The Single-Dose Shingles Vaccine Was Called Zostavax
The single-dose shingles vaccine was called Zostavax (zoster vaccine live, ZVL), which was the first licensed vaccine for prevention of herpes zoster. 1
Zostavax: The Original Single-Dose Shingles Vaccine
- Zostavax was a live, attenuated vaccine approved for use as a single dose for adults 50-79 years of age 1
- It contained approximately 14 times more varicella-zoster virus than the chickenpox vaccine (Varivax) 2
- Zostavax was licensed in 2006 and recommended by the Advisory Committee on Immunization Practices (ACIP) in 2008 for prevention of herpes zoster and its complications among adults aged ≥60 years 3
- The FDA approved Zostavax for adults aged 50-59 years in 2011 based on a large safety and efficacy study in this age group 3
Efficacy of Zostavax
- In the Shingles Prevention Study (SPS), Zostavax demonstrated vaccine efficacy of 51.3% in preventing herpes zoster and 66.5% in preventing postherpetic neuralgia in adults aged ≥60 years 1
- In the Zoster Efficacy and Safety Trial (ZEST), vaccine efficacy was 69.8% in preventing herpes zoster in adults aged 50-59 years 1
- Vaccine efficacy varied by age: 70% for ages 50-59,64% for ages 60-69,41% for ages 70-79, and only 18% for those aged ≥80 years 1
- Protection waned over time, with efficacy decreasing from 51.3% to 21.2% for herpes zoster incidence during follow-up from 7 through 11 years post-vaccination 1
Limitations of Zostavax
- Zostavax was contraindicated in individuals with primary or acquired immunodeficiency states due to the theoretical risk of serious disease from the attenuated, live virus 1
- It could not be safely administered to immunocompromised patients, including those with HIV/AIDS, pregnancy, and people taking immunosuppressive drugs 4
- The efficacy of Zostavax decreased significantly with age and waned over time 1, 5
Comparison to Current Recommendation (Shingrix)
- Shingrix (recombinant zoster vaccine, RZV) is now the preferred vaccine for prevention of herpes zoster 5
- Unlike Zostavax, Shingrix is administered as a two-dose series with the second dose given 2-6 months after the first dose 5, 6
- Shingrix demonstrates significantly higher efficacy (97.2% in adults aged ≥50 years) compared to Zostavax 5
- Shingrix maintains high efficacy across all age groups and provides protection for at least 8 years with minimal waning 5
- Shingrix is an inactivated, recombinant subunit vaccine that can be safely administered to immunocompromised patients, unlike Zostavax 5, 7
Clinical Implications
- Zostavax is no longer available in the United States, having been discontinued by the manufacturer
- Patients who previously received Zostavax should receive the Shingrix two-dose series, with no minimum interval required between the different vaccines 5
- For optimal protection against herpes zoster and its complications, adults aged ≥50 years and immunocompromised adults aged ≥18 years should receive the two-dose Shingrix series 5, 7