Shingles vaccine zostavax ii information for patients. Vaccine administration record var informed consent for. Standing orders for administering zoster shingrix vaccine. Record the generic abbreviation for the type of vaccine given e. Zoster vaccine it is not necessary to inquire about chickenpox or test for varicella immunity before administering zoster vaccine persons 60 years of age and older can be assumed to be immune. Record the publication date of each vis as well as the date it is given to the patient. The adverse event monitoring substudy of the sps, designed to provide detailed data on the safety profile of the zoster vaccine n3,345 received zostavax and n3,271 received placebo. A quick look at using herpes zoster vaccine zostavax, hzv contraindications a serious reaction to a prior dose of a varicellacontaining vaccine a serious reaction to a component of zoster vaccine, including gelatin or neomycin pregnant or planning on becoming pregnant in the next 4 weeks. Health information technology utilize electronic health record ehr capabilities to help improve vaccination rates. Publicly funded shingles herpes zoster immunization. Record the route by which the vaccine was given as either intramuscular im, subcutaneous subcut sc, intradermal id, intranasal nas, or oral po and also the site where it was administered as either ra right.
Zoster vaccine recombinant, adjuvanted shingrix was approved on october 20, 2017 by the food and drug administration for the prevention. Zoster vaccine fact sheet will be available on the moh site. Quick look at using herpes zoster vaccine zostavax, hzv. More detailed information can be found in the ncirs fact sheet. Record the route by which the vaccine was given as either intramuscu lar im, subcutaneous. It is not intended to provide or take the place of medical advice, diagnosis or treatment.
A new shingles vaccine called shingrix was licensed by the u. Vaccine administration record for adults chart number. Zostavax vaccine 7 march 2017 the tga has received a report of a death occurring in a person with preexisting compromised immune function after receiving zostavax a live, attenuated varicellazoster virus vaccine that is used to prevent shingles and preventiontreatment of nerve pain associated with the virus. This fact sheet provides responses to common questions about zoster disease and zoster vaccine. Vaccine administration record varinformed consent for. Record the site where vaccine was administered as either ra right arm. Food and drug administration fda in may 2006, in 2011, the fda approved the live vaccine for use in individuals 50. Patient information about zostavax pronounced zos tah. This questions and answers sheet for health care professionals provides basic information only.
Publicly funded shingles herpes zoster immunization program. This information does not take the place of talking about zostavax with your doctor, nurse, or other health care. Zostavax works by helping your immune system protect you from getting shingles. The most common vaccine side effects occur around the injection. Evaluation of efficacy and effectiveness of live attenuated. Vaccine administration record for adults state of michigan. Update the patients record with any new allergy, health condition or primary care provider information. Jan 09, 2018 download zostavax vaccine screening form for contraindications as pdf 704 kb, 3 pages download zostavax vaccine screening form for contraindications as word 41 kb, 3 pages we aim to provide documents in an accessible format. Both client and vaccinator must be seated for vaccine administration. If you have any questions about zostavax after reading this leaflet, you.
Standing orders for administering zoster vaccine to adults. Zostavax can be administered concurrently with inactivated influenza vaccine see section 4. Update the patient record with any new allergy, health condition or primary care provider information. Complete sections a,b,c section a please print clearly cell phone date of birth.
Zoster vaccine live you should readthis summary of information about zostavax before you are vaccinated. Zoster vaccine recombinant, adjuvanted shingrix was approved on october 20, 2017 by the food and drug administration for the prevention of herpes zoster in adults. Vaccine administration record var informed consent for vaccination for all health care providers ages 2 to 49 only section b the following questions will help us determine your eligibility to be. Contraindications do not give herpes zoster vaccine rzv or zvl to a person who has. Zostavax zoster vaccine live for healthcare professionals. Zostavax has an excellent safety record since it was introduced in the u.
Vaccine administration record var informed consent for vaccination for all health care providers ages 2 to 49 only section b the following questions will help us determine your eligibility to be vaccinated today. For zostavax, mmr ii, varivax, yfvax, menveo, imovax and rabavert, ensure the vaccine is reconstituted following the package inserts instructions. Vaccine administration prepare for vaccine administration, including storage and handling information. The most common vaccine side effects occur around the injection site, including redness, swelling andor pain, and headache. For a list of vaccine components, refer to the manufacturers pack. Contraindications do not give herpes zoster vaccine rzv or zvl to a person who has experienced a serious systemic or anaphylactic reaction to a vaccine component.
Date on vis 2 date given 2 vaccine information statement signature initials of vaccinator 1. Varivax varicella virus vaccine live dose, indications. After several plaintiffs filed lawsuits claiming the drugmakers shingles vaccine caused serious injury and death, attorneys say. For chickenpox, mmr ii, shingles, yellow fever only. Only answer these questions if you are receiving any vaccinations listed above. A subcutaneous vaccine for the prevention of herpes. If vaccine was not given, record the reason for nonreceipt. After several plaintiffs filed lawsuits claiming the drugmakers shingles vaccine caused serious injury and death, attorneys. Zostavax vaccine screening form for contraindications. Vaccine administration record for adults connecticare.
