From the Guidelines
All adults aged 50 years and older should receive the herpes zoster (shingles) vaccination, with a preference for the recombinant zoster vaccine, Shingrix (RZV), and there is no upper age limit for receiving the vaccine. The recommendation is based on the high efficacy of RZV in preventing herpes zoster (HZ) and postherpetic neuralgia (PHN), with a vaccine efficacy of 97.2% in individuals aged 50 years and 89.8% in those aged 70 years, as demonstrated in the ZOE-50 and ZOE-70 trials 1.
Key Points
- The Shingrix vaccine is given as a two-dose series, with the second dose administered 2-6 months after the first.
- Even people who have previously had shingles or received the older Zostavax vaccine should get Shingrix for better protection.
- The vaccine is particularly important for older adults because the risk of developing shingles and its complications increases with age.
- Shingrix is highly effective, reducing the risk of shingles by more than 90% in people 50 and older.
- Side effects are generally mild to moderate and may include pain at the injection site, muscle pain, fatigue, and headache, typically lasting 2-3 days.
Vaccine Efficacy and Safety
The vaccine efficacy of RZV was maintained above 83.3% for up to 8 years, and decreased to 73% at 10 years, as shown in the pooled analysis of participants from the ZOE-50 and ZOE-70 trials 1. The safety data from the ZOE-50 and ZOE-70 trials showed that there was no difference between the vaccinated and placebo groups in the incidence of serious adverse events (SAEs) and deaths, however, the vaccinated group had a significantly higher incidence of grade 3 injection site reactions and systemic symptoms compared to the placebo group 1.
Insurance Coverage
Medicare Part D and most private insurance plans cover the vaccine, though coverage and costs may vary. The benefits of vaccination in preventing shingles and its complications, particularly in older adults, outweigh the potential risks and costs.
From the FDA Drug Label
SHINGRIX is a vaccine indicated for prevention of herpes zoster (HZ) (shingles): • in adults aged 50 years and older. • in adults aged 18 years and older who are or will be at increased risk of HZ due to immunodeficiency or immunosuppression caused by known disease or therapy
The herpes zoster (shingles) vaccination should be administered to:
- Adults aged 50 years and older
- Adults aged 18 years and older who are or will be at increased risk of HZ due to immunodeficiency or immunosuppression caused by known disease or therapy There is no information in the provided drug labels that directly states an age at which the vaccination is no longer recommended 2, 2, 2.
From the Research
Eligibility for Herpes Zoster Vaccination
- The herpes zoster (shingles) vaccination is recommended for adults aged 50 years and older 3, 4, 5, 6.
- There is no upper age limit for receiving the vaccination, and it is still effective in adults aged 80 years and older 5.
- Individuals with autoimmune or immunosuppressive conditions can also receive the vaccination, and it is preferred over live attenuated vaccines in these cases 4, 5, 6.
Vaccination Recommendations
- The Centers for Disease Control and Prevention recommend vaccinating adults aged 50 years and older against herpes zoster 6.
- The vaccination is administered in two doses, with the second dose recommended between two and six months after the first dose 3, 4, 5.
- Completing the two-dose regimen is important for optimal effectiveness, and second doses administered beyond the recommended six months do not impair effectiveness 5.
Special Considerations
- Individuals with chronic respiratory diseases, such as asthma or chronic obstructive pulmonary disorder (COPD), may be at increased risk of herpes zoster and may benefit from vaccination 6.
- Health systems should consider including all adults with asthma or COPD in their herpes zoster vaccination programs 6.