{{distinguish|Varicella vaccine}} {{Short description|Vaccine to prevent shingles}} {{Use dmy dates|date=July 2024}} {{cs1 config |name-list-style=vanc |display-authors=6}} {{Infobox drug | verifiedrevid = 412737952 | type = vaccine | image = Shingles vaccines.jpg | alt = | width =
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A '''zoster vaccine''' is a vaccine that reduces the incidence of herpes zoster ({{aka}} shingles), a disease caused by reactivation of the varicella zoster virus, which is also responsible for chickenpox.<ref name=Gershon2015>{{cite journal | vauthors = Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D, Grose C, Hambleton S, Kennedy PG, Oxman MN, Seward JF, Yamanishi K | title = Varicella zoster virus infection | journal = Nature Reviews Disease Primers | volume = 1 | issue = | article-number = 15016 | date = July 2015 | pmid = 27188665 | pmc = 5381807 | doi = 10.1038/nrdp.2015.16 }}</ref> Shingles provokes a painful rash with blisters and can be followed by chronic pain (postherpetic neuralgia) and other complications. Older people are more often affected, as are people with weakened immune systems (immunosuppression). Both shingles and postherpetic neuralgia can be prevented by vaccination.<ref name=Saguil2017>{{cite journal |vauthors=Saguil A, Kane S, Mercado M, Lauters R |title=Herpes zoster and postherpetic neuralgia: prevention and management |journal=American Family Physician |volume=96 |issue=10 |pages=656–663 |date=November 2017 |pmid=29431387 |doi= |url=https://www.aafp.org/afp/2017/1115/p656.html |access-date=19 February 2021 |archive-date=25 April 2021 |archive-url=https://web.archive.org/web/20210425043628/https://www.aafp.org/afp/2017/1115/p656.html |url-status=live }}</ref>
Two zoster vaccines have been approved for use in people over 50 years old.<ref name=Saguil2017/> '''Shingrix''' (GSK) is a recombinant subunit vaccine that has been used in many countries since 2017.<ref name="pmid30361202" /> '''Zostavax''' (Merck), in use since 2006,<ref name="pmid35340552">{{cite journal | vauthors=Pan CX, Lee MS, Nambudiri VE | title=Global herpes zoster incidence, burden of disease, and vaccine availability: a narrative review | journal=Therapeutic Advances in Vaccines and Immunotherapy | volume=10 | year=2022 | article-number=25151355221084535 | doi = 10.1177/25151355221084535 | pmc=8941701 | pmid=35340552 }}</ref> is an attenuated vaccine which consists of a larger-than-normal dose of varicella vaccine.<ref name=Gershon2015>{{cite journal | vauthors = Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D, Grose C, Hambleton S, Kennedy PG, Oxman MN, Seward JF, Yamanishi K | title = Varicella zoster virus infection | journal = Nature Reviews Disease Primers | volume = 1 | issue = | article-number = 15016 | date = July 2015 | pmid = 27188665 | pmc = 5381807 | doi = 10.1038/nrdp.2015.16 }}</ref> Unlike Shingrix, Zostavax is not suitable for people with immunosuppression or diseases that affect the immune system.<ref name=Saguil2017/> Zostavax was discontinued in the United States in November 2020.<ref name="cdc" /> Shingrix appears to prevent more cases of shingles than Zostavax, although side effects seem to be more frequent.<ref name="pmid30361202"/><ref name="Cochrane2019">{{cite journal |vauthors = Gagliardi AM, Andriolo BN, Torloni MR, Soares BG, de Oliveira Gomes J, Andriolo RB, Canteiro Cruz E |date=November 2019 |title=Vaccines for preventing herpes zoster in older adults |journal=The Cochrane Database of Systematic Reviews |volume=2019 |issue=11 |pages= |doi=10.1002/14651858.CD008858.pub4 |pmc=6836378 |pmid=31696946}}</ref> Varicella vaccine is used to prevent diseases caused by the same virus.<ref>{{cite web|url=https://www.cdc.gov/vaccines/vpd/shingles/hcp/zostavax/hcp-vax-recs.html|title=Herpes Zoster Vaccination|work=U.S. Centers for Disease Control and Prevention (CDC)|access-date=26 October 2021|date=31 July 2015|archive-date=26 October 2021|archive-url=https://web.archive.org/web/20211026095854/https://www.cdc.gov/vaccines/vpd/shingles/hcp/zostavax/hcp-vax-recs.html|url-status=live}}</ref> {{TOC limit}}
== Medical uses == Zoster vaccination is used to prevent shingles and its complications, including postherpetic neuralgia.<ref name=Gershon2015/><ref name=Saguil2017/> It can be considered a therapeutic vaccine, given that it is used to treat a latent virus that has remained dormant in cells since chicken pox infection earlier in life.<ref name=Gershon2015/> The available zoster vaccine is intended for use in people over the age of 50.<ref name=Saguil2017/> {{As of|2021}} it was not confirmed whether a booster dose was required,<ref name=gboi>{{Cite book|url=https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1012943/Green_book_of_immunisation_28a_Shingles.pdf|title=Green Book of immunisation|chapter=Chapter 28a: Shingles (herpes zoster)|page=8|date=23 August 2021|quote=The need for booster doses of either Shingrix and Zostavax has not yet been determined.|access-date=11 November 2021|archive-date=29 September 2021|archive-url=https://web.archive.org/web/20210929023322/https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1012943/Green_book_of_immunisation_28a_Shingles.pdf|url-status=live}}</ref><ref name="pmid30361202"/> but the Advisory Committee on Immunization Practices (ACIP) in the United States recommends Shingrix for adults over the age of 50, including those who have already received Zostavax.<ref name=han/>
