Ministry of Health and Long-Term Care 

Publicly Funded Shingles (Herpes Zoster) Immunization Program: Information for Health Care Providers 

This questions and answers sheet for health care professionals provides basic information 
only. It is not intended to provide or take the place of medical advice, diagnosis or treatment. 

Effective September 15, 2016, Ontario will introduce shingles vaccine for individuals 65 
to 70 years of age, as part of Ontario’s publicly funded immunization program. 

Q1. What is herpes zoster? 

A1. The varicella zoster virus (VZV) causes 
two distinct clinical syndromes: varicella 
(chickenpox), and zoster (shingles). Herpes 
zoster (HZ) infection arises from the 
reactivation of latent varicella zoster virus 
from a previous chickenpox infection. 

Q2. Who is at risk for herpes zoster? 

A2. Herpes zoster can develop at any time 
following a varicella (chickenpox) infection 
and can occur in individuals of any age. 
However, herpes zoster occurs most 
frequently among older adults and 
immunocompromised persons. Age is the 
most important risk factor for development 
of herpes zoster and two-thirds of the cases 
occur in individuals over 50 years of age. In 
addition, the severity of illness associated 
with herpes zoster and its complications 
also increases with age. Post-herpetic 
neuralgia is the most frequent complication 
of HZ, and is characterized by prolonged 
and often debilitating neurogenic pain that 
persists for more than 90 days from the 
onset of rash. 

Q3. What is the incidence/prevalence 
of herpes zoster in Canada? 

A3. In recent studies, the lifetime risk of HZ 
has been estimated to be as high as 30 per 
cent in the general population. In Canada, 
there are an estimated 130,000 new cases 
of HZ, and 17,000 cases of post-herpetic 
neuralgia which result in 2,000 
hospitalizations. 

Q4. Who is eligible for the publicly 
funded shingles immunization 
program? 

A4. Effective September 15, 2016, 
individuals ages 65 to 70 years (i.e., from 
the 65th birthday to the day prior to the 71st 
birthday) will be eligible for a dose of 
publicly funded herpes zoster vaccine. 

PLEASE NOTE: Until December 31, 2016, 
individuals born in 1945 (i.e., those who 
have turned or will be turning 71 years of 
age in 2016), will be eligible for publicly 
funded herpes zoster vaccine through a 
one-time catch-up program. This one-
time catch up program will end on 
December 31, 2016, after which 
individuals ages 65 to 70 years will be 
eligible for publicly funded herpes zoster 
vaccine. 

Q5. How will the eligible cohort 
access publicly funded herpes zoster 
vaccine? 

A5. Individuals aged 65 to 70 will be able to 
receive herpes zoster vaccine through their 
primary care provider. Primary care 
providers are encouraged to identify and 
offer the herpes zoster vaccine to their 
eligible patients. 

Q6. What about my patients who are 
younger than 65 or older than 70, or 
those who are immunocompromised 
– are they eligible to receive the 
publicly funded vaccine? 

A6. Only individuals between 65 to 70 years 
of age are eligible to receive a dose of 
publicly funded shingles vaccine. For non-
eligible individuals, the vaccine can be 
purchased privately. Some of your patients 
may have private health care insurance that 
may cover the cost of the vaccine. 

Q7. Which vaccine is used to protect 
against herpes zoster? 

A7. Zostavax® II, manufactured by Merck 
Canada, is a live, attenuated virus vaccine 
containing a lyophilized preparation of the 
Oka/Merck strain of varicella-zoster virus. 
Zostavax® II is currently the only vaccine 
licensed for use in Canada for the 
prevention of herpes zoster. 

Zostavax® II is indicated for the prevention 
of shingles. It cannot be used to treat 
existing shingles or the pain associated with 
existing shingles. 

Q8. What is the safety and efficacy 
profile of herpes zoster vaccine? 

