Table 2. Summary of 2018 NACI recommendations on the use of herpex vaccines for individual level decision-making^a.

Vaccine type	NACI recommendation (Strength of recommendation)	Grade of evidence supporting recommendation
RZV	1. NACI recommends that RZV should be offered to individuals ≥50 years of age without contraindications. (Strong NACI Recommendation)	NACI concludes that there is good evidence to recommend immunization. (Grade A evidence)
	2. NACI recommends that RZV should be offered to individuals ≥50 years of age without contraindications who have previously been vaccinated with LZV. (Strong NACI Recommendation)	NACI concludes that there is good evidence to recommend immunization. (Grade A evidence)
	2a. NACI recommends that for adults ≥50 years of age who have previously been immunized with LZV, re-immunization with two doses of RZV may be considered one year after LZV. (Discretionary NACI Recommendation; based on expert opinion)	NACI concludes that there is insufficient evidence to recommend an interval between LZV and RZV. (Grade I evidence)
	3. NACI recommends that RZV should be offered to individuals ≥50 years of age without contraindications who have had a previous episode of HZ. (Strong NACI Recommendation)	NACI concludes that there is fair evidence to recommend immunization. (Grade B evidence)
	3a. NACI recommends that for adults ≥50 years of age who have had a previous episode of HZ, immunization with two doses of RZV may be considered at least one year after the HZ episode. (Discretionary NACI Recommendation; based on expert opinion)	NACI concludes that there is insufficient evidence to recommend an interval between a previous episode of HZ and vaccination with RZV. (Grade I evidence).
LZV	4. NACI recommends that LZV may be considered for immunocompetent individuals ≥50 years of age without contraindications when RZV is contraindicated unavailable, or inaccessible. (Discretionary NACI Recommendation)	NACI concludes that there is good evidence to recommend immunization. (Grade A evidence)
RZV vs LZV in immune-compromised populations	5. NACI recommends that RZV (not LZV) may be considered in immunocompromised adults ≥50 years of age on a case by case basis. (Discretionary NACI Recommendation; based on expert opinion) NACI will review the evidence as it evolves and reassess recommendations.	NACI concludes that there is insufficient evidence at this time to recommend immunization (Grade I evidence)

Abbreviations: HZ, herpes zoster; NACI, National Advisory Committee on Immunization; LZV, live attenuated zoster vaccine; RZV, recombinant subunit vaccine

^a In considering these recommendations, individuals/clinicians may wish to review the decision points with respect to vaccine and age at vaccination outlined in the 2018 NACI Statement.