Varicella Zoster Vaccine (Live/Attenuated)


Varicella Zoster Vaccine (Live/attenuated)
Commonly known or available as Varicella Zoster Vaccine (Live/Attenuated)
Accession Number
Biologic Classification

Live attenuated zoster vaccine is available as two products: Zostavax for the prevention of shingles in immunocompetent people over the age of 50, and Varivax for the prevention of chickenpox in individuals 12 months of age and older. While the two vaccines contain the same immunological components and provide protection against the same virus, Zostavax contains a higher dose and is used in older adults to prevent the development of shingles and post-herpetic neuralgia.

First approved in May 2006 by the Food and Drug Administration, Zostavax was the first vaccine available for the prevention of shingles. Since October 2017, however, it has been replaced as first line therapy by Shingrix (Varicella Zoster Vaccine (Recombinant)), a more effective and longer lasting vaccine3. Both Varivax and Zostavax are composed of a lyophilized preparation of live, attenuated Oka/Merck strain of varicella-zoster virus.

Varicella Zoster Virus (VZV) is the virus that commonly causes Chickenpox (also known as Varicella) in childhood 4. Following initial infection of VZV and resolution of Chickenpox as a child, VZV then lies dormant within the dorsal root ganglion of the central nervous sytem. Decades later, when the body's immune system weakens with age, VZV is able to reactivate and descend through the nerve cells to the surface of the skin where it causes a painful blistering rash, known as shingles (or Herpes Zoster). Risk factors for developing shingles include old age, with rates increasing substantially in person's over the age of 50, low immune function or immunosuppression, psychological stress, and diabetes. Person's living with HIV or cancer, those taking immunosuppressants, and transplant recipients are particularly at risk 2.

One of the most common complications associated with shingles is the development of Post-Herpetic Neuralgia (PHN), a persistant severe nerve pain that develops as a result of chronic pain from shingles lesions. PHN can last for days, months, or even years following resolution of shingles. Other complications also include bacterial infection, spread of the shingles rash to the eye (herpes zoster ophthalmicus) or ear, nerve palsies, or spread of VZV to non-immune persons via contact with varicella lesions.

There are numerous advantages to using Shingrix over Zostavax. Clinical trials for Shingrix have shown greater than 90% efficacy in adults aged 50 and older, with 89% efficacy in preventing postherpetic neuralgia in patients 70 years and older and 91% efficacy in patients 50-70 years of age. This is a significant improvement over its predecessor, Zostavax, which reduces the risk of shingles by only 51% and the risk of post-herpetic neuralgia by 67% 1. Efficacy of Zostavax also wanes over time, with protection against shingles and PHN lasting only around 5 years. Efficacy for prevention of shingles is highest in patients 60-69 years old and decreases with increasing age. Furthermore, because Shingrix is an inactivated vaccine it can also be used to prevent shingles and PHN in individuals with suppressed immune systems, who are already at increased risk of developing shingles, while Zostavax, a live attenuated vaccine, is contraindicated.

  • Chickenpox vaccine
  • Human herpesvirus 3 live (attenuated) antigen
  • Varicella vaccine
  • Varicella virus vaccine live (oka-merck) strain
  • Varicella zoster live (attenuated) antigen
  • Varicella zoster live(attenuated) antigen
  • Varicella-zoster virus (live, attenuated)
  • Varicella-zoster virus strain oka/merck live (attenuated) antigen
  • Varicella-zoster virus strain oka/merck live antigen
Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing End
VarivaxInjection, powder, lyophilized, for suspension1350 [PFU]/0.5mLSubcutaneousMerck Sharp & Dohme Corp.1995-03-17Not applicableUs
VarivaxInjection, powder, lyophilized, for suspension1350 [PFU]/0.5mLSubcutaneousMerck Sharp & Dohme Corp.1995-03-17Not applicableUs
Varivax IIIPowder, for solutionSubcutaneousMerck Ltd.2002-12-02Not applicableCanada
ZostavaxInjection, powder, lyophilized, for suspension19400 [PFU]/0.65mLSubcutaneousMerck Sharp & Dohme Corp.2006-05-25Not applicableUs
Additional Data Available
  • Application Number
    Application Number

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  • Product Code
    Product Code

