MS Speaks

New Shingles Vaccine Is Here!


Abigail Zuger, MD

Its arrival should be good news for immunocompromised and older patients.

FDA drug approvals seldom are newsworthy, but the October 2017 approval of a new herpes zoster vaccine generated real buzz.... Long awaited by both patients and doctors, the new “Shingrix” vaccine seems likely to remedy some of the major deficiencies of its predecessor, “Zostavax.”

Unlike Zostavax, which is a live attenuated vaccine, Shingrix consists of a recombinant zoster glycoprotein along with a potent adjuvant. Thus, it is safe for immunocompromised people who might risk disseminated zoster from a live vaccine. In addition, although no head-to-head trials have been performed, the new vaccine's efficacy seems to be substantially better than that of its predecessor.

In one trial that involved more than 15,000 patients (age, ≥50), the new vaccine's efficacy for preventing zoster exceeded 95%.... In a companion trial that involved almost 14,000 patients (age, ≥70), efficacy was about 90%, with no diminution of efficacy in those older than 80. In contrast, published efficacy of the live attenuated preparations has been 50% to 70%, with lower rates in older recipients....

The new vaccine does have some downsides, and some questions still need to be answered. A booster dose is required at 2 months, and both injections commonly elicit substantial local reactions. The vaccine's efficacy in specific forms of immunocompromise still is unknown, as is its efficacy in preventing recurrent zoster after a prior episode. The older vaccine did not confer long-term immunity: Most recipients lost protection by 10 years after a dose.... The new vaccine appears to work well in those already vaccinated with the old one and might be a good choice for reimmunizing these patients, although the duration of protection from the new vaccine itself is not yet known.

The low population uptake of Zostavax has been of substantial concern to both the manufacturer and public health experts: In 2013 (almost a decade after its approval) only about 30% of eligible patients had received it.... Shingrix might be easier to store and administer, as it does not require refrigeration, but whether its two-dose requirement will limit effective protection out of a research setting remains to be seen.