What is the recommended vaccination for Herpes Zoster (shingles)?

From the Guidelines

The shingles vaccine is recommended for adults aged 50 years and older, with a preference for Shingrix (recombinant zoster vaccine, RZV) due to its higher efficacy and longer duration of protection compared to Zostavax (ZVL) 1. The preferred vaccine, Shingrix, is given as a two-dose series with the second dose administered 2-6 months after the first.

• Shingrix is highly effective, providing over 90% protection against shingles and postherpetic neuralgia (PHN), a painful long-term complication, as demonstrated in the ZOE-50 and ZOE-70 trials 1.
• This vaccine is recommended even for those who previously received the older Zostavax vaccine or have already had shingles, as recurrence is possible.
• Common side effects of Shingrix include pain and swelling at the injection site, muscle pain, fatigue, and headache, which typically resolve within 2-3 days 1.
• These reactions indicate your immune system is responding to the vaccine.
• Shingrix works by boosting your immune response to the varicella-zoster virus, which causes both chickenpox and shingles.
• The virus remains dormant in nerve tissue after chickenpox infection and can reactivate later in life as shingles, particularly when immunity wanes with age or during periods of weakened immune function.
• The vaccine efficacy of Shingrix was maintained above 83.3% for up to 8 years, and decreased to 73% at 10 years, making it a more durable option compared to Zostavax 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.

The Shingles vaccine is indicated for prevention of herpes zoster (shingles) in:

• Adults aged 50 years and older
• 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 2.

From the Research

Shingles Vaccine Overview

• The shingles vaccine is used to prevent herpes zoster, a reactivated virus from varicella zoster virus (chickenpox) that causes a painful vesicular rash and can result in postherpetic neuralgia 3.
• There are two types of shingles vaccines: Zostavax, a live, attenuated vaccine, and Shingrix, a recombinant zoster vaccine 3, 4.

Efficacy of Shingles Vaccines

• Shingrix has been shown to have significantly better efficacy than Zostavax in preventing herpes zoster and postherpetic neuralgia 3, 4.
• Zostavax has been shown to reduce the incidence of herpes zoster by 51% and postherpetic neuralgia by 67% in adults aged 60 years and older 5, 6.
• Shingrix has been shown to reduce the risk of herpes zoster and postherpetic neuralgia in adults aged 50 years and older, with a minimal waning of protective efficacy over 4 years 4.

Safety and Tolerability of Shingles Vaccines

• Both Zostavax and Shingrix are generally well tolerated, with minor local injection site reactions being the most common adverse event 4, 5, 6, 7.
• Shingrix is more reactogenic than placebo, with injection-site reactions, myalgia, and fatigue being the most common solicited adverse reactions, but most solicited adverse reactions are transient and mild to moderate in severity 4.

Recommendations for Shingles Vaccination

• The shingles vaccine is recommended for adults older than 60 years, with Shingrix being the preferred vaccine due to its higher efficacy and longer duration of protection 3, 4, 7.
• Shingrix is not contraindicated in immunocompromised individuals and is preferred over a live attenuated HZ vaccine in immunocompetent individuals, according to the US and Canadian guidelines 4.