Is Shingrix (zoster vaccine) recommended for patients with a history of herpes zoster (shingles)?

Shingrix Vaccination for Patients with a History of Shingles

Shingrix is strongly recommended for all adults aged 50 years and older, regardless of prior history of herpes zoster (shingles), to prevent recurrence of shingles and its complications. 1

Rationale for Vaccination After Shingles

• The Centers for Disease Control and Prevention (CDC) recommends Shingrix as the preferred vaccine for prevention of herpes zoster and its complications in all adults aged 50 years and older 1
• Shingrix demonstrates high efficacy:
  • 97.2% efficacy in adults ≥50 years
  • 91.3% efficacy in adults ≥70 years against herpes zoster
  • 88.8% efficacy against postherpetic neuralgia 1
• Protection is maintained above 83.3% for up to 8 years and decreases to 73% at 10 years 1

Expanded Indications

Shingrix is indicated for:

• Adults aged 50 years and older
• Adults aged 18 years and older who are or will be at increased risk of herpes zoster due to immunodeficiency or immunosuppression 2

Vaccination Schedule

• Standard dosing: Two doses (0.5 mL each) administered intramuscularly
  • First dose at Month 0
  • Second dose 2-6 months later for immunocompetent adults 1, 2
• For immunocompromised individuals: Second dose 1-2 months after first dose 1, 2

Real-World Effectiveness

A large cohort study among Medicare beneficiaries showed:

• Two-dose vaccine effectiveness: 70.1% (95% CI, 68.6-71.5)
• One-dose vaccine effectiveness: 56.9% (95% CI, 55.0-58.8)
• Two-dose effectiveness against postherpetic neuralgia: 76.0% (95% CI, 68.4-81.8) 3
• Effectiveness was maintained even when second doses were administered beyond the recommended 6-month window 3

Special Considerations

Prior Shingles History

• Revaccination with Shingrix is well-tolerated without increased safety concerns and is strongly recommended for individuals who have previously had shingles 1
• No screening for history of varicella or laboratory testing is needed when vaccinating immunocompetent adults aged 50 years and older 1

Common Side Effects

• Local reactions: Pain (78%), redness (38%), and swelling (26%)
• Systemic reactions: Myalgia (45%), fatigue (45%), headache (38%), shivering (27%), fever (21%), and gastrointestinal symptoms (17%) 2

Important Caveats

1. Timing after shingles episode: Wait until the acute stage of shingles has resolved before administering Shingrix
2. Not for treatment: Shingrix is not indicated for treatment of active shingles, prevention of postherpetic neuralgia in individuals with active shingles, or treatment of ongoing postherpetic neuralgia 1
3. Contraindications: History of severe allergic reaction to any component of the vaccine or after a previous dose of Shingrix 2
4. Guillain-Barré syndrome risk: Increased risk observed during the 42 days following vaccination 2
5. Complete the series: Maximum effectiveness requires completion of the two-dose series 3

Advantages Over Previous Zoster Vaccine

Shingrix (recombinant zoster vaccine) offers significant advantages over the older Zostavax (live zoster vaccine):

• Higher efficacy across all age groups
• Not contraindicated in immunocompromised patients (unlike Zostavax)
• Longer duration of protection 1

Individuals who previously received Zostavax should still receive the complete Shingrix series, with a minimum interval of 8 weeks after Zostavax before administering Shingrix 1