===Shingrix=== thumb|Shingrix The ACIP voted that Shingrix is preferred over Zostavax for the prevention of zoster and related complications because data showed vaccine efficacy of more than 90% against shingles across all age groups. Unlike Zostavax<ref>{{cite web |title=What Everyone Should Know about Zostavax |url=https://archive.cdc.gov/www_cdc_gov/vaccines/vpd/shingles/public/zostavax/index.html |website=CDC |date=23 May 2023 |publisher=Centre for Disease Control |access-date=1 June 2025}}</ref>, which is given as a single shot, Shingrix<ref>{{cite web |title=Shingles Vaccination |url=https://www.cdc.gov/shingles/vaccines/index.html |website=CDC |date=21 August 2025 |publisher=U.S. Centres for Disease Control and Prevention}}</ref> is given as two identical intramuscular doses, two to six months apart.<ref name=han>{{cite web|vauthors=Han DH|date=25 October 2017|title=ACIP: New Vaccine Recommendations for Shingles Prevention|url=https://www.empr.com/home/news/acip-new-vaccine-recommendations-for-shingles-prevention/|publisher=MPR|access-date=30 October 2017|archive-date=11 May 2021|archive-url=https://web.archive.org/web/20210511150500/https://www.empr.com/home/news/acip-new-vaccine-recommendations-for-shingles-prevention/|url-status=live}}</ref><ref name="pmid35340552" /><ref>{{cite web| publisher=walrus| title=Are Dose One And Dose Two Of Shingrix The Same?| vauthors = Staiger B | date=27 October 2019| url=https://walrus.com/questions/are-dose-one-and-dose-two-of-shingrix-the-same| access-date=5 February 2024| archive-date=5 February 2024| archive-url=https://web.archive.org/web/20240205211121/https://walrus.com/questions/are-dose-one-and-dose-two-of-shingrix-the-same| url-status=live}}</ref><!---citation for "identical"---> Shingrix provides high levels of immunity for at least 7 years after vaccination, but it is possible the vaccine may provide protection for much longer.<ref name="Shingrix-CDC" /><ref>{{cite journal | vauthors = Shah RA, Limmer AL, Nwannunu CE, Patel RR, Mui UN, Tyring SK | title = Shingrix for Herpes Zoster: A Review | journal = Skin Therapy Letter | volume = 24 | issue = 4 | pages = 5–7 | date = July 2019 | pmid = 31339679 }}</ref>
A large randomized clinical trial{{which?|date=March 2024}} showed Shingrix reduced the incidence of shingles 96.6% (relative risk reduction, RRR) in the 50–59 age group, and 91.3% (relative risk reduction, RRR) in those over age 70.{{citation needed|date=March 2024}} The absolute decrease in risk (absolute risk reduction, ARR) of herpes zoster following immunization over three and a half years is 3.3% (3.54% down to 0.28%) while the decrease in the risk of postherpetic neuralgia is 0.3% (0.34% down to 0.06%).<ref name=TI2018>{{cite web |title=[114] Shingrix: A New Vaccine for Shingles |url=https://www.ti.ubc.ca/2018/10/10/114-shingrix-a-new-vaccine-for-shingles/ |website=Therapeutics Initiative |access-date=14 October 2018 |date=11 October 2018 |archive-date=14 October 2018 |archive-url=https://web.archive.org/web/20181014130121/https://www.ti.ubc.ca/2018/10/10/114-shingrix-a-new-vaccine-for-shingles/ |url-status=live }}</ref><ref>{{cite web | url=https://www.ti.ubc.ca/2018/10/10/114-shingrix-a-new-vaccine-for-shingles/ | title=Therapeutics Initiative | [114] Shingrix: A New Vaccine for Shingles }}</ref><ref>{{cite web | url=https://www.ti.ubc.ca/2018/10/10/114-shingrix-a-new-vaccine-for-shingles/#ref1 | title=Therapeutics Initiative | [114] Shingrix: A New Vaccine for Shingles }}</ref>
===Zostavax=== thumb|Zostavax vaccine The Zostavax vaccine (both single dose and two-dose regime) is likely effective at protecting people from herpes zoster disease for a duration of up to three years.<ref name=":0">{{cite journal | vauthors = de Oliveira Gomes J, Gagliardi AM, Andriolo BN, Torloni MR, Andriolo RB, Puga ME, Canteiro Cruz E | title = Vaccines for preventing herpes zoster in older adults | journal = The Cochrane Database of Systematic Reviews | volume = 2023 | issue = 10 | article-number = CD008858 | date = October 2023 | pmid = 37781954 | pmc = 10542961 | doi = 10.1002/14651858.CD008858.pub5 | collaboration = Cochrane Acute Respiratory Infections Group }}</ref> The degree of longer term protection (beyond 4 years from the initial vaccination) is not clear. The need for re-vaccination after the first full vaccine schedule is complete remains to be confirmed.<ref name=":0" />
