Discontinuation of Live Zoster Vaccine (Zostavax)
Yes, the live zoster vaccine (Zostavax) has been discontinued and replaced by the recombinant zoster vaccine (Shingrix) as the preferred vaccine for herpes zoster prevention. 1
Transition from Zostavax to Shingrix
- Zostavax (zoster vaccine live, ZVL), the first licensed vaccine for prevention of herpes zoster, was a live attenuated vaccine that contained the Oka strain of varicella zoster virus (VZV) 2
- Shingrix (recombinant zoster vaccine, RZV) has now replaced Zostavax as the preferred vaccine for herpes zoster prevention due to its superior efficacy and safety profile 1, 3
- Shingrix is administered as a two-dose series with the second dose given 2 to 6 months after the first dose 1
Advantages of Shingrix over Zostavax
- Shingrix demonstrates significantly higher efficacy (97.2% in adults aged 50 years and older) compared to Zostavax 1
- Protection from Shingrix persists for at least 8 years with minimal waning, maintaining efficacy above 83.3% during this period 1
- Shingrix maintains high efficacy across all age groups, while Zostavax efficacy decreased significantly with age (70% in ages 50-59 vs. 18% in those ≥80 years) 1
- Shingrix is an inactivated, recombinant subunit vaccine, making it safe for use in immunocompromised patients, unlike the live Zostavax vaccine 2
Safety Considerations
- Live-attenuated vaccines like Zostavax were contraindicated in immunocompromised patients due to the risk of uncontrolled viral replication 2
- Shingrix can be safely administered to most immunocompromised patients, unlike Zostavax which was contraindicated in these individuals 3
- For patients with autoimmune inflammatory rheumatic diseases, Shingrix is preferred over the live-attenuated vaccine due to safety considerations 1
Current Recommendations
- Shingrix is recommended for adults aged 50 years and older or adults aged at least 18 years who are or will be at increased risk of herpes zoster due to immunodeficiency or immunosuppression 2
- Current guidelines specifically note that live vaccines, including "live shingles (Zostavax)" are contraindicated in patients receiving immunosuppressive therapy 2
- For patients who previously received Zostavax, Shingrix should be administered at least 2 months after the Zostavax dose 1
Clinical Implications
- Healthcare providers should now recommend Shingrix for eligible patients instead of Zostavax 1, 4
- The transition from Zostavax to Shingrix represents a significant improvement in herpes zoster prevention strategy due to Shingrix's higher efficacy and broader applicability 4, 5
- Patients who previously received Zostavax should still be considered for Shingrix vaccination due to its superior efficacy and longer-lasting protection 1
The discontinuation of Zostavax in favor of Shingrix reflects the medical community's recognition of Shingrix's superior efficacy, longer duration of protection, and better safety profile, particularly for immunocompromised patients who were unable to receive the live vaccine.