A patient who received the flu vaccine had early active herpes zoster (unbeknownst to the vaccine administrator). Redness developed at the injection site, along with upper-arm pruritus. Are there any contraindications to this patient’s receiving flu vaccine in the future?
—Stephen S. Falkowski, DO, Marlton, N.J.

This is a difficult question to answer. Differentiating between a local reaction to the influenza vaccination and a reactivation of herpes zoster may be possible if additional details concerning the herpes zoster could be provided. A prodrome to zoster reactivation can include pruritus, but virtually all zoster lesions at some time manifest some form of pain. If this patient had no pain, then I would be concerned that the reaction was secondary to the influenza vaccination and not to herpes zoster. An excellent review of herpes zoster appears in N Engl J Med. 2002;347:340-346.
—Cedric W. Spak, MD, MPH (110-15)