title: Concomitant administration of pneumococcal-23 and zoster vaccines provides adequate herpes zoster coverage.
abstract: OBJECTIVE
  To determine whether concomitant administration of zoster vaccine and polysaccharide pneumococcal-23 vaccine (PPV23) provides sufficient protection against herpes zoster infections.
  
  
  METHODS
  Literature was retrieved through the Centers for Disease Control and Prevention (CDC) website, PubMed (inception-February 2013), and Scopus (inception-February 2013) using the key words herpes zoster, pneumococcal, vaccine, concomitant, simultaneous administration, Pneumovax, Zostavax, and barriers. In addition, reference citations from publications were used.
  
  
  METHODS
  All English-language articles identified from the data sources were evaluated. Two studies evaluating concomitant and nonconcomitant administration of zoster vaccine and PPV23 were included.
  
  
  RESULTS
  Current product labeling recommends a 4-week interval between zoster vaccine and PPV23 administration; however, the Food and Drug Administration (FDA) and the CDC promote concomitant administration to prevent a missed opportunity to vaccinate. This has caused confusion among health care professionals regarding the appropriate timing of these vaccines. A randomized trial that evaluated the immunogenicity of zoster vaccine and PPV23 given together versus separated by at least 4 weeks demonstrated that the varicella zoster virus (VZV) antibody levels of concomitant versus nonconcomitant vaccination groups did not meet noninferiority requirements. However, a large retrospective cohort trial that compared the incidence of herpes zoster infections following concomitant versus nonconcomitant administration of PPV23 and zoster vaccine did not find a statistically significant between-group difference.
  
  
  CONCLUSIONS
  Concomitant administration of zoster vaccine and PPV23 is advocated by the CDC and FDA to improve immunization rates among vaccine-eligible individuals. Since there is no direct evidence that simultaneous administration of zoster vaccine and PPV23 puts patients at increased risk of developing herpes zoster, the vaccines should be given during the same office visit to avoid a missed opportunity to vaccinate against 2 serious diseases.
authors.affiliation: Department of Pharmacy, Drug Information Center, Cleveland Clinic, Cleveland, OH, USA. wymanm@ccf.org
authors.forename: Marcia J
authors.initials: MJ
authors.lastname: Wyman
authors.forename: Katie L
authors.initials: KL
authors.lastname: Stabi
mesh_terms: D000818:Animals; D002487:Centers for Disease Control and Prevention, U.S. / Q000639:trends; D004359:Drug Therapy, Combination; D006562:Herpes Zoster / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D053061:Herpes Zoster Vaccine / Q000008:administration & dosage*; D006801:Humans; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D014481:United States; D014486:United States Food and Drug Administration / Q000639:trends
chemical_list: C414006:23-valent pneumococcal capsular polysaccharide vaccine; D053061:Herpes Zoster Vaccine; D022242:Pneumococcal Vaccines