Shingrix Vaccination After Previous Zostavax
Patients who received Zostavax 10-12 years ago should receive the complete two-dose series of Shingrix now, as Shingrix provides superior protection against herpes zoster and its complications. 1, 2
Rationale for Shingrix After Previous Zostavax
- Shingrix (recombinant zoster vaccine, RZV) is recommended for adults aged 50 years and older, regardless of previous vaccination with Zostavax (zoster vaccine live, ZVL) 1
- Previous vaccination with Zostavax does not provide long-term protection, with efficacy waning significantly over time - by year 10, vaccine efficacy against herpes zoster drops to only 14.1% 2
- The FDA label for Shingrix specifically addresses revaccination after Zostavax, confirming there is no evidence of interference in immune response to Shingrix in subjects previously vaccinated with Zostavax 3
Timing Between Zostavax and Shingrix
- There is no minimum interval required between receiving Zostavax and subsequently receiving Shingrix 1
- The CDC recommends that Shingrix should be administered at least 2 months after Zostavax 1
- For patients who received Zostavax 10-12 years ago (as in this case), this timing requirement is easily met 1
Shingrix Dosing Schedule
- Shingrix is administered as a two-dose series with the second dose given 2-6 months after the first dose 1, 2
- The minimum interval between doses is 4 weeks; if administered earlier than this minimum interval, the dose should be repeated 1
- Complete vaccination with both doses is strongly recommended for optimal protection 2, 4
Efficacy Comparison
- Shingrix demonstrates significantly higher efficacy compared to Zostavax across all age groups 1, 5
- Real-world effectiveness studies show Shingrix has approximately 70% effectiveness with two doses, even in adults over 80 years of age 4
- 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
- Protection from Shingrix persists for at least 8 years with minimal waning, maintaining efficacy above 83.3% during this period 1
Safety Considerations
- Shingrix is a non-live recombinant vaccine, making it safe for most patients, including those who are immunocompromised 2, 1
- Common side effects include injection-site reactions (pain, redness, swelling) and systemic symptoms such as fatigue, myalgia, headache, and fever 1
- No serious safety concerns have been identified in large clinical trials 1
Special Populations
- For immunocompromised adults, Shingrix is preferred over Zostavax (which is contraindicated in immunocompromised individuals due to its live virus composition) 2, 1
- For patients with autoimmune conditions, Shingrix is also preferred due to safety considerations 1
Clinical Pitfalls to Avoid
- Not completing the full two-dose series - single-dose effectiveness is lower at approximately 57% compared to 70% with two doses 4
- Assuming that previous Zostavax vaccination provides adequate long-term protection 2, 6
- Waiting too long to administer Shingrix after previous Zostavax, as protection from Zostavax wanes significantly over time 2, 5