Zostavax was shown to reduce the incidence of shingles by 51% in a study of 38,000 adults aged 60 and older who received the vaccine. The vaccine also reduced by 67% the number of cases of postherpetic neuralgia (PHN) and reduced the severity and duration of pain and discomfort associated with shingles, by 61%.<ref name=Mitka2006>{{cite journal| vauthors=Mitka M | title=FDA approves shingles vaccine: herpes zoster vaccine targets older adults| journal=JAMA| date=July 2006| volume=296| issue=2| pages=157–158| pmid=16835412| doi=10.1001/jama.296.2.157 }}</ref><ref>{{cite press release| url=https://www.pharmaceuticalonline.com/doc/fda-licenses-new-vaccine-to-reduce-older-amer-0001| title=FDA Licenses New Vaccine to Reduce Older Americans' Risk of Shingles| access-date=31 October 2009| date=26 May 2006| publisher=U.S. Food and Drug Administration (FDA)| archive-date=12 November 2017| archive-url=https://web.archive.org/web/20171112131752/https://www.pharmaceuticalonline.com/doc/fda-licenses-new-vaccine-to-reduce-older-amer-0001| url-status=live}}</ref><ref name="Zostavax FDA label">{{cite web | title=Zostavax – zoster vaccine live injection, powder, lyophilized, for suspension Sterile Diluent – sterile water injection | website=DailyMed | date=26 September 2019 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=30a0464e-e012-4c16-bc05-88f07e412203 | access-date=6 September 2020 | archive-date=25 September 2020 | archive-url=https://web.archive.org/web/20200925014237/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=30a0464e-e012-4c16-bc05-88f07e412203 | url-status=live }}</ref> The FDA originally recommended it for individuals 60 years of age or older who are not severely allergic to any of its components and who meet the following requirements:<ref>{{cite web|url=https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm132880.htm |title=Patient Information about Zostavax |access-date=31 October 2009 |date=May 2006 |publisher=U.S. Food and Drug Administration (FDA) |archive-url=https://web.archive.org/web/20090619154705/https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm132880.htm |archive-date=19 June 2009 }}</ref><ref>{{cite web| url=https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm176335.htm| archive-url=https://web.archive.org/web/20090827043729/http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm176335.htm| archive-date=27 August 2009| title=Patient Information about Zostavax (Text) 12/2008| access-date=31 October 2009| date=December 2008| publisher=U.S. Food and Drug Administration (FDA)}}</ref> * do not have a weakened immune system due to HIV/AIDS or another disease or medications (such as steroids, radiation and chemotherapy) that affect the immune system; * do not have a history of cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma; and * do not have active, untreated tuberculosis.
In 2006, the US Advisory Committee on Immunization Practices (ACIP) recommended that the live vaccine be given to all adults age 60 and over, including those who have had a previous episode of shingles,<ref name="CDC">{{cite press release| url=https://www.cdc.gov/media/pressrel/r061026.htm| title=CDC's Advisory Committee Recommends "Shingles" Vaccination| date=26 October 2006| publisher=U.S. Centers for Disease Control and Prevention (CDC)| access-date=31 October 2009| archive-date=5 November 2009| archive-url=https://web.archive.org/web/20091105120851/http://www.cdc.gov/media/pressrel/r061026.htm| url-status=live}}</ref> and those who do not recall having had chickenpox, since more than 99% of Americans ages 40 and older have had chickenpox.<ref name=Shingrix-CDC/>
==Side effects== ===Shingrix=== Temporary side effects from the Shingrix shots are likely and can be severe enough in one out of six people to affect normal daily activities for up to three days.<ref name=Shingrix-CDC/> Mild to moderate pain at the injection site is common, and some may have redness or swelling.<ref name=Shingrix-CDC/> Side effects include fatigue, muscle pain, headache, shivering, fever, and nausea.<ref name=Shingrix-CDC/> Symptoms usually resolve in two to three days.<ref name="Shingrix-CDC">{{Cite web |date=24 May 2022 |title=Shingles Vaccination: What Everyone Should Know |url=https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html |access-date=1 January 2023 |publisher=U.S. Centers for Disease Control and Prevention (CDC) |archive-date=20 April 2018 |archive-url=https://web.archive.org/web/20180420202420/https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html |url-status=live }}</ref> Side effects with Shingrix are greater than those with Zostavax and occur more frequently in individuals aged 50 to 69 years compared with those 70 years and older.