Herpes zoster (shingles) vaccine (Zostavax, Shingrix)

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Introduction

Tradenames:

Indications

* above

Contraindications

Benefit/risk

Dosage

* Shingrix also recommended (1 dose) after Zostvax[29][32]

  • immunogenicity & safety profile of Shingrix similar in those previously vaccinated with Zostavax & vaccine-naive patients[30]
  • Shigrex more effective than Zostavax[35]
  • Shigrex more cost effective than Zostavax even when only 1 of 2 doses given[37]

Keep frozen (< -15 degrees C), reconstitute & use immediately. 19,400 plaque forming units per dose

Pharmacokinetics

Adverse effects

Drug interactions

Mechanism of action

Notes

More general terms

More specific terms

Additional terms

References

  1. ↑ Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, Arbeit RD, Simberkoff MS, Gershon AA, Davis LE, Weinberg A, Boardman KD, Williams HM, Zhang JH, Peduzzi PN, Beisel CE, Morrison VA, Guatelli JC, Brooks PA, Kauffman CA, Pachucki CT, Neuzil KM, Betts RF, Wright PF, Griffin MR, Brunell P, Soto NE, Marques AR, Keay SK, Goodman RP, Cotton DJ, Gnann JW Jr, Loutit J, Holodniy M, Keitel WA, Crawford GE, Yeh SS, Lobo Z, Toney JF, Greenberg RN, Keller PM, Harbecke R, Hayward AR, Irwin MR, Kyriakides TC, Chan CY, Chan IS, Wang WW, Annunziato PW, Silber JL; Shingles Prevention Study Group. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005 Jun 2;352(22):2271-84. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15930418
  2. ↑ 2.0 2.1 Prescriber's Letter 12(7): 2005 Vaccination for Herpes Zoster and Postherpetic Neuralgia Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210712&pb=PRL (subscription needed) http://www.prescribersletter.com
  3. ↑ Prescriber's Letter 13(7): 2006 Herpes Zoster (Zostavax) Vaccine Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220702&pb=PRL (subscription needed) http://www.prescribersletter.com
  4. ↑ 4.0 4.1 Hornberger J and Robertus K Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. Ann Intern Med 2006, 145:317 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16954357
    Koplan JP & Harpaz R Shingles vaccine: Effective and costly or cost-effective? Ann Intern Med 2006, 145:386 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16954362
  5. ↑ Prescriber's Letter 13(12): 2006 Issues with Herpes Zoster (Zosatvax) Vaccine Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=221201&pb=PRL (subscription needed) http://www.prescribersletter.com http://www.cdc.gov/nip/publications/VIS/vis-shingles.pdf
  6. ↑ Kimberlin DW & Whitley RJ Varicella-zoster vaccine for the prevention of herpes zoster. N Engl J Med 2007, 356:1338 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17392303
    Chaves SS et al, Loss vaccine-induced immunity to varicella overtime. N Engl J Med 2007, 356:1121 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17360990
  7. ↑ Prescriber's Letter 15(1): 2008 Reimbursement for Medicare Part D-Covered Vaccines Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=240113&pb=PRL (subscription needed) http://www.prescribersletter.com
  8. ↑ Harpaz R, Ortega-Sanchez IR, Seward JF; Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2008 Jun 6;57(RR-5):1-30; quiz CE2-4. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18528318
  9. ↑ Simberkoff MS et al Safety of herpes zoster vaccine in the shingles prevention study: A randomized trial. Ann Intern Med 2010 May 4; 152:545. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20439572 <Internet> http://dx.doi.org/10.1059/0003-4819-152-9-201005040-00004
    Hurley LP et al. Barriers to the use of herpes zoster vaccine. Ann Intern Med 2010 May 4; 152:555. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20439573 <Internet> http://dx.doi.org/10.1059/0003-4819-152-9-201005040-00005
