Should a 78-year-old patient who received Zostavax (zoster vaccine live) in 2015 get Shingrix (recombinant zoster vaccine)?

From the Guidelines

A 78-year-old patient who received Zostavax in 2015 should get the Shingrix vaccine, as it provides stronger, longer-lasting protection against shingles and post-herpetic neuralgia compared to Zostavax. According to the most recent study 1, Shingrix has a vaccine efficacy of 91.3% against herpes zoster and 88.8% against post-herpetic neuralgia in individuals 70 years of age or older, which is significantly higher than Zostavax. The study also shows that the protection conferred by Shingrix persists for up to 10 years, with a vaccine efficacy of 73% at 10 years.

The patient should receive two doses of Shingrix, given 2-6 months apart, as recommended by the CDC 1. There is no need to wait any specific time period after having received Zostavax years ago. Shingrix is a non-live recombinant vaccine, making it safe for most patients, including those who are immunocompromised.

Key points to consider:

• Shingrix is the preferred shingles vaccine due to its higher efficacy and longer-lasting protection compared to Zostavax 1
• The CDC recommends that adults who previously received Zostavax should get Shingrix, regardless of when they received Zostavax 1
• Shingrix is more than 90% effective at preventing shingles and post-herpetic neuralgia, and this protection remains high for at least 7 years 1
• The risk of shingles and its complications increases with age, making it particularly important for older adults like this 78-year-old patient to receive the Shingrix vaccine 1

From the FDA Drug Label

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 anti-gE antibody (Ab) concentration measured by ELISA 1 month following 2 doses of SHINGRIX in subjects who had previously been vaccinated with ZOSTAVAX was non-inferior to that of subjects who had never been vaccinated with ZOSTAVAX. There was no evidence for interference in the immune response to SHINGRIX in subjects previously vaccinated with ZOSTAVAX.

Recommendation:

• The patient is 78 years old and received Zostavax in 2015, which is more than 5 years ago.
• Based on the study, it is recommended that the patient receive Shingrix, as there is no evidence of interference in the immune response to Shingrix in subjects previously vaccinated with Zostavax.
• The patient should receive 2 doses of Shingrix, 2-6 months apart, to be protected against Herpes Zoster. 2

From the Research

Patient Eligibility for Shingrix

• The patient is 78 years old and received Zostavax in 2015.
• According to the studies, Shingrix is recommended for adults aged 50 years and older, regardless of their previous vaccination status with Zostavax 3, 4.

Efficacy of Shingrix

• Shingrix has been shown to have significantly better efficacy than Zostavax in preventing herpes zoster and postherpetic neuralgia 5, 3, 6.
• The vaccine effectiveness of Shingrix is estimated to be around 70% for two doses, and 56.9% for one dose 5.

Recommendations for Shingrix Administration

• The Advisory Committee on Immunization Practices recommends Shingrix as the preferred vaccine for preventing herpes zoster and related complications in immunocompetent adults aged 50 years and older 4.
• The vaccine is administered in two doses, with the second dose recommended to be given 2-6 months after the first dose 7, 5.
• There is no upper age limit for Shingrix administration, and the vaccine has been shown to be effective in adults aged 80 years and older 5.

Considerations for Patients with Previous Zostavax Vaccination

• Patients who have previously received Zostavax can still receive Shingrix, as the vaccines are not interchangeable and Shingrix provides better protection against herpes zoster and postherpetic neuralgia 3, 6.
• The timing of Shingrix administration after Zostavax vaccination is not specified, but it is recommended to follow the standard vaccination schedule for Shingrix 4.