The American Advisory Committee on Immunization Practices (ACIP) issued guidelines for shingles prevention. The guidelines provide an overview of the epidemiology of herpes zoster and its sequelae, and recommend for the first time a vaccine approved by the U.S. Food and Drug Administration (FDA) for the prevention of herpes zoster in people over 60 years of age. Herpes zoster is a clustered and painful skin rash caused by the reemergence of varicella-zoster virus (VZV) infection that is latent in the body and commonly occurs in the elderly and immunodeficient individuals. Herpes zoster affects 1 million people each year in the United States, and about 1/3 of the population has been infected with herpes zoster. 10% to 18% of patients have chronic pain disorder, postherpetic neuralgia (PHN); 10% to 25% of patients have chronic or persistent pain involving the eyes, with occasional facial scarring; 3% of patients require hospitalization, and most are immunodeficient. Patients with immunocompetent herpes zoster have a lower mortality rate. To reduce the severity of herpes zoster and shorten the duration of acute pain, guidelines recommend prompt oral administration of the antivirals acyclovir and valacyclovir. In some patients, cortisol as well as analgesics may be required for pain control. Analgesics, tricyclic depressants, and other pharmacologic therapies may help control PHN. In May 2006, the FDA approved a live attenuated vaccine, Zostavax, for the prevention of shingles in people over 60 years of age. The vaccine is administered subcutaneously in the deltoid region of the upper arm in a single injection dose of 0.65 ml. Its minimum potency is at least 14 times that of the original varicella vaccine (approved by the FDA in 1995). A large clinical trial confirmed its effectiveness. The rest of the guideline reads as follows: When herpes zoster virus was administered concurrently with trivalent inactivated influenza vaccine, the immunity of the two vaccines was not neutralized, but there are no data from studies in which the herpes zoster vaccine was given concurrently with other vaccines recommended for routine administration to people over 60 years of age. The other recommended vaccines are inactivated and can be given at the same time as the herpes zoster vaccine to patients attending the clinic, but with different syringes and at different sites for each vaccine. The herpes zoster vaccine should not be administered to persons under 60 years of age and is not recommended for any age group who have already received the varicella vaccine. Contraindications to the vaccine include hypersensitivity to vaccine components, immunodeficiency status, and pregnancy. Vaccination against herpes zoster should be delayed in patients with severe acute illness until the patient recovers. The guidelines also publish measures for dealing with violations of vaccination practices and note that there are still issues that need to be studied, such as the duration of the protective effect of the herpes zoster vaccine and the best preventive and therapeutic measures for herpes zoster and PHN.