Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Efficacy of Herpes Zoster Vaccines in Adults

BMJ; ePub 2018 Oct 25; Tricco, Zarin, et al

The herpes zoster adjuvant recombinant subunit vaccine might prevent more cases of herpes zoster than using live attenuated vaccine in adults aged ≥50 years, however, the recombinant subunit vaccine may also carry a greater risk of adverse events at injection sites. This according to a systemic review and network meta-analysis that compared the efficacy, effectiveness, and safety of herpes zoster vaccines for adults aged ≥50 years. Among the details:

  • 27 studies including 2,044,504 patients were included in the analysis.
  • Network meta-analysis of 5 randomized controlled trials found no statistically significant differences between the live attenuated vaccine and placebo for incidence of laboratory-confirmed herpes zoster.
  • However, the adjuvant recombinant subunit vaccine was statistically superior to both the live attenuated vaccine and placebo.
  • Network meta-analysis of 11 randomized controlled trials also showed the adjuvant recombinant subunit vaccine to be associated with statistically more adverse events at injection sites vs the live attenuated vaccine and placebo.


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. [Published online ahead of print October 25, 2018]. BMJ. doi:10.1136/bmj.k4029.


The new recombinant zoster vaccine is far superior to the previous live zoster vaccine. It is much better than the previous vaccine that received a preferential recommendation from the ACIP. It is nice to see that in studies of over 2 million vaccine recipients that the new recombinant vaccine has a good safety signal. There were more local reactions but overall, the new zoster vaccine did not have increased serious safety events. —John Russell, MD

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