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ACIP’s Recommendations for Herpes Zoster Vaccines

MMWR; 2018 Jan 26; Dooling, et al

The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) has issued recommendations for the use of the new recombinant herpes zoster vaccine Shingrix. Among the details:

  • Shingrix is a 2-dose, subunit vaccine containing recombinant glycoprotein E in combination with a novel adjuvant recommended for use in immunocompetent adults aged ≥50 years.
  • Shingrix is recommended for patients who have already received the live zoster vaccine Zostavax.
  • Shingrix is preferred over Zostavax for the prevention of herpes zoster and related complications.

Citation:

Dooling KL, Guo A, Patel M, et al. Recommendations of the Advisory Committee on Immunization Practices for use of herpes zoster vaccines. MMWR Morb Mortal Wkly Rep. 2018;67:103-108. doi:10.15585/mmwr.mm6703a5.

Commentary:

This new vaccine in studies seems to have a greater efficacy than the existing vaccine, 95% vs 60%. This led to a preferential recommendation of the (Shingrix) RZV over the (Zostavax) VZL. It does not happen often that the ACIP gives a preferential recommendation. It got an 8-7 vote on this issue at the ACIP. I think it was recommended because this new vaccine has more efficacy and hopefully will last longer. I think that the close vote was due to concerns of this being a new vaccine and limiting production to a single manufacturer. If a patient previously received the VZL, he or she can get this RZV 2 or more months later. Even though this is not a live vaccine, at this point it is not recommended for moderate to severe immunocompromised patients. Patients on less than 20 mg per day of prednisone may get this vaccine. ACIP will address this more clearly in the future. How long this vaccine will last is not known at this time, but 4 years of studies still show efficacy rates > 80%. — John Russell, MD

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