    Donahue JG and Belongia EA. The looming rash of herpes zoster and the challenge of adult immunization. Ann Intern Med 2010 May 4; 152:609. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20439578 <Internet> http://dx.doi.org/10.1059/0003-4819-152-9-201005040-00011
  10. ↑ 10.0 10.1 Tseng HF et al Herpes Zoster Vaccine in Older Adults and the Risk of Subsequent Herpes Zoster Disease JAMA. 2011;305(2):160-166 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21224457 <Internet> http://jama.ama-assn.org/content/305/2/160.short
  11. ↑ 11.0 11.1 11.2 FDA NEWS RELEASE: March 24, 2011 FDA approves Zostavax vaccine to prevent shingles in individuals 50 to 59 years of age http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm248390.htm
  12. ↑ 12.0 12.1 12.2 Prescriber's Letter 19(1): 2012 Lower Age Limit for Zostavax (Herpes Zoster Vaccine) Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=280118&pb=PRL (subscription needed) http://www.prescribersletter.com
  13. ↑ 13.0 13.1 13.2 13.3 13.4 13.5 13.6 13.7 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
    Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
    Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  14. ↑ Schmader KE et al. Efficacy, safety, and tolerability of herpes zoster vaccine in persons aged 50-59 years. Clin Infect Dis 2012 Apr 1; 54:922. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22291101
    Li H-T et al. Herpes zoster vaccination in people aged 50-59 years. Clin Infect Dis 2012 Apr 1; 54:929. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22291101
  15. ↑ 15.0 15.1 Zhang J, Xie F, Delzell E et al Association Between Vaccination for Herpes Zoster and Risk of Herpes Zoster Infection Among Older Patients With Selected Immune-Mediated Diseases JAMA. 2012;308(1):43-49 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22760290 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1212306
  16. ↑ 16.0 16.1 16.2 Tseng HF et al. Herpes zoster vaccine and the incidence of recurrent herpes zoster in an immunocompetent elderly population. J Infect Dis 2012 Jul 15; 206:190. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22669900
  17. ↑ 17.0 17.1 Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  18. ↑ 18.0 18.1 Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  19. ↑ 19.0 19.1 Schmader KE et al. Persistence of the efficacy of zoster vaccine in the shingles prevention study and the short-term persistence substudy. Clin Infect Dis 2012 Nov 15; 55:1320. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22828595
  20. ↑ 20.0 20.1 Oxman MN. Zoster vaccine: current status and future prospects. Clin Infect Dis. 2010 Jul 15;51(2):197-213 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20550454
  21. ↑ 21.0 21.1 21.2 Forbes HJ et al Quantification of risk factors for herpes zoster: population based case-control study. BMJ 2014;348:g2911 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25134101 <Internet> http://www.bmj.com/content/348/bmj.g2911
  22. ↑ 22.0 22.1 Tseng HF et al. Vaccination against zoster remains effective in older adults who later undergo chemotherapy. Clin Infect Dis 2014 Oct 1; 59:913. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25097079 <Internet> http://cid.oxfordjournals.org/content/59/7/913
    Oxman MN and Schmader KE. Zoster vaccine in immunocompromised patients: Time to reconsider current recommendations. Clin Infect Dis 2014 Oct 1; 59:920. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25097080 <Internet> http://cid.oxfordjournals.org/content/59/7/920
  23. ↑ 23.0 23.1 Brisson M. Estimating the number needed to vaccinate to prevent herpes zoster-related disease, health care resource use and mortality. Can J Public Health. 2008 Sep-Oct;99(5):383-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19009921
