A new vaccine for shingles is now recommended for adults aged 50 and older. Following the Food and Drug Administration (FDA) approval of Shingrix in October 2017, the Advisory Committee on Immunization Practices (ACIP) has issued its recommendation for Shingrix as the preferred vaccine for shingles over the 2006 approved shingles vaccine Zostavax (MMWR Morb Mortal Wkly Rep. 2018;67:103–108).
The recommendation is based on data showing an overall efficacy of 97% in adults aged 50 years and older, and approximately 90% in adults aged 70 and older (N Engl J Med. 2015;372:2087–2096; N Engl J Med. 2016;375:1019–1032). The vaccine shows a high efficacy in preventing the shingles rash (mid-to high 90% range) as well as postherpetic neuralgia (around 90%). In addition, Shingrix has a longer duration of protective efficacy than Zostavax. At four years after immunization, protective efficacy with Shingrix is still approximately 85%.
Kathleen L. Dooling, MD, MPH, medical officer in the division of viral diseases at the National Center for Immunization and Respiratory Disease at the Centers for Disease Control and Prevention and first author of the ACIP recommendations, emphasized that patients need to get both doses of the vaccine to receive maximum benefit.
“The protection provided by only one dose is unknown,” she said.
She also emphasized that patients should be encouraged to receive both doses even if they experience a reaction to the first dose. Most people experience a sore arm at and near the injection site; however, some patients may also experience systemic symptoms such as fatigue, myalgia, headache, shivering, or fever.
“About one in six people had symptoms severe enough to prevent them from doing regular activities,” she said, adding that the symptoms generally last two to three days. “Patients should plan to avoid strenuous activities for a few days after vaccination,” she said.
Commenting on the vaccine, Paul A. Offit, MD, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, said the efficacy data are remarkable.
“This is amazing in the world of medicine,” he said. “Nothing works this well.”
Dr. Offit emphasized that it is hard to find a medical product that works this well in people who are older. He emphasized, however, the importance of post-marketing studies to ensure the safety of the vaccine.
Dr. Dooling encourages patients to contact insurance providers prior to receiving the vaccine to ensure coverage is in place.