What are the methods for preventing Herpes Zoster (Shingles)?

From the Guidelines

The most effective way to prevent Herpes Zoster is through vaccination with the recombinant zoster vaccine (Shingrix), which is recommended for adults 50 years and older, administered as two doses given 2-6 months apart. This vaccine has been shown to be highly effective in preventing Herpes Zoster, with a vaccine efficacy of 97.2% in individuals aged 50 years and 89.8% in those aged 70 years 1. The vaccine works by boosting the immune response to the varicella-zoster virus, which remains dormant in nerve tissues after a chickenpox infection. As we age, our natural immunity to this virus weakens, increasing the risk of reactivation as shingles.

Some key points to consider when preventing Herpes Zoster include:

• The recombinant zoster vaccine (Shingrix) is preferred over the live zoster vaccine (Zostavax) due to its higher efficacy and longer duration of protection 1
• The vaccine is recommended for immunocompetent adults 50 years and older, as well as immunocompromised adults 19 years and older 1
• The vaccine is administered as two doses given 2-6 months apart, and has been shown to be safe and well-tolerated, with common side effects including pain at the injection site, muscle pain, fatigue, headache, shivering, fever, and stomach upset 1
• For those who have never had chickenpox, avoiding contact with people who have active chickenpox or shingles can also help prevent initial infection with the virus

It's worth noting that the vaccine efficacy of Shingrix has been shown to persist for up to 10 years, with a vaccine efficacy of 73% against Herpes Zoster and 88.8% against postherpetic neuralgia (PHN) 1. Overall, vaccination with Shingrix is a highly effective way to prevent Herpes Zoster and its complications, and is recommended for all adults 50 years and older.

From the Research

Prevention of Herpes Zoster

To prevent Herpes Zoster, the following methods can be employed:

• Vaccination with the recombinant zoster vaccine (RZV), also known as Shingrix, which has been shown to be effective in preventing herpes zoster in adults aged 50 years and older 2, 3, 4, 5
• Completing the 2-dose regimen of RZV, with the second dose administered 2-6 months after the first dose, to achieve optimal vaccine effectiveness 2, 6
• Considering vaccination with RZV even for individuals with autoimmune or immunosuppressive conditions, as it has been shown to be effective in these populations 2

Vaccine Effectiveness

The effectiveness of RZV in preventing herpes zoster has been demonstrated in several studies:

• A cohort study found that the vaccine effectiveness of RZV was 70.1% for 2 doses and 56.9% for 1 dose 2
• A systematic review found that RZV was effective in preventing herpes zoster, with a risk ratio of 0.08 (95% CI 0.03 to 0.23) compared to placebo 3
• Studies have also shown that RZV is more effective than the live attenuated zoster vaccine (LZV) in preventing herpes zoster 3, 4

Special Populations

RZV can be considered for use in special populations, including:

• Immunocompetent adults aged 50 years and older 5
• Individuals with autoimmune or immunosuppressive conditions, although the efficacy and safety of RZV in these populations may vary 2
• Adults aged 50-64 years, for whom RZV series completion rates have been shown to be high 6