Is Shingrix (zoster vaccine recombinant) indicated for a 60-year-old male?

From the Guidelines

I strongly recommend Shingrix vaccination for a 60-year-old male, as it is the preferred vaccine for this age group, given as a 2-dose series 2-6 months apart. According to the recommended adult immunization schedule, United States, 2020 1, Shingrix is preferred over Zostavax for adults 60 years or older, and it should be administered regardless of previous herpes zoster or history of Zostavax vaccination. The Shingrix vaccine is a recombinant zoster vaccine that is over 90% effective in preventing herpes zoster and its complications in adults 50 years and older.

• Key points to consider:
  • The vaccine is given as a 2-dose series, with the second dose administered 2-6 months after the first, and a minimum interval of 4 weeks between doses.
  • Each dose is 0.5 mL given intramuscularly, preferably in the deltoid muscle.
  • Common side effects include pain at the injection site, muscle pain, fatigue, and headache, which typically resolve within 2-3 days.
  • Shingrix works by boosting the immune response against the varicella-zoster virus, which remains dormant in nerve tissue after chickenpox infection and can reactivate later in life as shingles.
  • The risk of developing shingles increases with age, making Shingrix particularly important for a 60-year-old male. The vaccine's effectiveness and safety profile, as outlined in the 2020 immunization schedule 1, support its use in this age group, making it a crucial preventive measure against shingles and its complications.

From the FDA Drug Label

SHINGRIX is a vaccine indicated for prevention of herpes zoster (HZ) (shingles): • in adults aged 50 years and older. Of the total number of subjects who received at least 1 dose of SHINGRIX in Studies 1 and 2 (n = 14,645), 2,243 (15%) were aged 60 to 69 years, 6,837 (47%) were aged 70 to 79 years, and 1,921 (13%) were aged 80 years and older. There were no clinically meaningful differences in efficacy across the age groups.

Indication for Use: SHINGRIX is indicated for prevention of herpes zoster (shingles) in adults aged 50 years and older.

• The vaccine can be used in a 60-year-old male as it falls within the approved age range.
• Efficacy was consistent across different age groups, including those aged 60 years and older 2.

From the Research

Shingrix Vaccine Effectiveness

• The Shingrix vaccine has been shown to be effective in preventing herpes zoster in adults aged 50 years and older, with a vaccine effectiveness of 70.1% (95% CI, 68.6-71.5) for 2 doses and 56.9% (95% CI, 55.0-58.8) for 1 dose 3.
• The 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 vaccine effectiveness of 76.0% (95% CI, 68.4-81.8) against postherpetic neuralgia 3.

Second-Dose Series Completion

• Second-dose Shingrix series completion was estimated to be around 70% within 6 months and 80% within 12 months of the first dose in adults aged 50-64 years 4.
• Among those who received only 1 dose with at least 12 months of follow-up time, 96% had a missed opportunity for a second-dose vaccination, with 36% having a visit for influenza or pneumococcal vaccination within 2-12 months of their first dose 4.

Special Populations

• The adjuvanted recombinant zoster vaccine (RZV) has been shown to be effective and safe in adults aged ≥65 years who were previously vaccinated with a live-attenuated herpes zoster vaccine (ZVL) ≥5 years earlier 5.
• RZV induced strong humoral and polyfunctional cell-mediated immune responses that persisted above prevaccination levels through 1 year after dose 2 in adults aged ≥65 years, irrespective of previous ZVL vaccination 5.
• National recommendations for RZV use vary by country, with some countries recommending RZV for immunocompromised adults ≥18 years, while others do not 6.
• Research has shown that immunocompromised individuals can benefit from HZ vaccination, and clinicians should consider HZ vaccination in eligible at-risk populations to protect against HZ and its associated complications 7.