A8. Zostavax® II has been shown to be 
safe and effective for the prevention of 
herpes zoster and its complications. Based 
on a clinical study, the incidence of herpes 
zoster and post-herpetic neuralgia (the 
most frequent complication of acute herpes 
zoster), as well as the duration and severity 
of herpes zoster were significantly reduced 
in herpes zoster vaccine recipients. Overall 
vaccine efficacy was 51.3 per cent for 
herpes zoster incidence and 66.5 per cent 
for post-herpetic neuralgia. 

Q9. What is the recommended 
dosing schedule? 

A9. A single dose of herpes zoster vaccine 
should be administered subcutaneously. 
The vaccine can be given to those with or 
without a prior history of herpes zoster. The 
vaccine should be given at least one year 
following the last episode of HZ. 

Please note: Individuals with a history of 
herpes zoster ophthalmicus (HZO) should 
be informed that cases of recurrent HZO 
following vaccine have occurred, although 
causality has not been established, and that 
the risk of recurrent HZO relative to the 
potential benefit of preventing future 
recurrences is unknown. 

Q10. Are booster doses of herpes 
zoster vaccine recommended? 

A10. The duration of protection from herpes 
zoster vaccination is unknown beyond 
seven years and it is not known whether 
booster doses of vaccine are beneficial. 
The National Advisory Committee on 
Immunization (NACI) believes that there is 
insufficient evidence at this time to 
recommend booster doses of herpes zoster 
vaccine. This remains an area of ongoing 
research. 

Q11. What if an individual does not 
have a previous history of 
chickenpox - should they still be 
offered the vaccine? 

A11. Yes, herpes zoster vaccine should be 
administered to individuals eligible for the 
vaccine regardless of whether or not the 
person has a history of varicella infection. 
Nearly all Canadians eligible for HZ 
immunization will have had prior varicella 
exposure, even if a diagnosis of varicella 
cannot be recalled. Therefore, the vaccine 
should still be offered to individuals to 
protect against herpes zoster. 

Q12. Can the herpes zoster vaccine 
be given simultaneously with the 
other vaccines? 

A12. As referenced in the Canadian 
Immunization Guide (CIG), in general, HZ 
vaccine may be administered concurrently 
with other live vaccines given by the 
parenteral, oral, or intranasal routes. For 
concurrent parenteral injections, different 
injection sites and separate needles and 
syringes should be used. 

If two live parenteral vaccines are not 
administered concurrently, there should be 
a period of at least 4 weeks before the 
second live parenteral vaccine is given. 

Although the product monograph for 
Zostavax® II indicates that Zostavax® II 
and Pneumovax® 23 should not be given 
concomitantly, it should be noted that the 
CIG indicates that “Concomitant 
administration of pneumococcal 23-valent 
polysaccharide vaccine (Pneu-P-23) and 
HZ vaccine has not resulted in decreased 
efficacy and so the two vaccines can be 
given concomitantly.” 

In general, influenza and pneumococcal 
vaccines may be administered 
concomitantly with the herpes zoster 
vaccine at a different injection site. 

Q13. Are there any side effects? 

A13. In studies, the most common side 
effects of receiving the shingles vaccine are 
mild and include injection site pain, swelling 
or redness. Other side effects that have 
been reported include: hard lump, itching, 
warmth, and bruising at the injection site. 
Headache and pain in an arm or leg were 
also reported. 

Please see the product monograph for a 
complete list of reported side effects. 

Q14. Who should not receive the 
herpes zoster vaccine? 

A14. Zostavax® II is a live attenuated 
vaccine and should not be given to: 

• Individuals with primary and acquired 
immunodeficiency states due to 
conditions such as: acute and 
chronic leukemias; lymphoma; other 
conditions affecting the bone marrow 
or lymphatic system; 
immunosuppression due to 
HIV/AIDS 
• Individuals on immunosuppressive 
therapy (including high-dose 
corticosteroids) 
• Individuals with a history of 
anaphylaxis after previous 
administration of the vaccine 
• Individuals with proven immediate or 
anaphylactic hypersensitivity to any 
component of the vaccine or its 
container, including gelatin or 
neomycin 
• Individuals with active herpes zoster 
• Individuals with active untreated 
tuberculosis 
• Individuals that are pregnant 


Administration of HZ vaccine should be 
postponed in persons suffering from severe 
acute illness, however, immunization should 
not be delayed because of minor acute 
illness, with or without fever. 

