Shingrix (Recombinant Zoster Vaccine) Is the Newest Shingles Vaccine
Shingrix (recombinant zoster vaccine or RZV) is the newest and most effective shingles vaccine, providing over 90% protection against herpes zoster across all age groups, significantly outperforming the older Zostavax vaccine. 1, 2
Vaccine Composition and Mechanism
Shingrix works through a novel approach that differs from the previous live-attenuated vaccine (Zostavax):
- Contains recombinant varicella zoster virus glycoprotein E (gE) antigen combined with the AS01B adjuvant system 2, 3
- The glycoprotein E is a key component that helps stimulate the immune system to recognize and fight the virus
- The AS01B adjuvant system significantly enhances both cellular and antibody immune responses 3
- As a non-live recombinant vaccine, it cannot cause infection, making it safe for immunocompromised patients 1
Efficacy and Effectiveness
Shingrix demonstrates superior protection compared to the older Zostavax vaccine:
- Clinical trials showed >90% efficacy against herpes zoster in all age groups 3
- Maintains ≥89% efficacy against post-herpetic neuralgia (PHN) 3
- Real-world effectiveness shows 70.1% protection with two doses and 56.9% with one dose 4
- Effectiveness remains high even in adults over 80 years of age 4
- Protection is sustained with minimal waning over at least 4 years of follow-up 3, 5
Comparison with Zostavax:
| Age Group | Shingrix Efficacy | Zostavax Efficacy |
|---|---|---|
| 50+ years | 97.2% | 70% (50-59 years) |
| 70+ years | 91.3% | 18% (80+ years) |
| [1] |
Administration Schedule
Shingrix is administered as a two-dose series:
- Standard schedule: Two 0.5 mL doses administered intramuscularly
- First dose at Month 0
- Second dose 2-6 months later 2
- For immunocompromised individuals:
Safety Profile
While Shingrix has more side effects than placebo, they are generally manageable:
- Most common local reactions: pain (78%), redness (38%), and swelling (26%) 2
- Most common systemic reactions: myalgia (45%), fatigue (45%), headache (38%), shivering (27%), fever (21%) 2
- Reactions are typically mild to moderate and resolve within 2-3 days 5
- The only contraindication is a history of severe allergic reaction to any component of the vaccine or after a previous dose 2
Special Considerations
- Patients who previously received Zostavax should still receive the complete Shingrix series (minimum interval of 8 weeks after Zostavax) 1
- For patients who received anti-CD20 antibody therapy, consider delaying vaccination until at least 6 months after the last dose 1
- For patients who underwent autologous hematopoietic stem cell transplant, vaccination can begin 3-12 months post-transplant 1
- In a postmarketing observational study, an increased risk of Guillain-Barré syndrome was observed during the 42 days following vaccination 2
Clinical Implications
Shingrix represents a significant advancement in shingles prevention due to its:
- Higher efficacy across all age groups
- Sustained protection over time
- Safety profile suitable for immunocompromised patients
- Ability to prevent both herpes zoster and its complications, particularly post-herpetic neuralgia
The CDC and multiple medical societies recommend Shingrix as the preferred vaccine for prevention of herpes zoster in adults aged 50 years and older, including those with immunocompromising conditions 1.