<ref name="pmid30361202">{{cite journal |vauthors=Tricco AC, Zarin W, Cardoso R, Veroniki AA, Khan PA, Nincic V, Ghassemi M, Warren R, Sharpe JP, Page AV, Straus SE |title=Efficacy, effectiveness, and safety of herpes zoster vaccines in adults aged 50 and older: systematic review and network meta-analysis |journal=BMJ |volume=363 |date=October 2018 |article-number=k4029 |doi=10.1136/bmj.k4029|pmid=30361202 |pmc=6201212 }}</ref><ref name="Shingrix FDA label">{{cite web | title=Shingrix- zoster vaccine recombinant, adjuvanted kit | website=DailyMed | date=4 October 2019 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0280849d-5c78-4a9d-8941-4eab429f6bd8 | access-date=6 September 2020 | archive-date=25 September 2020 | archive-url=https://web.archive.org/web/20200925081742/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0280849d-5c78-4a9d-8941-4eab429f6bd8 | url-status=live }}</ref>
===Zostavax=== The live vaccine (Zostavax) is very safe; one to a few percent of people develop a mild form of chickenpox, often with about five or six blisters around the injection site, and without fever. The blisters are harmless and temporary.<ref name="Milvax" /><ref>{{cite web| url= https://www.webmd.com/vaccines/features/shingles-vaccine-for-adults| title= Shingles Vaccine: Expert Q&A| vauthors= Harris S| date= 18 January 2011|website=WebMD| access-date= 4 January 2014 |archive-date= 3 January 2014| archive-url= https://web.archive.org/web/20140103114546/http://www.webmd.com/vaccines/features/shingles-vaccine-for-adults| url-status= live}}</ref> In one study 64% of the Zostavax group and 14% of the controls had some adverse reaction. However, the rates of serious adverse events were comparable between the Zostavax group (0.6%) and those receiving the placebo (0.5%).<ref>{{cite web | url=https://www.rxlist.com/zostavax-side-effects-drug-center.htm | title=Zostavax Side Effects Center | vauthors=Cunha JP | publisher=RxList | access-date=4 January 2014 | archive-date=5 January 2014 | archive-url=https://web.archive.org/web/20140105003948/http://www.rxlist.com/zostavax-side-effects-drug-center.htm | url-status=live }}</ref> A study including children with leukaemia found that the risk of getting shingles after vaccination is much lower than the risk of getting shingles for children with natural chicken pox in their history. Data from healthy children and adults point in the same direction.<ref name="Milvax" />
Zostavax is not used in people with compromised immune function.<ref>{{cite press release | title=Zostavax vaccine | website=Therapeutic Goods Administration (TGA) | date=7 March 2017 | url=https://www.tga.gov.au/alert/zostavax-vaccine | access-date=11 July 2020 | archive-date=12 July 2020 | archive-url=https://web.archive.org/web/20200712022958/https://www.tga.gov.au/alert/zostavax-vaccine | url-status=live }}</ref><ref>{{cite press release | title=Zostavax vaccine | website=Therapeutic Goods Administration (TGA) | date=6 July 2020 | url=https://www.tga.gov.au/alert/zostavax-vaccine-0 | access-date=11 July 2020 | archive-date=11 July 2020 | archive-url=https://web.archive.org/web/20200711234357/https://www.tga.gov.au/alert/zostavax-vaccine-0 | url-status=live }}</ref>
== Composition == ===Shingrix=== Shingrix is a suspension for intramuscular injection consisting of a lyophilized recombinant varicella zoster virus glycoprotein E antigen that is reconstituted at the time of use with AS01<sub>B</sub> suspension as an immunological adjuvant. The antigen is a purified truncated form of the glycoprotein, expressed in Chinese hamster ovary cells. The AS01<sub>B</sub> adjuvant suspension is composed of 3-''O''-desacyl-4'-monophosphoryl lipid A (MPL) from ''Salmonella'' (Minnesota strain) and a saponin molecule (QS-21) purified from ''Quillaja saponaria'' (soap bark tree) extract, combined in a liposomal formulation consisting of dioleoyl phosphatidylcholine (DOPC) and cholesterol in phosphate-buffered saline solution.<ref>{{cite web | url = https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/BloodVaccinesandOtherBiologics/VaccinesandRelatedBiologicalProductsAdvisoryCommittee/UCM575190.pdf | title = FDA Shingrix Briefing Document | publisher = U.S. Food and Drug Administration (FDA) | access-date = 28 October 2017 | archive-date = 2 November 2017 | archive-url = https://web.archive.org/web/20171102233317/https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/BloodVaccinesandOtherBiologics/VaccinesandRelatedBiologicalProductsAdvisoryCommittee/UCM575190.pdf }}</ref>
