Abstract
A vaccine for the prevention of herpes zoster outbreaks in adults over the age of 60 years has recently been approved. A 76-year-old white female with a history of recurrent left axillary breast cancer undergoing chemotherapy was given a Zostavax® injection by her primary care physician. Eight days later, the patient developed a rash. Given the recent administration of live, attenuated varicella zoster virus (VZV), a diagnosis of disseminated cutaneous herpes zoster was made. The patient was treated successfully with a course of famciclovir for 10 days and cephalexin for 7 days for a secondary bacterial infection. A review of the medical literature disclosed no reports of Zostavax® given to adult cancer patients immunocompromised by systemic chemotherapy. Therefore, we believe this report is the first to describe the consequences of Zostavax® administration to such a host. Clinicians should take care to review contraindications and precautions prior to administering the Zostavax® vaccine.
References
Merck and Company. Zostavax® subcutaneous injection product information. 2006. Retrieved November 20, 2007 from: www.merck.com/product/usa/pi_circulars/z/zostavax/zostavax_pi.pdf.
MMWR Quick Guide. Recommended adult immunization schedule—United States, October 2007–September 2008. MMWR 2007;56:Q1-Q4. Retrieved November 20, 2007 from http://www.cdc.gov/mmwr/pdf/wk/mm5641-Immunization.pdf.
Oxman M, Levin M, Johnson G, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005;352:2271–84.
Kraft J, Shaw J. Varicella infection caused by Oka strain vaccine in a heart transplant recipient. Arch Dermatol. 2006;142:943–5.
Centers for Disease Control and Prevention. Update on safety of herpes zoster vaccine. Retrieved November 20, 2007 from: www.cdc.gov/vaccines/recs/acip/downloads/mtg-slides-jun07/12-zoster-chavez.pdf.
Acknowledgments
The authors wish to thank Jorge Rakela, MD and Keith J. Cannon, MD, Department of Internal Medicine, Mayo Clinic Arizona. The authors received no funding in support of the work described herein.
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Curtis, K.K., Connolly, M.K. & Northfelt, D.W. Live, Attenuated Varicella Zoster Vaccination of an Immunocompromised Patient. J GEN INTERN MED 23, 648–649 (2008). https://doi.org/10.1007/s11606-008-0558-4
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DOI: https://doi.org/10.1007/s11606-008-0558-4