Zostavax and Shingrix Vaccination Guidelines

Introduction to Herpes Zoster Vaccines

• The American Academy of Pediatrics recommends Zostavax administration as a single 0.5 mL subcutaneous dose containing a minimum of 1350 plaque-forming units (PFU) of Oka/Merck varicella zoster virus 1

Efficacy and Comparisons

• Zostavax has an efficacy of 51.3% against herpes zoster and 66.5% against postherpetic neuralgia in adults ≥60 years, with efficacy declining markedly with age 4
• Shingrix has an efficacy of 97.2% against herpes zoster in adults ≥50 years, providing substantially higher and more durable protection than Zostavax 4, 3

Administration and Storage

• Zostavax should be stored frozen at an average temperature of -15°C or colder until reconstitution, and after reconstitution, kept at room temperature for a maximum of 30 minutes 1

Contraindications and Precautions

• Zostavax is contraindicated in immunocompromised patients due to the theoretical risk of serious disease from the live attenuated virus, including those with primary or acquired immunodeficiency states, receiving immunosuppressive therapy, or with hematologic malignancies 2, 3

Current Recommendations

• Patients who previously received Zostavax should receive the two-dose Shingrix series, with no minimum interval required between the different vaccines, as Shingrix provides higher and more durable protection and can be safely administered to immunocompromised patients 2, 3
• Shingrix maintains efficacy above 83.3% for at least 8 years with minimal waning 3