From the Guidelines
The CDC recommends Shingrix (recombinant zoster vaccine) for all adults 50 years and older, as well as immunocompromised individuals 19 years and older, given as a two-dose series with the second dose administered 2-6 months after the first, with no boosters currently recommended beyond the initial two-dose series. This recommendation is based on the most recent and highest quality study available, which prioritizes the use of Shingrix due to its effectiveness in providing over 90% protection against shingles for at least four years after vaccination 1.
Shingles Vaccination Recommendations
- The preferred vaccine is the recombinant zoster vaccine (RZV, Shingrix), which is given as a two-dose series, 2 to 6 months apart, for immunocompetent adults 50 years or older, including those who are dialysis dependent 1.
- For immunocompromised individuals, Shingrix is recommended for those 19 years and older, as it contains a non-live viral component with an adjuvant that produces a strong immune response, making it safe for this population 1.
- The live zoster vaccine (ZVL, Zostavax) is not preferred due to its lower efficacy compared to Shingrix, especially in immunocompromised individuals 1.
Treatment of Active Shingles
- Antiviral medications should be started within 72 hours of rash onset to reduce the severity and duration of shingles 1.
- Standard treatment includes valacyclovir (1,000 mg three times daily for 7 days), famciclovir (500 mg three times daily for 7 days), or acyclovir (800 mg five times daily for 7-10 days) 1.
- Immunocompromised patients may require longer treatment courses (7-14 days) and sometimes intravenous therapy depending on the severity of the disease 1.
- Pain management is also crucial, using medications like acetaminophen, NSAIDs, gabapentin, pregabalin, or tricyclic antidepressants 1.
Special Considerations
- Immunocompromised patients should be vaccinated against herpes zoster before beginning immunosuppressive therapy, if possible, to reduce the risk of shingles 1.
- Household contacts of immunocompromised patients should be immunized appropriately to reduce the risk of exposure to vaccine-preventable diseases, including shingles 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Shingles Vaccination Boosters and Treatment
- The German Standing Committee on Vaccination (STIKO) at the Robert Koch Institute suggested the active immunization against varicella with a live attenuated varicella vaccine (Oka strain) for all children and young persons 2.
- The Shingles Prevention Study demonstrated that vaccination is the most effective strategy for prevention of herpes zoster and postherpetic neuralgia 2.
- In 2018, CDC recommended a highly efficacious adjuvanted recombinant zoster vaccine (RZV) as a 2-dose series for prevention of herpes zoster (HZ) for immunocompetent persons age ≥ 50 years, with the 2nd dose recommended 2-6 months after the 1st dose 3.
Treatment of Herpes Zoster
- Five antiviral agents are approved for antiviral therapy in zoster patients (acyclovir, valacyclovir, famciclovir, brivudine, and foscarnet) and should be administered within 72 h after rash onset 2.
- Famciclovir and valacyclovir have been shown to be effective in reducing the time to complete cessation of zoster-associated pain, including post-herpetic neuralgia, compared to acyclovir 4, 5.
- Valacyclovir has been found to be more efficacious than famciclovir in the management of herpes zoster, providing significant benefit by accelerating the resolution of zoster-associated pain 6.
Immunocompromised and Immunocompetent Individuals
- High-risk individuals, such as pregnant women, immunocompromised patients, or newborns, may require passive immunization as postexposure prophylaxis within 72-96 h after exposure 2.
- Immunocompetent adults aged 50 years or older may benefit from famciclovir or valacyclovir treatment for herpes zoster, with valacyclovir being more efficacious in some studies 4, 5, 6.
- Second-dose RZV series completion was found to be around 70% within 6 months and 80% within 12 months of the first dose in adults aged 50-64 years in the United States 3.