Table 1.
Comparison of live attenuated and recombinant subunit herpes zoster vaccines.
| Live attenuated VZV zoster vaccine (ZVL, or Zostavax) | Adjuvant recombinant subunit zoster vaccine (RZV, or Shingrix) | |
|---|---|---|
| Mechanism | Contains a minimum of 19,400 plaque forming units (PFUs) of the Oka/Merck strain of live attenuated VZV 1 | Contains antigen gE (glycoprotein E), the main target of CD4+ T-cell response and liposome-based AS01B adjuvant 3 |
| Formulation | Lyophilized 12 | Lyophilized (reconstituted with AS01B adjuvant) 13 |
| Approval date by FDA | 5/2006 (for >60 years old), 3/2011 (for 50–59 years old) 13 | 10/2017 (for >50 years old) 13 |
| Vaccine schedule (U.S.) | Previously in >60 years old via a single dose. No longer used in the United States as of 11/202014 | Adults >50 years old in two-dose series (2–6 months apart); immediate use as booster in patients previously vaccinated with ZVL 15 |
| Duration of protection | 8 years (for reducing HZ incidence); 10 years (for reducing HZ burden of disease, e.g., pain and discomfort) 16 |
7 years (for reducing HZ incidence;
14
10 years (for immunogenicity) |
| Vaccine efficacy | Reduces incidence of HZ by 51.3%. Reduces incidence of PNH by 66.5% 17 |
Reduces incidence of HZ by 96.6%. Reduces incidence of PNH by 88.8% 18 |
| Vaccine adverse effects | Local, systemic, and serious adverse effects:
17
Local reaction: Vaccinated: 48.3%. Placebo: 16.6%. AR: 31.7% (95% CI, 28.3–32.6) Systemic reaction: Vaccinated: 6.3%. Placebo: 4.9%. AR: 1.4% (95% CI, 0.3–2.5) Serious AEs: Vaccinated: 1.9%. Placebo: 1.3%. AR: 0.1% (95% CI, −8.8 to 9.0) |
Local, systemic, and serious adverse effects:19,18
Local reaction: Vaccinated: 81.5% [80.3–82.6]. Placebo: 11.9% [11.0–12.9]. AR: 69.6% Systemic reaction: Vaccinated: 66.1% [64.7–67.6]. Placebo: 29.5% [28.2–30.9]. AR: 36.6%. Serious AEs: Vaccinated: 9.0% [8.3–9.6]. Placebo: 8.9% [8.3–9.6]. AR: 0.1%. |
| Contra-indication | Immunosuppression, prior history of anaphylactic reaction to vaccine or vaccine component, active untreated tuberculosis, and pregnancy | Prior history of anaphylactic reaction to vaccine or vaccine component |
| Vaccine cost-effectiveness | Cost-effective | Highly cost-effective |
| Global availability | >60 countries, 34 million doses distributed12,20 | >30 countries, including but not limited to the United States, European Union, Canada, Japan, Australia, and China 21 |
AE, adverse events; AR, attributable risk; CD4, cluster of differentiation 4; CI, confidence interval;; FDA, United States Food and Drug Administration; HZ, herpes zoster; PHN, post-herpetic neuralgia; PFU, plaque-forming unit; RZV, recombinant zoster vaccine, or Shingrix; VZV, varicella-zoster virus; ZVL, zoster vaccine live, or Zostavax.