Provide a current vaccine information statement vis and answer any questions. Food and drug administration fda in may 2006, in 2011, the fda approved the live vaccine for use in individuals 50 to 59 years of age. However, live shingles vaccine may be used in some circumstances for example if a person is allergic to recombinant. However, live shingles vaccine may be used in some circumstances for example if a person is allergic to. Sep 01, 2019 the adverse event monitoring substudy of the sps, designed to provide detailed data on the safety profile of the zoster vaccine n3,345 received zostavax and n3,271 received placebo used vaccination report cards vrc to record adverse events occurring from days 0 to 42 postvaccination 97% of subjects completed vrc in both vaccination groups. Always talk to a health care professional about any health concerns you have, and before you make any changes to your diet, lifestyle or treatment. Another type of shingles vaccine, recombinant shingles vaccine, is the preferred vaccine for. Record all required data elements in the clients permanent health record. Zostavax is indicated for prevention of herpes zoster zoster or shingles and herpes zosterrelated postherpetic neuralgia phn. All subjects received a vaccination report card vrc to record adverse events occurring from days 1 to 42 postvaccination in addition to undergoing routine safety monitoring throughout the study. Shingrix provides strong protection against shingles and phn. Zostavax is a live attenuated virus vaccine indicated for prevention of herpes zoster shingles in individuals 50 years of age and older. Zostavax fda prescribing information, side effects and uses. All subjects received a vaccination report card vrc to record adverse events.
Zostavax vaccine therapeutic goods administration tga. Shingrix is a zoster vaccine developed by glaxosmithkline that was approved in the united states in october 2017. Zostavax and pneumovax 23 should not be given concomitantly because concomitant use resulted in reduced immunogenicity of zostavax see section 5. Cdc recommends that healthy adults 50 years and older get two doses of shingrix, 2 to 6 months apart. Be prepared to manage a medical emergency related to the administration of vaccines by. If you have any questions about zostavax after reading this leaflet, you shouldask your health care provider. Vaccine administration record for adults pennsylvania. Zostavax contains a weakened chickenpox virus varicellazoster virus. Vaccine administration record var informed consent for vaccination for all health care providers patient. Acip first recommended the zostavax vaccine in 2008. Herpes zoster subunit vaccine rzv shingrix 1 oregon.
Nov 26, 2018 be aware that 2 different types of zoster vaccine are commercially available in the us zoster vaccine recombinant rzv. Vaccine administration record varinformed consent for vaccination. Indication for zostavax zostavax zoster vaccine live is a live attenuated virus vaccine indicated for prevention of herpes zoster shingles in individuals 50 years of age and older. Zostavax zoster vaccine live for health care professionals. Vaccination strategies guide your vaccination process with ideas for improvement. Vaccine administration record for adults immunization action. Zostavax is a live attenuated virus vaccine indicated for prevention of herpes zoster. The zostavax zoster vaccine package insert pdf icon 12 pages external icon makes no reference to varicella history, and almost all people 60 years old or older are immune to varicella. Zostavax ii zoster vaccine live, attenuated okamerck, refrigeratorstable page 4 of 29 zostavax ii is a live, attenuated varicellazoster vaccine and administration to individuals who are immunosuppressed or immunodeficient may result in disseminated varicellazoster virus disease, including fatal outcomes. Always provide or update the patients personal record card. With the exception of hepatitis b vaccines, record the generic abbreviation e. Dosage and administration of zostavax zoster vaccine live. The zoster vaccine, developed by merck and nowadays commercially available, has an antigen content higher than at least 19,400 pfu plaqueforming units, i.
Mar 18, 2019 the adverse event monitoring substudy of the sps, designed to provide detailed data on the safety profile of the zoster vaccine n3,345 received zostavax and n3,271 received placebo used vaccination report cards vrc to record adverse events occurring from days 0 to 42 postvaccination 97% of subjects completed vrc in both vaccination groups. Occasionally itching or a rash around the injection site may occur. Limited safety and immunogenicity data from clinical trials are available on the concurrent administration of pneumovax 23 and vaccines other than zostavax. Zostavax is a live, attenuated varicellazoster vaccine and administration to individuals. It must not take the place of medical advice, diagnosis or treatment. Before administering any vaccines, give the patient copies of all pertinent vaccine information statements viss and make sure heshe understands the risks and benefits of the vaccines. Vaccine administration record20172018 tennessee law.
Zostavax is a lyophilized preparation of live, attenuated varicellazoster virus okamerck to be reconstituted with sterile diluent to give a single dose suspension with a minimum of 19,400 pfu. Download zostavax vaccine screening form for contraindications as pdf 704 kb, 3 pages download zostavax vaccine screening form for contraindications as word 41 kb, 3 pages we. Varicella virus vaccine live should also not be administered to those with cellular immune deficiency or those patients on immunosuppressive therapy such as highdose corticosteroid therapy. The safety of administering zoster vaccine should always be considered on a casebycase basis. With the exception of hepatitis b vaccines, record the generic abbrevia. Patient information about zostavax pronounced zos tah vax. Complete sections a,b,c section a please print clearly cell phone date of birth age gender male female first name mi last name home address city state zip code. Zostavax is indicated for immunization of individuals 50 years of age. Shingles vaccine zostavaxii information for patients.