===Zostavax=== Zostavax contains live attenuated varicella-zoster virus.<ref name="Milvax">{{cite web|url=https://www.merckvaccines.com/Products/Zostavax|title=About Zostavax|date=May 2018|publisher=Merck Sharp & Dohme Corp|access-date=16 November 2018|archive-date=17 November 2018|archive-url=https://web.archive.org/web/20181117022240/https://www.merckvaccines.com/Products/Zostavax}}</ref><ref name="cdc">{{cite web|url=https://www.cdc.gov/vaccines/vpd/shingles/public/zostavax/index.html|title=What everyone should know about Zostavax|publisher=U.S. Centers for Disease Control and Prevention (CDC)|date=18 June 2018|access-date=16 November 2018|archive-date=17 November 2018|archive-url=https://web.archive.org/web/20181117063215/https://www.cdc.gov/vaccines/vpd/shingles/public/zostavax/index.html|url-status=live}}</ref> It is injected subcutaneously (under the skin) in the upper arm.<ref>{{cite web |url= https://www.medicinenet.com/zoster_vaccine_live__shingles_vaccine/article.htm |title= Shingles Vaccine (Zoster Shingles Vaccine Live, Zostavax) |publisher= Medicinenet.com |access-date= 29 April 2018 |archive-date= 12 November 2017 |archive-url= https://web.archive.org/web/20171112132202/https://www.medicinenet.com/zoster_vaccine_live__shingles_vaccine/article.htm |url-status= live }}</ref> The live vaccine is produced using the MRC-5 line of fetal cells.<ref name="Zostavax FDA label" /> This has raised religious and ethical concerns for some potential users, since that cell line was derived from an aborted fetus.<ref>{{cite web|url=https://micro.magnet.fsu.edu/primer/techniques/fluorescence/gallery/cells/mrc5/mrc5cells.html|title=Human Fetal Lung Fibroblast Cells (MRC-5 Line)|publisher=Florida State University|vauthors=Davidson MW|date=13 November 2015|access-date=6 September 2020|archive-date=27 April 2021|archive-url=https://web.archive.org/web/20210427073549/https://micro.magnet.fsu.edu/primer/techniques/fluorescence/gallery/cells/mrc5/mrc5cells.html|url-status=live}}</ref>
==Cost effectiveness== A 2007 study found that the live vaccine is likely to be cost-effective in the US, projecting an annual savings of {{US$|82}} to {{US$|103}} million in healthcare costs with cost-effectiveness ratios ranging from {{US$|16,229}} to {{US$|27,609}} per quality-adjusted life year gained.<ref>{{cite journal | vauthors = Pellissier JM, Brisson M, Levin MJ | title = Evaluation of the cost-effectiveness in the United States of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults | journal = Vaccine | volume = 25 | issue = 49 | pages = 8326–8337 | date = November 2007 | pmid = 17980938 | doi = 10.1016/j.vaccine.2007.09.066 }}</ref> In 2007, the live vaccine was officially recommended in the US for healthy adults aged 60 and over, but is no longer given out in the United States {{as of|2020|lc=y}}, given the superiority of Shingrix.<ref name="MMWR_57(05)">{{cite journal | vauthors = Harpaz R, Ortega-Sanchez IR, Seward JF | title = Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP) | journal = MMWR. Recommendations and Reports | volume = 57 | issue = RR-5 | pages = 1–30; quiz CE2–4 | date = June 2008 | pmid = 18528318 | url = https://www.cdc.gov/mmwr/PDF/rr/rr5705.pdf | access-date = 6 September 2020 | archive-date = 8 June 2021 | archive-url = https://web.archive.org/web/20210608232821/http://www.cdc.gov/mmwr/pdf/rr/rr5705.pdf | url-status = live }}</ref><ref name="pmid17947396">{{cite journal | author = Advisory Committee on Immunization Practices | title = Recommended adult immunization schedule: United States, October 2007-September 2008 | journal = Annals of Internal Medicine | volume = 147 | issue = 10 | pages = 725–729 | date = November 2007 | pmid = 17947396 | doi = 10.7326/0003-4819-147-10-200711200-00187 | s2cid = 31630647 }}</ref><ref>{{cite journal | vauthors = Dooling KL, Guo A, Patel M, Lee GM, Moore K, Belongia EA, Harpaz R | title = Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 67 | issue = 3 | pages = 103–108 | date = January 2018 | pmid = 29370152 | pmc = 5812314 | doi = 10.15585/mmwr.mm6703a5 | doi-access = free | url = https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6703a5-H.pdf | access-date = 10 June 2023 | archive-date = 29 August 2021 | archive-url = https://web.archive.org/web/20210829055010/https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6703a5-H.pdf | url-status = live }}</ref>
In Canada the cost of Shingrix is about {{CA$|300}} for the two doses.<ref name="TI2018" /> This likely represents a more cost effective intervention than the live vaccine given its lower cost and increased effectiveness.<ref>{{cite journal | vauthors = Le P, Rothberg MB | title = Cost-effectiveness of the Adjuvanted Herpes Zoster Subunit Vaccine in Older Adults | journal = JAMA Internal Medicine | volume = 178 | issue = 2 | pages = 248–258 | date = February 2018 | pmid = 29297049 | pmc = 5838796 | doi = 10.1001/jamainternmed.2017.7431 }}</ref>
==History== === European Union ===
In 2006, the European Medicines Agency (EMA) issued a marketing authorization for the zoster vaccine to Sanofi Pasteur for routine vaccination in individuals aged 60 and over.<ref>{{cite web | url=https://www.ema.europa.eu/en/documents/overview/zostavax-epar-summary-public_en.pdf | title=Zostavax EPAR | date=July 2006 | access-date=27 March 2011 | publisher=European Medicines Agency (EMA) | archive-date=5 July 2019 | archive-url=https://web.archive.org/web/20190705162552/https://www.ema.europa.eu/en/documents/overview/zostavax-epar-summary-public_en.pdf | url-status=live }}</ref><ref name="Zostavax EPAR" /> In 2007, the EMA updated the marketing authorization for routine vaccination in individuals aged 50 and over.<ref>{{cite web| url=https://www.ema.europa.eu/en/documents/scientific-discussion-variation/zostavax-h-c-674-ii-0003-epar-scientific-discussion-variation_en.pdf| title=Zostavax-H-C-674-II-03 Scientific Discussion| date=21 June 2007| access-date=27 March 2011| archive-date=5 July 2019| archive-url=https://web.archive.org/web/20190705162622/https://www.ema.europa.eu/en/documents/scientific-discussion-variation/zostavax-h-c-674-ii-0003-epar-scientific-discussion-variation_en.pdf| url-status=live}}</ref><ref name="Zostavax EPAR">{{cite web | title=Zostavax EPAR | website=European Medicines Agency (EMA) | date=17 September 2018 | url=https://www.ema.europa.eu/en/medicines/human/EPAR/zostavax | access-date=31 July 2020 | archive-date=5 August 2020 | archive-url=https://web.archive.org/web/20200805022553/https://www.ema.europa.eu/en/medicines/human/EPAR/zostavax | url-status=live }}</ref>
Shingrix was approved for medical use in the European Union in March 2018, with an indication for the prevention of herpes zoster (HZ) and post-herpetic neuralgia (PHN) in adults 50 years of age or older.<ref name="Shingrix EPAR">{{cite web | title=Shingrix EPAR | website=European Medicines Agency (EMA) | date=17 September 2018 | url=https://www.ema.europa.eu/en/medicines/human/EPAR/shingrix | access-date=31 July 2020 | archive-date=4 August 2018 | archive-url=https://web.archive.org/web/20180804190847/http://www.ema.europa.eu/ema/index.jsp?curl=pages%2Fmedicines%2Fhuman%2Fmedicines%2F004336%2Fhuman_med_002240.jsp&mid=WC0b01ac058001d124 | url-status=live }} Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.</ref>
=== United Kingdom ===
From 2013, the UK National Health Service (NHS) started offering shingles vaccination to elderly people. People aged either 70 or 79 on 1 September 2013, were offered the vaccine. People aged 71 to 78 on that date would only have an opportunity to have the shingles vaccine after reaching the age of 79.<ref>{{cite web|title=Shingles Vaccination (16 July 2013, archived)|website=NHS UK|url=https://www.nhs.uk/Conditions/vaccinations/Pages/shingles-vaccination.aspx|archive-url=https://web.archive.org/web/20140602024601/https://www.nhs.uk/Conditions/vaccinations/Pages/shingles-vaccination.aspx|archive-date=2 June 2014|url-status=live}}</ref> The original intention was for people aged ''between'' 70 and 79 to be vaccinated, but the NHS later said that the vaccination program was being staggered as it would be impractical to vaccinate everyone in their 70s in a single year.<ref>{{cite web|title=Who can have the shingles vaccine? (16 July 2013, archived)|website=NHS UK|url=https://www.nhs.uk/Conditions/vaccinations/Pages/who-can-have-the-shingles-vaccine.aspx|archive-url=https://web.archive.org/web/20140410102402/https://www.nhs.uk/Conditions/vaccinations/Pages/who-can-have-the-shingles-vaccine.aspx|archive-date=10 April 2014|url-status=live}}</ref>
In 2021, vaccination against shingles is available on the NHS to people aged 70 to 79.<ref name="NHS Shingles 2021" /> Vaccination is with single-dose Zostavax, except for people for whom Zostavax is deemed unsuitable, for example, with a condition that affects the immune system, for whom two-dose Shingrix vaccine is recommended.<ref name="NHS Shingles 2021" /> The NHS stated "The shingles vaccine is not available on the NHS to anyone aged 80 or over because it seems to be less effective in this age group".<ref name="NHS Shingles 2021">{{cite web | title=Shingles vaccine overview | website=National Health Service (NHS) | date=31 August 2021 | url=https://www.nhs.uk/conditions/vaccinations/shingles-vaccination/ | access-date=26 November 2021 | archive-date=2 June 2014 | archive-url=https://web.archive.org/web/20140602024601/https://www.nhs.uk/Conditions/vaccinations/Pages/shingles-vaccination.aspx | url-status=live }}</ref> Since 2023, the shingles vaccines is being offered to healthy people turning 65.<ref>{{Cite web |title=Why you may have to wait for your shingles vaccine |url=https://www.gov.uk/government/publications/shingles-vaccination-why-you-are-being-asked-to-wait/why-you-may-have-to-wait-for-your-shingles-vaccine |access-date=14 April 2024 |website=GOV.UK |language=en}}</ref>
===United States=== Zostavax was developed by Merck & Co. and approved and licensed by the US Food and Drug Administration (FDA) in May 2006,<ref name=Mitka2006/> In 2011, the FDA approved the live vaccine for use in individuals 50 to 59 years of age.<ref name="Zostavax FDA label" /><ref>{{cite press release |date = 24 March 2011 |title = FDA approves Zostavax vaccine to prevent shingles in individuals 50 to 59 years of age |url = https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm248390.htm |publisher = U.S. Food and Drug Administration (FDA) |access-date = 27 March 2011 |archive-url = https://web.archive.org/web/20110327063156/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm248390.htm |archive-date = 27 March 2011 }}</ref> Shingrix is a zoster vaccine developed by GlaxoSmithKline that was approved in the United States in October 2017.<ref>{{cite web |url = https://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM581750.pdf |title = BBL approval |date = 20 October 2017 |access-date = 29 April 2018 |publisher = U.S. Food and Drug Administration (FDA) |archive-date = 1 November 2017 |archive-url = https://web.archive.org/web/20171101133001/https://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM581750.pdf }}</ref> Shingrix, which provides strong protection against shingles and PHN, was preferred over Zostavax before Zostavax was discontinued.<ref name=CDC2019Sym>{{cite web|title=Shingles (Herpes Zoster) Vaccination |url=https://www.cdc.gov/shingles/vaccination.html|publisher=U.S. Centers for Disease Control and Prevention (CDC) |archive-url=https://web.archive.org/web/20181207192225/https://www.cdc.gov/shingles/vaccination.html|archive-date=7 December 2018}}</ref>
In June 2020, Merck discontinued the sale of Zostavax in the US. Vaccine doses already held by practitioners could still be administered up to the expiration date (none expired later than November 2020).<ref>{{cite web | title = Product Discontinuation Notice: Zostavax (Zoster Vaccine Live)| url = https://www.merckvaccines.com/wp-content/uploads/sites/8/2020/06/US-CIN-00033.pdf | archive-url = https://web.archive.org/web/20200818193428/https://www.merckvaccines.com/wp-content/uploads/sites/8/2020/06/US-CIN-00033.pdf | archive-date = 18 August 2020 }}</ref><ref name="cdc" />
The US Centers for Disease Control and Prevention (CDC) recommends that healthy adults 50 years and older get two doses of Shingrix, at least two months apart. Initial clinical trials only tested a gap of less than six months between doses, but unexpected popularity and resulting shortages caused further testing to validate wider spacing of the two doses.<ref>{{cite news |title=Don't panic if you're put on a waiting list for the new shingles vaccine |url=https://www.washingtonpost.com/national/health-science/dont-panic-if-youre-put-on-a-waiting-list-for-the-new-shingles-vaccine/2018/07/24/248d972e-8e8d-11e8-8322-b5482bf5e0f5_story.html |newspaper=The Washington Post |date=29 July 2018 |access-date=24 January 2020 |vauthors=Cimons M |quote=The Centers for Disease Control and Prevention, which issues vaccine recommendations, says patients who wait longer than six months needn't worry, but they should get that second dose as soon as possible. Be sure not to skip it, because two doses convey the maximum immunity, more than 90%. |archive-date=5 August 2019 |archive-url=https://web.archive.org/web/20190805210246/https://www.washingtonpost.com/national/health-science/dont-panic-if-youre-put-on-a-waiting-list-for-the-new-shingles-vaccine/2018/07/24/248d972e-8e8d-11e8-8322-b5482bf5e0f5_story.html |url-status=live }}</ref><ref>{{cite web |title=Frequently Asked Questions About Shingrix |url=https://www.cdc.gov/vaccines/vpd/shingles/hcp/shingrix/faqs.html |publisher=U.S. Centers for Disease Control and Prevention (CDC) |date=26 March 2018 |access-date=23 January 2020 |quote=You and patients should make every effort to ensure that two doses are administered within the recommended 2–6 month interval. If more than 6 months have elapsed since the first dose, administer the second dose as soon as possible. Do not restart the vaccine series... |archive-date=1 May 2021 |archive-url=https://web.archive.org/web/20210501204759/https://www.cdc.gov/vaccines/vpd/shingles/hcp/shingrix/faqs.html |url-status=live }}</ref> Adults 19 years and older who are immunocompromised because of disease or therapy are also recommended to receive two doses of Shingrix.<ref name="Shingrix-CDC" />
The zoster vaccine is covered by Medicare Part D. In 2019, more than 90% of Medicare Part D vaccine spending was for the zoster vaccine. 5.8 million vaccine doses were administered to Part D beneficiaries that year at a cost of $857 million.<ref>{{Cite book|url=https://www.medpac.gov/document/june-2021-report-to-the-congress-medicare-and-the-health-care-delivery-system/|title=Report to the Congress: Medicare and the Health Care Delivery System|publisher=Medicare Payment Advisory Commission|date=June 2021|page=254|access-date=15 June 2022|archive-date=24 May 2022|archive-url=https://web.archive.org/web/20220524175108/https://www.medpac.gov/document/june-2021-report-to-the-congress-medicare-and-the-health-care-delivery-system/|url-status=live}}</ref>