  24. ↑ 24.0 24.1 24.2 Morrison VA et al. Long-term persistence of zoster vaccine efficacy. Clin Infect Dis 2015 Mar 15; 60:900 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25416754 <Internet> http://cid.oxfordjournals.org/content/60/6/900
    Whitley RJ. Waning efficacy of the herpes zoster vaccine. Clin Infect Dis 2015 Mar 15; 60:910. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25416752 <Internet> http://cid.oxfordjournals.org/content/60/6/910
  25. ↑ 25.0 25.1 25.2 Le P, Rothberg MB Cost-Effectiveness of Herpes Zoster Vaccine for Persons Aged 50 Years. Ann Intern Med. Published online 8 September 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26344036 <Internet> http://annals.org/article.aspx?articleid=2434619
  26. ↑ 26.0 26.1 Kwon HJ et al. Asthma as a risk factor for zoster in adults: A population- based case-control study. J Allergy Clin Immunol 2015 Dec 11 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26739414 <Internet> http://www.jacionline.org/article/S0091-6749%2815%2901641-3/abstract
  27. ↑ Langan SM, Smeeth L, Margolis DJ, Thomas SL. Herpes zoster vaccine effectiveness against incident herpes zoster and post-herpetic neuralgia in an older US population: a cohort study. PLoS Med. 2013;10(4):e1001420. Epub 2013 Apr 9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23585738 Free PMC Article
  28. ↑ Centers for Disease Control and Prevention (CDC). Update on herpes zoster vaccine: licensure for persons aged 50 through 59 years. MMWR Morb Mortal Wkly Rep. 2011 Nov 11;60(44):1528. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22071592
  29. ↑ 29.0 29.1 29.2 29.3 29.4 29.5 NEJM JWatch Editors FDA Advisers Recommend Approval of New Shingles Vaccine. Physician's First Watch, Sept 14,2017 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
    GlaxoSmithKline. Oct 23, 2017 Shingrix approved in the US for prevention of shingles in adults aged 50 and over. Pooled clinical trial results showed > 90 percent efficacy across all age groups. https://www.gsk.com/en-gb/media/press-releases/shingrix-approved-in-the-us-for-prevention-of-shingles-in-adults-aged-50-and-over/
    Young K, Sadoughi S, Saitz R CDC Advisers Recommend New Herpes Zoster Vaccine over Zostavax. Physician's First Watch, Oct 23, 2017 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
    HIGHLIGHTS OF PRESCRIBING INFORMATION. SHINGRIX SHINGRIX (Zoster Vaccine Recombinant, Adjuvanted) Suspension for Intramuscular Injection https://www.gsksource.com/pharma/content/dam/GlaxoSmithKline/US/en/Prescribing_Information/Shingrix/pdf/SHINGRIX.PDF
  30. ↑ 30.0 30.1 Grupping K, Campora L, Douha M, et al. Immunogenicity and safety of the HZ/su adjuvanted herpes zoster subunit vaccine in adults previously vaccinated with a live- attenuated herpes zoster vaccine. J Infect Dis 2017 Sep 26 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29029122 https://academic.oup.com/jid/article-abstract/doi/10.1093/infdis/jix482/4209275?redirectedFrom=fulltext
  31. ↑ 31.0 31.1 Le P, Rothberg, MB Cost-effectiveness of the Adjuvanted Herpes Zoster Subunit Vaccine in Older Adults. JAMA Intern Med. Published online January 2, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29297049 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2666789
    Najafzadeh M. Evolution of Herpes Zoster Vaccines and Their Economic Value. JAMA Intern Med. Published online January 2, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29297047 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2666787
  32. ↑ 32.0 32.1 32.2 32.3 Dooling KL, Guo A, Patel M, et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. MMWR Morb Mortal Wkly Rep 2018;67:103-108 https://www.cdc.gov/mmwr/volumes/67/wr/mm6703a5.htm
  33. ↑ 33.0 33.1 Shimabukuro TT, Miller ER, Strikas RA, et al. Notes from the Field: Vaccine Administration Errors Involving Recombinant Zoster Vaccine - United States, 2017-2018. MMWR Morb Mortal Wkly Rep 2018;67:585-586 https://www.cdc.gov/mmwr/volumes/67/wr/mm6720a4.htm
