From the Guidelines
The recommended age to start vaccinating for shingles is 50 years, with a preference for the recombinant zoster vaccine, Shingrix, due to its higher efficacy and longer-lasting protection compared to Zostavax. This recommendation is based on the latest evidence from the Journal of Microbiology, Immunology and Infection 1, which highlights the superior efficacy of Shingrix in preventing herpes zoster (HZ) and postherpetic neuralgia (PHN) across all age groups.
Key Points
- The vaccine efficacy of Shingrix was 97.2% in individuals aged 50 years and 89.8% in those aged 70 years, with persistence of protection maintained above 83.3% for up to 8 years 1.
- In contrast, the vaccine efficacy of Zostavax decreased with increasing age, ranging from 70% in those aged 50-59 years to 18% in those aged 80 years and above 1.
- Shingrix is associated with a higher incidence of grade 3 injection site reactions and systemic symptoms, but no difference in serious adverse events (SAEs) or deaths compared to the placebo group 1.
Clinical Considerations
- Adults aged 50 years and older should receive the Shingrix vaccine, regardless of their history of shingles or chickenpox, to prevent HZ and PHN.
- The vaccine is administered as a two-dose series, with the second dose given 2 to 6 months after the first dose.
- Common side effects of Shingrix include pain and swelling at the injection site, muscle pain, fatigue, and headache, which typically resolve within 2-3 days.
From the FDA Drug Label
SHINGRIX is a vaccine indicated for prevention of herpes zoster (HZ) (shingles): • in adults aged 50 years and older. • in adults aged 18 years and older who are or will be at increased risk of HZ due to immunodeficiency or immunosuppression caused by known disease or therapy
The recommended age to start vaccinating for shingles is 50 years and older for adults without immunodeficiency or immunosuppression, and 18 years and older for those who are or will be at increased risk of HZ due to immunodeficiency or immunosuppression caused by known disease or therapy 2.
- Key points:
- Adults aged 50 years and older can receive the vaccine.
- Adults aged 18 years and older with immunodeficiency or immunosuppression can also receive the vaccine.
From the Research
Shingles Vaccination Age
The recommended age to start vaccinating for shingles has been a topic of discussion in various studies.
- According to 3, the Advisory Committee on Immunization Practices (ACIP) recommended that all adults aged 50 and over be vaccinated against shingles, starting in 2017.
- This change was made from the previous recommendation of vaccinating only adults aged 60 and over 3.
- Other studies, such as 4 and 5, also support the recommendation of vaccinating adults aged 50 and over against shingles.
- The recombinant zoster vaccine (RZV) has been shown to be effective in preventing herpes zoster and postherpetic neuralgia in adults aged 50 and over 4, 5.
Factors Influencing Vaccination Uptake
Several factors can influence the uptake of shingles vaccination, including:
- Physician recommendation: Studies have shown that physician recommendation is a significant factor in increasing shingles vaccination uptake 6.
- Influenza vaccination: Receiving an influenza vaccination has also been associated with increased shingles vaccination uptake 6.
- Perception of shingles risk: Individuals who perceive shingles as a significant risk are more likely to get vaccinated 6.
- Awareness of the vaccine: Lack of awareness about the shingles vaccine is a significant barrier to vaccination, and efforts to increase awareness should be prioritized 6, 7.
Vaccination Coverage
Shingles vaccination coverage varies significantly across different states and demographics.
- A study analyzing 2014 data found that shingles vaccination coverage among adults aged 60 and over was 31.8% nationally, with significant variations across states 7.
- Coverage was higher among non-Hispanic whites compared to non-white races, and characteristics such as age, education, and health insurance status were also associated with vaccination uptake 7.