From the Guidelines
The varicella-zoster vaccine is not routinely recommended for young adults with healthy immune systems after herpes zoster infection.
Key Considerations
- The CDC recommends vaccination against herpes zoster in immunocompetent adults 50 years or older, including patients who are dialysis dependent 1.
- Individuals who have had shingles may still benefit from vaccination if they are at increased risk of recurrence or complications, and vaccination can be considered 1-3 months after the rash has resolved.
- A 2-dose series of Shingrix, administered 2-6 months apart, is the preferred vaccine regimen for individuals who require vaccination, as it is an inactivated, recombinant, subunit vaccine that can be used in adults aged 50 years and older or adults aged at least 18 years who are or will be at increased risk of HZ due to immunodeficiency or immunosuppression caused by known disease or therapy 1.
Vaccine Options
- Shingrix (recombinant zoster vaccine): a 2-dose series, administered 2-6 months apart, is the preferred vaccine regimen for individuals who require vaccination.
- Zostavax (live attenuated herpes zoster vaccine): is approved for use as a single dose for adults 50-79 years of age, but contraindicated in individuals with primary or acquired immunodeficiency states due to a theoretical risk of serious disease that can be caused by the attenuated, live virus 1.
From the Research
Varicella-Zoster Vaccine Recommendation
The varicella-zoster vaccine is recommended for adults aged 50 years and older to prevent herpes zoster (shingles) and postherpetic neuralgia (PHN) 2, 3, 4, 5, 6.
Eligibility for Young Adults with Healthy Immune Systems
There is no direct evidence to support the recommendation of varicella-zoster vaccine in young adults with healthy immune systems after herpes zoster infection. However, the following points can be considered:
- The vaccine is approved for use in adults aged 50 years and older 2, 3, 4, 5, 6.
- The Advisory Committee on Immunization Practices (ACIP) recommends that the vaccine be routinely administered only to patients aged 60 years or older 4.
- Some studies suggest that the vaccine can be effective in preventing herpes zoster and PHN in adults aged 50-59 years 3, 4.
- The recombinant zoster vaccine (Shingrix) is preferred over the live attenuated vaccine in immunocompetent individuals, according to the US and Canadian guidelines 6.
Key Considerations
Some key considerations include:
- The risk of herpes zoster and PHN increases with age, which correlates with decreasing cell-mediated immunity 5.
- The vaccine can reduce the incidence of herpes zoster and PHN, thereby reducing the burden of illness associated with herpes zoster 2, 3, 6.
- The vaccine has a favorable safety and tolerability profile, with the most commonly reported adverse events being non-severe injection-site reactions 2, 3, 6.