Further information on who should not 
receive the herpes zoster vaccine can be 
found in the Canadian Immunization Guide. 

Q15. How do I order herpes zoster 
vaccine? 

A15. Health care providers are able to order 
herpes zoster vaccine through their vaccine 
supply source (i.e., local public health unit 
or the Ontario Government Pharmaceutical 
and Medical Supply Service (OGPMSS). 
Information about your local public health 
unit can be found at: Public Health Unit Locator

Q16. How should herpes zoster 
vaccine be stored? 

A16. In order to ensure optimal protection, 
herpes zoster vaccine must be maintained 
at a temperature between +2°C to +8°C 
from the time of manufacture until the 
vaccine is administered to individuals. This 
temperature must be monitored and 
maintained at all times. For additional 
information on provincial vaccine storage 
and handling requirements please refer to 
the Vaccine Storage and Handling 
Guidelines available at: Infectious Diseases Program Standards


Q17. How should I document 
administration of the vaccine to the 
eligible cohort? 

A17. As with all vaccines administered in 
Ontario, health care providers are expected 
to document administration of the vaccine in 
both the patient’s medical record and 
personal immunization record (i.e., the 
"Yellow Card"). 

Q18. What is an adverse event 
following immunization (AEFI)? 
Which adverse events should I 
observe for? 

A18. An adverse event following 
immunization (also known as an AEFI) is an 
unwanted or unexpected change in health 
that happens after someone receives a 
vaccine. An adverse event may or may not 
be caused by the vaccine. Prior to 
immunization, individuals should be advised 
of the benefits and risks of the herpes 
zoster vaccine as well as the importance of 
immediately reporting an AEFI. 

In addition to reportable events (see Health 
Protection and Promotion Act, R.S.O. 
1990) health care providers are asked to 
report any of the following events to their 
local public health unit: 

• In rare instances, transmission has 
been documented following varicella 
vaccine administration. Suspected 
transmission of herpes zoster 
vaccine-strain virus to a close 
household or occupational contact 
has not been documented and 
therefore should be reported as a 
reportable event 
• Recurrent herpes zoster following 
immunization of individuals with a 
history of herpes zoster prior to 
immunization, noting the area of 
recurrence 
• Recurrent herpes zoster 
ophthalmicus (HZO) following HZ 
vaccination of a person who has had 
a previous episode of HZO 


Q19. What should I do if a patient 
reports an AEFI? 

A19. Under section 38 of the Health 
Protection and Promotion Act, R.S.O. 1990, 
Ontario physicians, nurses, pharmacists 
and other health care providers (as listed 
under the section) are required to inform the 
person who consents to immunization of the 
importance of immediately reporting to a 
physician or a registered nurse in the 
extended class (nurse practitioner) of any 
reaction that may be a reportable event. 

Health care providers should call their local 
public health unit to report the AEFI and 
then complete the Report of Adverse Event 
Following Immunization (AEFI) reporting 
form to document any reported AEFIs. The 
AEFI reporting form is available on Public 
Health Ontario’s website: Vaccine Safety


Public health units investigate adverse 
events following immunization (AEFI) and 
provide support to health care providers, 
individuals and their families. Public Health 
Ontario analyzes AEFIs that are reported in 
Ontario to monitor the safety of 
administered vaccines and contribute to 
national and international vaccine safety 
surveillance systems. 

Q20. Where can I get more 
information? 

A20. For more information on Ontario’s 
publicly funded immunization program 
including herpes zoster vaccine, please 
visit: Vaccines and immunization

You may also contact your local public 
health unit. 

The Zostavax® II product monograph can 
be found at: Merck Vaccines


Canadian Immunization Guide: Canadian Immunization Guide: