Shingles Vaccine Efficacy and Recommendations

Introduction to Zostavax

The single-dose shingles vaccine was called Zostavax, which was the first licensed vaccine for prevention of herpes zoster, approved for use as a single dose for adults 50-79 years of age 1

In the Shingles Prevention Study, Zostavax demonstrated vaccine efficacy of 51.3% in preventing herpes zoster and 66.5% in preventing postherpetic neuralgia in adults aged ≥60 years 1
Vaccine efficacy varied by age: 70% for ages 50-59, 64% for ages 60-69, 41% for ages 70-79, and only 18% for those aged ≥80 years 1
Protection waned over time, with efficacy decreasing from 51.3% to 21.2% for herpes zoster incidence during follow-up from 7 through 11 years post-vaccination 1

Zostavax was contraindicated in individuals with primary or acquired immunodeficiency states due to the theoretical risk of serious disease from the attenuated, live virus 2
The efficacy of Zostavax decreased significantly with age and waned over time 1, 3

The Centers for Disease Control and Prevention recommends Shingrix, which demonstrates significantly higher efficacy (97.2% in adults aged ≥50 years) compared to Zostavax 3
Shingrix maintains high efficacy across all age groups and provides protection for at least 8 years with minimal waning 3
Shingrix is an inactivated, recombinant subunit vaccine that can be safely administered to immunocompromised patients, unlike Zostavax 3, 4

Patients who previously received Zostavax should receive the Shingrix two-dose series, with no minimum interval required between the different vaccines, as recommended by the Advisory Committee on Immunization Practices 3
For optimal protection against herpes zoster and its complications, adults aged ≥50 years and immunocompromised adults aged ≥18 years should receive the two-dose Shingrix series, according to the Centers for Disease Control and Prevention 3, 4