First AD

Second AD

You order a shingles vaccine for your 62-year-old patient. Your nurse comes to you in tears to report that she mistakenly gave the patient a dose of varicella vaccine (Varivax) and not the zoster shot. The patient is adamant about getting protected against shingles ASAP.

A. Go ahead and administer the zoster vaccine now

B. Have the patient return in a week for the zoster vaccine

C. Tell the patient that the shingles vaccine is made of the varicella vaccine and the dose given should provide adequate protec

D. Have the patient come back in 4 weeks for the zoster vaccine

The best answer is A: Give the vaccine now. 

Options B and C are unacceptable. Option D is an approved option, but would delay protection. The shingles vaccine is, in fact, a high-dose form of the varicella vaccine; it contains 13 times the amount of antigen used in the varicella vaccine. When giving live vaccines, you can give multiple different ones on the same day but then need to wait 4 weeks before giving another live vaccine. Some individuals do not respond well immunologically to a second live vaccine if it is given too soon after another live vaccine.

Note that the ACIP states that if the wrong vaccine is given, “the event should be documented and procedures put in place to prevent this from happening again.”

Centers for Disease Control and Prevention. Vaccines and preventable diseases: herpes zoster vaccination information for health care professionals: vaccine administration errors. 

http://www.cdc.gov/vaccines/vpd-vac/shingles/hcp-vaccination.htm

Nervous System Diseases

Do you know what the ACIP says about mixing the zoster and varicella vaccines?

Zoster Vaccine Administration Error: What Would You Do?