Does a patient who has received the Zoster (live) vaccine and Shingrix (Recombinant Zoster Vaccine) require additional doses?

From the Guidelines

Yes, the patient needs one more dose of Shingrix, as the recommended series consists of 2 doses administered 2-6 months apart, regardless of prior vaccination with the live zoster vaccine (Zostavax) 1. The patient has already received one dose of Shingrix, but to complete the series and ensure optimal protection against shingles, a second dose is necessary.

• The live zoster vaccine (Zostavax) is no longer the preferred option, and Shingrix is recommended for adults 50 years and older due to its superior efficacy and longer-lasting protection 1.
• According to the recommended adult immunization schedule, United States, 2019, a 2-dose series of RZV (Shingrix) is recommended for adults 50 years or older, with doses administered 2-6 months apart 1.
• Completing the Shingrix series is crucial to provide the best possible protection against shingles and its complications, such as postherpetic neuralgia.
• The second Shingrix dose should be administered 2-6 months after the first Shingrix dose, with a minimum interval of 4 weeks, and the dose should be repeated if administered too soon 1.

From the FDA Drug Label

14.6 Revaccination after Vaccination with ZOSTAVAX (Zoster Vaccine Live) In an open-label clinical study (NCT02581410), subjects aged 65 years and older, who had been previously vaccinated with ZOSTAVAX more than 5 years prior to study enrollment (n = 215) or who had never been vaccinated with ZOSTAVAX (n = 215), received 1 dose of SHINGRIX at Months 0 and 2

• The patient received one shot of zoster live and one shot of Shingrix.
• According to the label, the standard regimen for Shingrix is 2 doses, given 2-6 months apart 2.
• Since the patient only received one shot of Shingrix, they would likely need an additional dose to complete the series.

From the Research

Vaccine Effectiveness

• The effectiveness of the Shingrix vaccine (recombinant zoster vaccine) was found to be 70.1% for two doses and 56.9% for one dose 3.
• The live zoster vaccine (LZV) was found to have a cumulative incidence of herpes zoster at up to three years of follow-up that was lower in participants who received the vaccine than in those who received placebo (risk ratio 0.49,95% confidence interval 0.43 to 0.56) 4.
• The recombinant zoster vaccine (RZV) was found to have a lower cumulative incidence of herpes zoster at 3.2 years follow-up (RR 0.08,95% CI 0.03 to 0.23) compared to placebo 4.

Booster Shots

• There are no data to recommend revaccination after receiving the basic schedule for each type of vaccine 4.
• The pre-licensure clinical trials show the efficacy of the live zoster vaccine to be between 50 and 70% and for the recombinant vaccine to be higher at 90 to 97% 5.
• Real-world effectiveness studies, with a follow-up of approximately 10 years, show vaccine effectiveness being 46% and 85% for the live and recombinant vaccines, respectively 5.

Vaccine Safety

• Both the live zoster vaccine and the recombinant zoster vaccine produce systemic and injection site adverse events of mild to moderate intensity 4, 5.
• Rare adverse events, occurring less than 1% of the time, have been seen with both vaccine types and include disseminated herpes zoster with the live zoster vaccine and Guillain-Barré syndrome with the recombinant vaccine 5.

Recommendations

• The recombinant adjuvanted vaccine is recommended in the USA and Canada for people who are 50 years of age and older 6.
• The varicella vaccine is effective and safe, and universal vaccination has almost eliminated varicella 7.