigen with adjuvant and can generate stronger and more durable immune responses in immunocompromised individuals. It is generally given as two doses, usually 2 to 6 months apart.

2.Live attenuated vaccine: contains live weakened virus. Because it may pose a risk to immunocompromised patients, it is generally not recommended in this group.

The newer recombinant non-live shingles vaccine has shown protective efficacy of over 90% in adults aged 50 years or above, with protection sustained for more than 11 years. Studies in adults with solid tumors who are receiving or about to receive chemotherapy have also shown strong immunogenicity comparable to that seen in healthy adults.

For cancer patients whose immune function may be affected, vaccine choice requires particular caution. Current clinical guidelines generally recommend the non-live recombinant vaccine because of its better safety profile. By contrast, live attenuated vaccine contains weakened live virus and may pose risk to patients with weaker immune systems, so it is usually not recommended.

The recombinant non-live shingles vaccine has been recommended by the American Society of Clinical Oncology (ASCO), the U.S. Centers for Disease Control and Prevention (CDC), and the National Comprehensive Cancer Network (NCCN). CDC guidance also notes that even for certain eligible individuals who previously received the older live attenuated shingles vaccine, the newer recombinant vaccine may still be recommended after medical assessment to provide more appropriate protection.

1.Patients with cancer before or during chemotherapy, targeted therapy, or immunotherapy

2.Patients receiving long-term or high-dose corticosteroids, immunosuppressants, hematopoietic stem cell transplantation, or organ transplantation

3.Older cancer patients (for example, aged 50 years or above) who may be at risk of impaired immune function

Before vaccination, the patient’s immune status and current medications should be assessed by an oncology specialist in order to choose the most appropriate vaccine type and timing.

According to the ASCO guideline, shingles vaccination may be given before, during, or after cancer treatment. For patients receiving ongoing treatment, vaccination should preferably be scheduled when the immune response is expected to be most stable. The first dose may be administered before treatment begins, while the second dose may be arranged before the start of the next treatment cycle so that the immune system has time to recover and generate the best possible vaccine response. These are general guideline principles for patient reference only; because each patient’s condition is different, the exact timing must be discussed in detail with the treating doctor.

1.Local reactions: pain, redness, swelling, or induration at the injection site, usually resolving within a few days

2.Systemic reactions: fever, fatigue, muscle pain, headache, or gastrointestinal discomfort, usually mild to moderate and temporary

3.Serious adverse events such as allergic reactions are rare, but if facial or throat swelling, breathing difficulty, or generalized rash occurs, seek medical attention immediately

Our clinic provides shingles vaccination service. If you are receiving immunosuppressive therapy, have undergone hematopoietic stem cell transplantation, or have a history of severe allergy, we recommend booking a pre-vaccination assessment so that our healthcare team can develop an individualized vaccination plan for you. If you have any questions or would like further information, please feel free to consult our healthcare staff.

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