Recommended Shingles Vaccine for Elderly Individuals
Shingrix (recombinant zoster vaccine, RZV) is the preferred vaccine for prevention of herpes zoster (shingles) in adults aged 50 years and older due to its superior efficacy and longer duration of protection compared to the live zoster vaccine (Zostavax). 1, 2
Vaccine Options and Efficacy
Shingrix (RZV)
- Efficacy:
- 97.2% effective in adults 50+ years
- 91.3% against herpes zoster and 88.8% against postherpetic neuralgia (PHN) in adults 70+ years
- Protection maintained above 83.3% for up to 8 years, decreasing to 73% at 10 years 1
- Dosing: Two doses (0.5 mL each) administered intramuscularly, 2-6 months apart 2
- Type: Non-live recombinant subunit vaccine containing VZV glycoprotein E and AS01B adjuvant system 1
Zostavax (ZVL)
- Efficacy:
- 70% in ages 50-59 years
- 64% in ages 60-69 years
- 41% in ages 70-79 years
- 18% in ages 80+ years
- Efficacy wanes significantly over time, from 51.3% to 21.2% for HZ incidence over 7-11 years 1
- Type: Live-attenuated vaccine (no longer recommended in some countries) 1
Why Shingrix is Preferred
- Superior efficacy: Significantly higher protection across all age groups compared to ZVL 1, 2
- Longer duration of protection: Maintains high efficacy for up to 8-10 years 1
- Consistent efficacy in older adults: Maintains strong protection even in those 70+ years old, unlike ZVL which shows marked decline in efficacy with increasing age 1
- Safety in immunocompromised individuals: As a non-live vaccine, it can be safely administered to immunocompromised patients 3
Safety Profile
- Most common adverse reactions include:
- Injection site reactions (pain, redness, swelling)
- Systemic symptoms (myalgia, fatigue, headache) 2
- Higher incidence of grade 3 injection site reactions (9.5% vs 0.4%) and systemic symptoms (11.4% vs 2.4%) compared to placebo 1
- Despite higher reactogenicity, most reactions are transient and mild to moderate in severity 3
- No significant differences in serious adverse events or deaths compared to placebo 1
Special Considerations
- Previous Zostavax vaccination: CDC recommends Shingrix even for those previously vaccinated with Zostavax, after an interval of more than 5 years (strong recommendation) 2
- Immunocompromised patients: Shingrix is not contraindicated in immunocompromised individuals, unlike the live Zostavax vaccine 3
- Temporary deferral: Consider deferring vaccination in patients with active, severe acute infection with high fever (>101.3°F or 38.5°C) until fever resolves 2
Implementation
- Complete the full two-dose series for optimal protection (70.1% effectiveness with two doses vs. 56.9% with a single dose) 2
- Document vaccination in the patient's immunization record 2
- Advise patients about potential side effects, which are generally mild to moderate and transient 2
Expert Consensus
The American College of Physicians, the Centers for Disease Control and Prevention (CDC), and the Advisory Committee on Immunization Practices (ACIP) all recommend Shingrix as the preferred vaccine for prevention of herpes zoster in adults aged 50 years and older 2. This recommendation is supported by multiple high-quality clinical trials and real-world effectiveness studies 4, 5.