Does Shingrix (zoster vaccine) provide lifelong immunity against shingles?

Shingrix Does Not Provide Lifelong Immunity Against Shingles

Shingrix (recombinant zoster vaccine) does not provide lifelong immunity against shingles, with protection persisting for at least 8 years with minimal waning, maintaining efficacy above 83.3% during this period, but decreasing to 73% at 10 years. 1, 2

Duration of Protection with Shingrix

• Shingrix demonstrates high initial efficacy of 97.2% in adults aged 50 years and older in preventing herpes zoster (shingles) 2
• Protection remains robust but gradually declines over time:
  • Efficacy remains above 83.3% for up to 8 years post-vaccination 1, 2
  • By 10 years, efficacy decreases to approximately 73% 1
• No additional booster doses beyond the initial two-dose series are currently recommended in any guidelines 2

Comparison to Previous Zoster Vaccine (Zostavax)

• Shingrix provides significantly longer-lasting protection compared to the older Zostavax vaccine 2, 3
• Zostavax efficacy waned dramatically over time:
  • Decreased from 51.3% to only 21.2% for herpes zoster prevention during follow-up from 7 through 11 years post-vaccination 3
  • By year 10, Zostavax efficacy against herpes zoster dropped to only 14.1% 2
• 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) 2, 3

Real-World Effectiveness of Shingrix

• A large real-world observational study among Medicare beneficiaries aged >65 years showed two-dose vaccine effectiveness of 70.1% (95% CI, 68.6-71.5) 4
• This effectiveness was lower than clinical trial estimates, likely due to differences in outcome specificity 4
• Effectiveness against postherpetic neuralgia was 76.0% (95% CI, 68.4-81.8) 4

Recommended Vaccination Schedule

• Shingrix is administered as a two-dose series with the second dose given 2 to 6 months after the first dose 2
• For optimal protection, completing both doses is essential 2
• If the second dose is delayed beyond the recommended 6-month window, it should still be administered as soon as possible without restarting the series 2, 4

Clinical Implications and Pitfalls

• Since immunity wanes over time, patients should be aware that they may not have lifelong protection against shingles 1, 2
• Having one episode of shingles does not provide reliable protection against future recurrences, making vaccination important even after a shingles outbreak 5
• The risk of shingles recurrence without vaccination is significant, with a cumulative incidence of 10.3% at 10 years 5
• No current guidelines recommend additional booster doses beyond the initial two-dose series, despite the evidence of waning immunity 2

Special Populations

• Shingrix can be safely administered to most immunocompromised patients, unlike the live Zostavax vaccine 2
• For immunocompromised adults, a shorter schedule with the second dose given 1-2 months after the first dose may be considered 2, 5
• Patients who previously received Zostavax should receive the Shingrix two-dose series for optimal protection 2, 3

While Shingrix represents a significant improvement over previous vaccines with its high efficacy and longer duration of protection, the evidence clearly indicates that it does not confer lifelong immunity against shingles.