What is the efficacy of the Herpes Zoster (shingles) vaccine?

From the Guidelines

The shingles vaccine, specifically Shingrix, is highly effective at preventing shingles and its complications, with an efficacy of around 90% across all age groups, and is recommended for adults 50 years and older. The vaccine works by boosting your immune system's response to the varicella-zoster virus, which causes both chickenpox and shingles 1. According to the most recent study, Shingrix has been shown to be significantly more effective in preventing shingles and postherpetic neuralgia (PHN) compared to the older Zostavax vaccine, with protection remaining above 85% for at least four years after vaccination 1.

The recommended schedule for Shingrix is a two-dose series, given 2-6 months apart, and it is preferred over Zostavax due to its higher efficacy and longer duration of protection 1. The vaccine is also recommended for adults who have previously received Zostavax or have had shingles before, as it can provide additional protection against future episodes 1.

Some common side effects of the vaccine include pain at the injection site, muscle pain, fatigue, headache, shivering, fever, and stomach upset, which are generally mild to moderate and last for 2-3 days 1. These reactions indicate that your immune system is responding to the vaccine.

Getting vaccinated is particularly important as we age because our natural immunity to the virus declines over time, increasing the risk of shingles reactivation 1. The Centers for Disease Control and Prevention (CDC) and other health organizations recommend the use of Shingrix for adults 50 years and older, and it is considered a crucial step in preventing shingles and its complications 1.

Key points to consider:

• Shingrix is the preferred vaccine due to its higher efficacy and longer duration of protection
• The recommended schedule is a two-dose series, given 2-6 months apart
• The vaccine is recommended for adults 50 years and older, including those who have previously received Zostavax or have had shingles before
• Common side effects are generally mild to moderate and last for 2-3 days
• Getting vaccinated is particularly important as we age due to declining natural immunity to the virus.

From the FDA Drug Label

The primary efficacy analysis population (referred to as the modified Total Vaccinated Cohort [mTVC]) included 14,759 subjects aged 50 years and older who received 2 doses (0 and 2 months) of either SHINGRIX (n = 7,344) or placebo (n = 7,415) and did not develop a confirmed case of HZ within 1 month after the second dose. Compared with placebo, SHINGRIX significantly reduced the risk of developing HZ by 97.2% (95% CI: 93.7,99. 0) in subjects aged 50 years and older (Table 4). In a descriptive analysis, vaccine efficacy against HZ in subjects aged 50 years and older was 93.1% (95% CI: 81.3,98.2) in the fourth year post-vaccination. The efficacy of SHINGRIX to prevent HZ and PHN in subjects aged 70 years and older was evaluated by combining the results from Studies 1 and 2 through a pre-specified pooled analysis in the mTVC. Compared with placebo, SHINGRIX significantly reduced the risk of developing HZ by 91.3% (95% CI: 86.9,94. 5) in subjects aged 70 years and older (Table 6).

The shingles vaccine efficacy is 97.2% (95% CI: 93.7,99.0) in subjects aged 50 years and older, and 91.3% (95% CI: 86.9,94.5) in subjects aged 70 years and older 2.

• The vaccine efficacy against HZ in subjects aged 50 years and older was 93.1% (95% CI: 81.3,98.2) in the fourth year post-vaccination.
• The vaccine efficacy against HZ in subjects aged 70 years and older was 85.1% (95% CI: 64.5,94.8) in the fourth year after vaccination.

From the Research

Shingles Vaccine Efficacy

• The efficacy of the shingles vaccine has been studied in several clinical trials and real-world observational studies 3, 4, 5, 6, 7.
• The recombinant zoster vaccine (Shingrix) has been shown to have an efficacy of >90% against herpes zoster in clinical trials 4, 6, 7.
• A real-world observational study found a vaccine effectiveness of 70.1% (95% confidence interval [CI], 68.6-71.5) for 2 doses of Shingrix 3.
• The vaccine effectiveness was also found to be 56.9% (95% CI, 55.0-58.8) for 1 dose of Shingrix 3.
• The 2-dose vaccine effectiveness was not significantly lower for beneficiaries aged >80 years, for second doses received at ≥180 days, or for individuals with autoimmune conditions 3.
• The vaccine was also effective among individuals with immunosuppressive conditions, with a 2-dose vaccine effectiveness against postherpetic neuralgia of 76.0% (95% CI, 68.4-81.8) 3.

Comparison of Vaccines

• The live attenuated shingles vaccine (Zostavax) has also been shown to be effective in preventing herpes zoster and postherpetic neuralgia, but its efficacy is lower than that of Shingrix 5.
• A study found that Zostavax provided continued benefit in the longer term, albeit with a gradual decline in vaccine efficacy over time 5.
• The need for a booster dose of Zostavax is still unknown, but a study showed that a booster dose administered to adults aged ≥70 years who received their first dose of Zostavax ≥10 years previously was immunogenic 5.

Safety and Tolerability

• Shingrix has been found to have a favorable safety and tolerability profile, with the most common local adverse events being injection site pain, redness, and swelling, and the most common systemic adverse events being myalgia, fatigue, and headache 7.
• Zostavax has also been found to have a favorable safety and tolerability profile, with the most commonly reported adverse events being non-severe injection-site reactions 5.