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Mixture Products
NameIngredientsDosageRouteLabellerMarketing StartMarketing End
ProquadVaricella Zoster Vaccine (Live/attenuated) (3.99 log10 tcid50/0.5mL) + Measles virus strain enders' attenuated edmonston live antigen (3 log10 tcid50/0.5mL) + Mumps virus strain B level jeryl lynn live antigen (4.3 log10 tcid50/0.5mL) + Rubella virus vaccine (3 log10 tcid50/0.5mL)Powder, for solutionSubcutaneousMerck Ltd.2014-05-09Not applicableCanada
ProQuadVaricella Zoster Vaccine (Live/attenuated) (9772 [PFU]/0.5mL) + Measles virus strain enders' attenuated edmonston live antigen (1000 [TCID_50]/0.5mL) + Mumps virus strain B level jeryl lynn live antigen (20000 [TCID_50]/0.5mL) + Rubella virus vaccine (1000 [TCID_50]/0.5mL)Injection, powder, lyophilized, for suspensionSubcutaneousMerck Sharp & Dohme Corp.2015-07-01Not applicableUs
ProQuadVaricella Zoster Vaccine (Live/attenuated) (9772 [PFU]/0.5mL) + Measles virus strain enders' attenuated edmonston live antigen (1000 [TCID_50]/0.5mL) + Mumps virus strain B level jeryl lynn live antigen (20000 [TCID_50]/0.5mL) + Rubella virus vaccine (1000 [TCID_50]/0.5mL)Injection, powder, lyophilized, for suspensionSubcutaneousMerck Sharp & Dohme Limited2005-09-062018-08-31Us
VarilrixVaricella Zoster Vaccine (Live/attenuated) (2000 unit) + Water (0.5 ml)Powder, for solutionSubcutaneousGlaxosmithkline Inc2003-04-09Not applicableCanada
CAS number
Not Available



Zostavax vaccine is indicated for the prevention of herpes zoster (shingles) in immunocompetent adults aged 50 years and older.

Varivax vaccine is indicated for active immunization for the prevention of varicella in individuals 12 months of age and older.

Associated Conditions
Not Available
Mechanism of action

Zostavax provides protection against Herpes Zoster reactivation by eliciting an immune response to Varicella Zoster Virus (VZV).

Varivax provides protection against chickenpox by eliciting both cell-mediated and humoral immune responses to varicella-zoster virus.

Additional Data Available
Adverse Effects

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Additional Data Available

Structured data covering drug contraindications. Each contraindication describes a scenario in which the drug is not to be used. Includes restrictions on co-administration, contraindicated populations, and more.

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Blackbox Warnings

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Not Available
Volume of distribution
Not Available
Protein binding
Not Available
Not Available
Route of elimination
Not Available
Half life
Not Available
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Affected organisms
Not Available
Not Available
Pharmacogenomic Effects/ADRs
Not Available


Drug Interactions
This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
2-MethoxyethanolThe risk or severity of infection can be increased when Varicella Zoster Vaccine (Live/attenuated) is combined with 2-Methoxyethanol.
9-(N-methyl-L-isoleucine)-cyclosporin AThe risk or severity of infection can be increased when Varicella Zoster Vaccine (Live/attenuated) is combined with 9-(N-methyl-L-isoleucine)-cyclosporin A.
AbacavirThe therapeutic efficacy of Varicella Zoster Vaccine (Live/attenuated) can be decreased when used in combination with Abacavir.
AbataceptThe risk or severity of infection can be increased when Varicella Zoster Vaccine (Live/attenuated) is combined with Abatacept.
AbetimusThe risk or severity of infection can be increased when Varicella Zoster Vaccine (Live/attenuated) is combined with Abetimus.
Acetylsalicylic acidThe risk or severity of adverse effects can be increased when Acetylsalicylic acid is combined with Varicella Zoster Vaccine (Live/attenuated).
ActeosideThe risk or severity of infection can be increased when Varicella Zoster Vaccine (Live/attenuated) is combined with Acteoside.
AcyclovirThe therapeutic efficacy of Varicella Zoster Vaccine (Live/attenuated) can be decreased when used in combination with Acyclovir.
AdafosbuvirThe therapeutic efficacy of Varicella Zoster Vaccine (Live/attenuated) can be decreased when used in combination with Adafosbuvir.
AdalimumabThe risk or severity of infection can be increased when Varicella Zoster Vaccine (Live/attenuated) is combined with Adalimumab.
Additional Data Available
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    Extended Description

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  • Severity

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  • Evidence Level
    Evidence Level

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  • Action

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Food Interactions
Not Available


