From the Guidelines
For a 63-year-old female with no varicella antibodies, the varicella (chickenpox) vaccine is recommended rather than the shingles vaccine. The patient should receive two doses of the varicella vaccine (Varivax), administered 4-8 weeks apart. This recommendation is based on the guidelines for the prevention of varicella, which suggest that vaccination of all adolescents and adults without evidence of immunity will provide protection in these age groups 1. The varicella vaccine is necessary to establish primary protection against varicella, as the shingles vaccine (Shingrix) is only effective for those who have previously been infected with the varicella-zoster virus and have established latent infection.
- Key points to consider:
- The patient's age and lack of varicella antibodies indicate a need for primary protection against varicella
- The varicella vaccine is recommended for adolescents and adults without evidence of immunity, regardless of age 1
- The shingles vaccine is not effective for primary protection against varicella and should only be considered after the patient has received the varicella vaccine series and has established latent infection
- The patient should wait at least 5 years after receiving the varicella vaccine series before considering the shingles vaccine, as this allows for the establishment of latent infection and increases the effectiveness of the shingles vaccine.
- Important considerations:
- Varicella disease is more severe and its complications more frequent among adolescents and adults, making vaccination crucial for this age group 1
- The risk of VZV transmission in health-care settings and the potential for congenital varicella syndrome in pregnant women highlight the importance of vaccination for individuals without evidence of immunity 1
From the FDA Drug Label
SHINGRIX is a vaccine indicated for prevention of herpes zoster (HZ) (shingles): • in adults aged 50 years and older. • in adults aged 18 years and older who are or will be at increased risk of HZ due to immunodeficiency or immunosuppression caused by known disease or therapy. Limitations of Use: • SHINGRIX is not indicated for prevention of primary varicella infection (chickenpox).
The Shingrix vaccine is recommended for a 63-year-old female for the prevention of herpes zoster (shingles) since she is over 50 years old. However, the vaccine is not indicated for the prevention of primary varicella infection (chickenpox), which would be the concern if she has no varicella antibodies. For the prevention of primary varicella infection, the varicella vaccine would be the recommended choice, but this information is not provided in the given drug labels 2, 2, 2.
From the Research
Vaccine Recommendations
For a 63-year-old female with no varicella antibodies, the recommendation would be to administer the varicella vaccine to prevent primary varicella infection.
- The varicella vaccine is a live attenuated varicella zoster virus (VZV) and is effective and safe 3.
- Universal varicella vaccination has significantly impacted the incidence, complications, and deaths related to this disease 4.
Shingles Vaccine
After the varicella vaccine, the shingles vaccine can be considered to prevent herpes zoster (HZ).
- There are two HZ vaccines available: the recombinant zoster vaccine (RZV) and the Zoster Vaccine Live (ZVL) 4.
- The advisory committee on immunization practices (ACIP) preferentially recommends RZV 4, 5.
- RZV has been shown to be superior to ZVL in efficacy and has a longer duration of protection 6, 5.
Considerations
- The immune responses to varicella vaccination can wane with increasing age or immune suppression 7.
- The varicella vaccine can establish latency and reactivate, but the vaccine virus reactivates less frequently than wild-type 3.
- The RZV vaccine has been shown to provide ~85-90% protection against herpes zoster for 7-8 years 7.