From the Guidelines
An 83-year-old female who received Zostavax in 2011 should be revaccinated with Shingrix. The recommended regimen for Shingrix consists of two doses given 2-6 months apart, administered intramuscularly. Shingrix is now preferred over Zostavax because it provides stronger and longer-lasting protection against shingles, with a vaccine efficacy of 91.3% against HZ and 88.8% against PHN in individuals 70 years of age or older, as shown in the ZOE-50 and ZOE-70 trials 1. The protection from Zostavax wanes significantly after 5 years, and since this patient received it in 2011 (over 10 years ago), she would benefit from revaccination. Some key points to consider when revaccinating with Shingrix include:
- Shingrix is a non-live recombinant vaccine that is more than 90% effective at preventing shingles and postherpetic neuralgia, even in older adults, compared to about 50% effectiveness for Zostavax 1.
- The vaccine is generally well-tolerated, though patients should be advised that temporary side effects like pain at the injection site, muscle aches, and fatigue are common 1.
- Shingrix is recommended for adults 50 and older, including those who previously received Zostavax, regardless of how long ago they received it, as stated by the Advisory Committee on Immunization Practices 1. Additionally, the persistence of protection conferred by RZV was maintained above 83.3% for up to 8 years, and decreased to 73% at 10 years, indicating long-term efficacy 1. It is essential to follow the recommended schedule and administer the vaccine intramuscularly to ensure optimal protection against shingles and postherpetic neuralgia.
From the Research
Zostavax and Shingrix Vaccination
- An 83-year-old female who received Zostavax in 2011 may be considered for revaccination with Shingrix, as the protective efficacy of Zostavax wanes over time 2.
- Shingrix is a recombinant zoster vaccine that has been shown to be more effective than Zostavax in preventing herpes zoster and postherpetic neuralgia, with a protective efficacy of over 90% 3, 4.
- The Centers for Disease Control and Prevention (CDC) recommends that adults aged 50 years and older receive two doses of Shingrix, 2 to 6 months apart, for the prevention of herpes zoster and postherpetic neuralgia 5, 4.
- Studies have shown that Shingrix is safe and effective in immunocompetent adults, including those with autoimmune or immunosuppressive conditions, and is preferred over Zostavax in these individuals 3, 4.
Revaccination Considerations
- The decision to revaccinate with Shingrix should be based on individual patient factors, such as the patient's medical history, current health status, and potential risks and benefits of vaccination 2, 6.
- Patients who have previously received Zostavax may still benefit from revaccination with Shingrix, as the two vaccines have different mechanisms of action and may provide additional protection against herpes zoster and postherpetic neuralgia 2, 5.
- Healthcare providers should discuss the potential benefits and risks of revaccination with their patients and make informed decisions based on individual patient needs and circumstances 6, 4.