  34. ↑ 34.0 34.1 34.2 Zuger A New Shingles Vaccine is here! NEJM Journal Watch. Jan 1, 2018. pg 8 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
  35. ↑ 35.0 35.1 35.2 35.3 35.4 Tricco AC, Zarin W, Cardoso R et al Efficacy, effectiveness, and safety of herpes zoster vaccines in adults aged 50 and older: systematic review and network meta-analysis. BMJ 2018;363:k4029 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30361202 Free full text https://www.bmj.com/content/363/bmj.k4029
  36. ↑ 36.0 36.1 Hesse EM, Shimabukuro TT, Su JR, et al. Postlicensure Safety Surveillance of Recombinant Zoster Vaccine (Shingrix) - United States, October 2017 - June 2018. MMWR Morb Mortal Wkly Rep 2019;68:91-94 https://www.cdc.gov/mmwr/volumes/68/wr/mm6804a4.htm
  37. ↑ 37.0 37.1 Prosser LA, Harpaz R, Rose AM et al A Cost-Effectiveness Analysis of Vaccination for Prevention of Herpes Zoster and Related Complications: Input for National Recommendations. Ann Intern Med. 2019. Feb 19 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30776797 https://annals.org/aim/article-abstract/2725147/cost-effectiveness-analysis-vaccination-prevention-herpes-zoster-related-complications-input
    Shafran SD Prevention of Shingles: Better Protection and Better Value With Recombinant Vaccine. Ann Intern Med. 2019. Feb 19 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30776802 https://annals.org/aim/article-abstract/2725148/prevention-shingles-better-protection-better-value-recombinant-vaccine
  38. ↑ 38.0 38.1 Bastidas A, de la Serna J, El Idrissi M et al Effect of Recombinant Zoster Vaccine on Incidence of Herpes Zoster After Autologous Stem Cell TransplantationA Randomized Clinical Trial. JAMA. 2019;322(2):123-133 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31287523 https://jamanetwork.com/journals/jama/fullarticle/2737683
  39. ↑ 39.0 39.1 39.2 39.3 Boutry C, Hastie A, Diez-Domingo J et al. The adjuvanted recombinant zoster vaccine confers long-term protection against herpes zoster: Interim results of an extension study of the pivotal phase III clinical trials (Zoe-50 And Zoe-70). Clin Infect Dis 2021 Jul 20; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/34283213 https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciab629/6324611
  40. ↑ 40.0 40.1 Goud R, Lufkin B, Duffy J et al. Risk of Guillain-Barre syndrome following recombinant zoster vaccine in Medicare beneficiaries. JAMA Intern Med 2021 Nov 1; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/34724025 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2785607
  41. ↑ 41.0 41.1 Lophatananon A, Mekli K, Cant R et aL Shingles, Zostavax vaccination and risk of developing dementia: a nested case-control study-results from the UK Biobank cohort. BMJ Open. 2021 Oct 8;11(10):e045871 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34625411 PMCID: PMC8504358 Free PMC article
  42. ↑ 42.0 42.1 Lehrer S, Rheinstein PH Vaccination Reduces Risk of Alzheimer's Disease, Parkinson's Disease and Other Neurodegenerative Disorders. Discov Med. 2022 Sep-Oct;34(172):97-101. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36281030 PMCID: PMC9608336 Free PMC article
  43. ↑ 43.0 43.1 Reardon S Does shingles vaccination cut dementia risk? Large study hints at a link. Analysis of nearly 300,000 people finds an association between the shingles jab and a lower rate of dementia - but questions linger. Nature. 2023. June 6 https://www.nature.com/articles/d41586-023-01824-1
    Eyting M et al Causal evidence that herpes zoster vaccination prevents a proportion of dementia cases. MedRxiv. 2023. May 25. https://www.medrxiv.org/content/10.1101/2023.05.23.23290253v1
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