What type of varicella-zoster (VZV) vaccine is recommended for use in an adult?

From the Guidelines

For adults, the recombinant zoster vaccine (RZV, Shingrix) is the preferred vaccine for preventing herpes zoster (shingles) and its complications. This recommendation is based on the most recent and highest quality study, which demonstrated that RZV is significantly more effective than the older live zoster vaccine (Zostavax) in preventing shingles and postherpetic neuralgia, with an efficacy of over 90% 1. The study also showed that RZV is safe for immunocompromised individuals and can be administered as a two-dose series, with the second dose given 2-6 months after the first dose.

Key Points

• RZV is recommended for immunocompetent adults aged 50 years and older, as well as for adults aged 19 years and older who are or will be immunodeficient or immunosuppressed due to disease or therapy 2.
• RZV is a non-live vaccine, making it safe for immunocompromised individuals who cannot receive live vaccines 3.
• Common side effects of RZV include pain at the injection site, muscle pain, fatigue, and headache, which typically resolve within 2-3 days 1.
• Even individuals who previously received Zostavax or who have had shingles in the past should receive the Shingrix vaccine series for optimal protection 2.

Benefits of RZV

• High efficacy in preventing shingles and postherpetic neuralgia, with an efficacy of over 90% 1.
• Safe for immunocompromised individuals who cannot receive live vaccines 3.
• Can be administered as a two-dose series, with the second dose given 2-6 months after the first dose 1.
• Persistent protection for at least 7-8 years after vaccination 1.

From the FDA Drug Label

1 INDICATIONS AND USAGE 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 type of varicella zoster vaccine to use in an adult is SHINGRIX, a vaccine indicated for the prevention of herpes zoster (shingles) in:

• Adults aged 50 years and older
• 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 4.

From the Research

Varicella Zoster Vaccine Options for Adults

The varicella zoster vaccine is available in two forms: live-attenuated and recombinant. The choice of vaccine depends on various factors, including the patient's age, immune status, and medical history.

Recombinant Zoster Vaccine (RZV)

• The RZV, also known as Shingrix, is a recombinant zoster vaccine that contains a varicella zoster virus glycoprotein E antigen and the AS01B adjuvant system 5.
• It is approved for the prevention of herpes zoster (HZ) and postherpetic neuralgia (PHN) in adults aged 50 years and older 5, 6.
• The vaccine is administered in two doses, with the second dose recommended between two and six months after the first dose 7.
• Studies have shown that RZV is highly effective in preventing HZ and PHN, with a vaccine effectiveness of 70.1% for two doses and 56.9% for one dose 8.
• RZV is also effective in preventing PHN, with a vaccine effectiveness of 76.0% for two doses 8.

Live-Attenuated Zoster Vaccine (ZVL)

• The ZVL, also known as Zostavax, is a live-attenuated varicella-zoster virus vaccine 6.
• It is approved for the prevention of HZ and PHN in healthy older adults, but its use is not recommended for immunocompromised individuals 6.
• Compared to RZV, ZVL has a lower efficacy rate and is not preferred for immunocompetent adults aged 50 years and older 6, 9.

Recommendations

• The Advisory Committee on Immunization Practices recommends the use of RZV for the prevention of HZ and PHN in immunocompetent adults aged 50 years and older 9.
• RZV is preferred over ZVL due to its higher efficacy rate and safety profile, especially in immunocompromised individuals 5, 6.