Shingrix® – The New and Improved Shingles Vaccine

By Emanuela Mooney, PharmD ~

Shingles or herpes zoster is a viral infection caused by the varicella zoster virus, which is the same virus that causes chickenpox. The CDC estimates that 1 in 3 people in the United States will develop shingles. This infection causes a painful rash that usually appears around the torso but can appear anywhere on the body. In addition to the pain, the rash can also be accompanied by redness, itching, and blisters. Postherpetic neuralgia is a complication of shingles that causes burning pain that lasts long after the shingles rash disappears and effects 10 to 15% of people who get shingles.

Zostavax® was the first vaccine approved by the FDA for prevention of shingles. Zostavax® is a live vaccine that has been available in the United States since 2006. This is a single dose vaccine recommended for immunocompetent patients 60 years of age and older. The FDA approved the second vaccine, Shingrix®, for prevention of shingles in October 2017. Shingrix® is a non-live vaccine approved for immunocompetent adults 50 years and older, including those with history of shingles or who previously received Zostavax®. For those individuals who have received Zostavax® previously, a minimum interval of 8 weeks between Zostavax® and Shingrix® administration is recommended. Shingrix® is a two dose vaccine, with the second immunization administered 2 to 6 months after the first vaccine. The CDC now recommends Shingrix® over Zostavax® for shingles prevention. You may be wondering, why is Shingrix® preferred?

The safety and efficacy of Zostavax® and Shingrix® have been evaluated in clinical trials. Zostavax® reduces the risk of shingles by 51% with the highest effectiveness observed in individuals 60 to 69 years of age. Protection from Zostavax® wanes off after approximately 5 years. By 6 years after administration, Zostavax® effectiveness against shingles is less than 35%. The risk of postherpetic neuralgia was decreased by 67% in clinical trials. The most common side effects with Zostavax® are pain, redness, and swelling at injection site and headache.

In comparison, Shingrix® has an overall effectiveness for shingles prevention of 97.2% and this is similar for the 50-59, 60-69, and 70 years age and older groups. In clinical trials, no cases of postherpetic neuralgia were observed in patients less than 70 years of age who were vaccinated with Shingrix®. For patients 70 years of age and older, efficacy of the vaccine against postherpetic neuralgia was 91.2%. More side effects were noted in clinical trials with Shingrix® compared to Zostavax®. The most common side effects with Shingrix® are pain, erythema, and swelling at injection site, muscle pain, fatigue, headache, shivering, fever, and gastrointestinal symptoms (nausea, vomiting, diarrhea or abdominal pain). On average, these side effects resolve after 2 to 3 days.

TAKEAWAYS:
• The CDC recommends Shingrix® over Zostavax® due to higher efficacy for both prevention of shingles and postherpetic neuralgia.
• Patients who have received Zostavax® previously can still receive Shingrix® 8 weeks after vaccination with Zostavax®.
• Shingrix® is a two dose vaccine, therefore it is extremely important to receive the second dose of the vaccine for ideal efficacy.