General References
  1. Bharucha T, Ming D, Breuer J: A critical appraisal of 'Shingrix', a novel herpes zoster subunit vaccine (HZ/Su or GSK1437173A) for varicella zoster virus. Hum Vaccin Immunother. 2017 Aug 3;13(8):1789-1797. doi: 10.1080/21645515.2017.1317410. Epub 2017 Apr 20. [PubMed:28426274]
  2. CDC - Clinical Overview of Shingles (Herpes Zoster) [Link]
  3. CDC - What Everyone Should Know about Shingles Vaccine [Link]
  4. CDC - About Chickenpox [Link]
External Links
PubChem Substance
RxList Drug Page Drug Page
AHFS Codes
  • 80:12.00 — Vaccines
FDA label
Download (408 KB)

Clinical Trials

Clinical Trials
1Active Not RecruitingBasic ScienceHerpes Zoster / Shingles1
1Active Not RecruitingPreventionImmunosenescence / Shingles1
1Active Not RecruitingTreatmentNeuroblastomas / Sarcoma, Osteogenic / Sarcomas1
1CompletedPreventionHerpes Zoster3
1CompletedPreventionImmunization; Infection / Varicella Zoster1
1CompletedPreventionRheumatoid Arthritis / Varicella Zoster1
1CompletedPreventionSystemic Lupus Erythematosus (SLE)1
1CompletedPreventionVaricella (Chicken Pox)1
1Not Yet RecruitingBasic ScienceHerpes Zoster1
1TerminatedPreventionChickenpox / Renal Transplant Recipient Patients / Transplantation, Kidney / Varicella Zoster1
1, 2Active Not RecruitingPreventionHerpes Zoster1
1, 2CompletedPreventionDengue Fever1
1, 2RecruitingOtherAcute fulminant liver failure / Heart Diseases / Renal Insufficiency,Chronic1
1, 2TerminatedPreventionMumps / Rubella / Rubeola / Varicella1
1, 2WithdrawnPreventionHerpes Zoster1
2Active Not RecruitingPreventionAnkylosing Spondylitis (AS) / Arthritis / Crohn's Disease (CD) / Enteropathic Arthritis / Inflammatory Arthritis / Psoriasis / Psoriatic Arthritis / Rheumatoid Arthritis2
2Active Not RecruitingTreatmentChildhood Cancers / Multiple Diseases1
2CompletedPreventionDiseases Caused by Measles, Mumps, Rubella and Varicella Viruses / Measles-Mumps-Rubella-Varicella Vaccine / Mumps / Rubella / Rubeola / Varicella1
2CompletedPreventionHaemophilus Influenzae Type B / Neisseria Meningitidis1
2CompletedPreventionHerpes Zoster2
2CompletedPreventionHerpes Zoster / Human Immunodeficiency Virus (HIV) Infections1
2CompletedPreventionMeasles-Mumps-Rubella Vaccine / Mumps / Rubella / Rubeola1
2CompletedPreventionMeningitis / Meningococcal Infections1
2CompletedPreventionMumps / Rubella / Rubeola / Varicella1
2CompletedPreventionVaricella / Varicella (Chickenpox)1
2RecruitingPreventionHerpes Zoster / Inflammatory Diseases / Rheumatoid Arthritis1
2, 3CompletedPreventionVaricella Zoster Virus Infection1
2, 3RecruitingPreventionHealthy Children1
2, 3RecruitingTreatmentImmunosuppression / Liver Diseases / Varicella1
2, 3Unknown StatusPreventionHepatitis A / Varicella1
3Active Not RecruitingPreventionInfections, Pneumococcal1
3Active Not RecruitingPreventionInfections, Pneumococcal / Vaccines, Pneumococcal1
3Active Not RecruitingPreventionVaricella1
3CompletedNot AvailableMumps / Rubeola / Varicella1
3CompletedPreventionAcellular Pertussis / Diphtheria / Pertussis and/or Poliomyelitis Diseases / Tetanus1
3CompletedPreventionBacterial Infections / Virus Diseases1
3CompletedPreventionChickenpox Vaccines / Varicella1
3CompletedPreventionDiphtheria / Haemophilus Infections / Mumps / Pertussis / Poliomyelitis / Rubella / Rubeola / Tetanus / Varicella / Viral Hepatitis B1
3CompletedPreventionDiphtheria / Pertussis / Poliomyelitis / Rubeola / Tetanus1
3CompletedPreventionEncephalitis, Japanese B / Varicella1
3CompletedPreventionFlu caused by Influenza1
3CompletedPreventionHaemophilus Influenza b Infections / Haemophilus Influenzae Type B / Meningococcal Infections / Neisseria Meningitidis / Neisseria Meningitidis-Haemophilus Influenzae Type b Vaccine1