== Link to lower dementia risk == Researchers analyzing the health records of Welsh older adults discovered that those who received Zostavax were 20% less likely to develop dementia over the next seven years than those who did not receive the vaccine.<ref>{{Cite web |title=Study strengthens link between shingles vaccine and lower dementia risk |url=https://med.stanford.edu/news/all-news/2025/03/shingles-vaccination-dementia.html |access-date=13 May 2025 |website=Stanford Medicine |date=2 April 2025 |language=en}}</ref>
Shingrix appears to have a stronger effect than Zostavax, providing 164 additional days lived without a diagnosis of dementia in those subsequently affected.<ref>{{multiref2|1={{cite journal | vauthors = Taquet M, Dercon Q, Todd JA, Harrison PJ | title = The recombinant shingles vaccine is associated with lower risk of dementia | journal = Nature Medicine | volume = 30 | issue = 10 | pages = 2777–2781 | date = October 2024 | pmid = 39053634 | doi = 10.1038/s41591-024-03201-5 | doi-access = free | pmc = 11485228 }}|2={{cite web | title=Study suggests shingles vaccine may reduce dementia risk | url=https://www.alzheimersresearchuk.org/news/study-suggests-shingles-vaccine-may-reduce-dementia-risk/ }}}}</ref> A June 2025 study suggests that the difference may be attributable to the AS01 adjuvant used in Shingrix as the AS01-containing RSV vaccine (Arexvy) shows a very similar reduction in dementia risks. This hypothesis is corroborated by mouse studies showing a possible anti-dementia effect of AS01.<ref>{{multiref2|1={{cite journal | vauthors = Taquet M, Todd JA, Harrison PJ | title = Lower risk of dementia with AS01-adjuvanted vaccination against shingles and respiratory syncytial virus infections | journal = npj Vaccines | volume = 10 | issue = 1 | article-number = 130 | date = June 2025 | pmid = 40562756 | doi = 10.1038/s41541-025-01172-3 | pmc = 12198376 }}|2={{cite web | title=How do vaccines reduce the risk of dementia? | University of Oxford | date=25 June 2025 | url=https://www.ox.ac.uk/news/2025-06-25-how-do-vaccines-reduce-risk-dementia }}}}</ref>
==References== {{Reflist}}
==Further reading== {{refbegin}} * {{cite journal | year=2014 | title=Varicella and herpes zoster vaccines: WHO position paper, June 2014 | journal=Weekly Epidemiological Record | volume=89 | issue=25 | pages=265–287 | hdl=10665/242227 | url=https://www.who.int/immunization/position_papers/WHO_pp_varicella_herpes_zoster_june2014_summary.pdf?ua=1 | pmid=24983077 | access-date=20 December 2019 | archive-date=28 July 2021 | archive-url=https://web.archive.org/web/20210728105047/http://www.who.int/immunization/position_papers/WHO_pp_varicella_herpes_zoster_june2014_summary.pdf?ua=1 | url-status=live }} * {{cite book | publisher = U.S. Centers for Disease Control and Prevention (CDC) | title = Epidemiology and Prevention of Vaccine-Preventable Diseases | veditors = Hall E, Wodi AP, Hamborsky J, Morelli V, Schillie S | edition = 14th | location = Washington D.C. | year = 2021 | chapter = Chapter 23: Zoster | chapter-url = https://www.cdc.gov/vaccines/pubs/pinkbook/herpes-zoster.html | url = https://www.cdc.gov/vaccines/pubs/pinkbook/index.html | access-date = 9 January 2020 | archive-date = 30 December 2016 | archive-url = https://web.archive.org/web/20161230001534/https://www.cdc.gov/vaccines/pubs/pinkbook/index.html | url-status = live }} {{refend}}
==External links== * [https://www.fda.gov/vaccines-blood-biologics/vaccines/zostavax Zostavax Product Page] U.S. Food and Drug Administration (FDA) * [https://www.fda.gov/vaccines-blood-biologics/vaccines/shingrix Shingrix Product Page] U.S. Food and Drug Administration (FDA) * {{cite web | title=Shingrix Vaccine Information Statement | website=U.S. Centers for Disease Control and Prevention (CDC) | date=15 January 2025 | url=https://www.cdc.gov/vaccines/hcp/current-vis/shingles.html }} * {{Cite web|url=https://www.fda.gov/vaccines-blood-biologics/vaccines/zostavax-herpes-zoster-vaccine-questions-and-answers |title=Zostavax (Herpes Zoster Vaccine) Questions and Answers |website=Questions about Vaccines |date=18 February 2021 |publisher=U.S. Food and Drug Administration (FDA)}} * {{ClinicalTrialsGov|NCT02723773|A Long-term Follow-up Study (ZOE-LTFU) of Two Studies 110390 (ZOSTER-006) and 113077 (ZOSTER-022) to Assess the Efficacy, Safety, and Immunogenicity Persistence of GSK Biologicals' Herpes Zoster Subunit (HZ/su) Vaccine and Assessment of 1 or 2 Additional Doses in Two Subgroups of Older Adults}}
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