3CompletedPreventionHaemophilus Influenzae Type B / Haemophilus Influenzae Type B Infection / Meningococcal Infections / Neisseria Meningitidis1
3CompletedPreventionHepatitis A1
3CompletedPreventionHerpes Zoster5
3CompletedPreventionHerpes Zoster / Infections, Pneumococcal1
3CompletedPreventionHerpes Zoster / Shingles2
3CompletedPreventionHerpes Zoster / Varicella-zoster Vaccine1
3CompletedPreventionMeasles-Mumps-Rubella / Mumps / Rubella / Rubeola1
3CompletedPreventionMeasles; Mumps; Rubella1
3CompletedPreventionMeningitis / Meningococcal Infections1
3CompletedPreventionMeningococcal Meningitis1
3CompletedPreventionMeningococcal Meningitis / Mumps / Rubella / Rubeola / Varicella3
3CompletedPreventionMumps / Rubella / Rubeola2
3CompletedPreventionMumps / Rubella / Rubeola / Varicella12
3CompletedPreventionPrevention of : Herpes-Zoster1
3CompletedPreventionStreptococcal Infections / Streptococcus Pneumoniae Vaccines1
3CompletedPreventionVaricella Virus Infection1
3RecruitingPreventionMeningococcal Infections2
3RecruitingTreatmentInfections, Pneumococcal1
3TerminatedPreventionMumps / Rubella / Rubeola / Varicella1
3Unknown StatusTreatmentImmunosuppression / Transplantation, Organ1
4Active Not RecruitingNot AvailableHealthy Volunteers1
4Active Not RecruitingBasic ScienceShingles1
4Active Not RecruitingPreventionCartilage-hair Hypoplasia1
4Active Not RecruitingPreventionChickenpox1
4Active Not RecruitingPreventionHepatitis A / Rubeola / Varicella1
4Active Not RecruitingPreventionHerpes Zoster1
4Active Not RecruitingPreventionTransplant, Kidney1
4CompletedNot AvailableMumps / Rubella / Rubeola / Varicella1
4CompletedBasic ScienceShingles1
4CompletedPreventionChickenpox / Encephalitis, Japanese B1
4CompletedPreventionChickenpox / Hepatitis A / Mumps / Rubella / Rubeola1
4CompletedPreventionFibrosis / Herpes Zoster1
4CompletedPreventionFlu caused by Influenza / Respiratory Infections, Acute1
4CompletedPreventionHepatitis A Virus1
4CompletedPreventionHerpes Zoster1
4CompletedPreventionHerpes Zoster / Shingles1
4CompletedPreventionSystemic Lupus Erythematosus (SLE)1
4Enrolling by InvitationPreventionVaricella1
4Not Yet RecruitingHealth Services ResearchPersistence of Varicella Immunity1
4Unknown StatusPreventionImmune Response to Zoster Vaccine1
4Unknown StatusPreventionVaricella1
Not AvailableActive Not RecruitingNot AvailableHerpes Zoster / Shingles1
Not AvailableCompletedNot AvailableHematopoietic Stem Cell Transplant (HSCT)1
Not AvailableCompletedNot AvailableImmune System Diseases1
Not AvailableCompletedNot AvailableVaricella1
Not AvailableCompletedNot AvailableVaricoceles1
Not AvailableCompletedBasic ScienceHealthy Volunteers1
Not AvailableCompletedBasic ScienceShingles1
Not AvailableCompletedPreventionHerpes Zoster1
Not AvailableCompletedPreventionShingles1
Not AvailableRecruitingPreventionBruton's agammaglobulinemia / Common Variable Immune Deficiency (CVID) / Specific Antibody Deficiency1
Not AvailableTerminatedBasic ScienceHepatitis C Viral Infection1
Not AvailableWithdrawnNot AvailableTransplanted / Varicella1


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Dosage forms
Injection, powder, lyophilized, for suspensionSubcutaneous
Powder, for solutionSubcutaneous
Injection, powder, lyophilized, for suspensionSubcutaneous1350 [PFU]/0.5mL
Powder, for solutionSubcutaneous
Injection, powder, lyophilized, for suspensionSubcutaneous19400 [PFU]/0.65mL
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Experimental Properties
Not Available


Not classified

Drug created on December 01, 2015 13:03 / Updated on July 11, 2020 00:05

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