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    Shingrix vs Zostavax

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    The FDA has recently approved a new vaccine for Varicella Zoster Virus named Shingrix for all those 50 years and older.

    Since 2006, all that’s been available is the Zostavax, which was only recommended in adults 60 years and older.

    I will first start off with a little about Herpes Zoster.  You can review my colleague Daniel Champigny’s article on Herpes Zoster for a full review of this disease.

    Following an initial infection, the varicella-zoster virus remains dormant in the sensory ganglion.  Cell-mediated immunity keeps this virus at bay, but if at some point the protection is compromised or lowers, the Varicella Zoster virus can reactivate and present as Shingles.

    To aid in the prevention of the reactivation of the Varicella Zoster virus, in 2006, Zostavax was created.  This was shown to be a live-attenuated vaccine that considerably reduced the incidence and severity of herpes zoster, but also decreased the rate of post-herpetic neuralgia.

    Some downfalls with the vaccine were that the effectiveness quickly declines with age.  Also, since Zostavax is a live-attenuated vaccination it also limited its use to those who were not immunocompromised. 

    Regarding storage of the Zostavax, it must be kept frozen during storage and transport until ready for use.  Lastly, the ACIP recommends that Zostavax only be used for adults 60 years and older, even though the FDA approved it in those 50 years and older.

    Now for the novel Shingrix.

    shingrix vaccine

    This is a new recombinant vaccine that incorporates varicella-zoster virus glycoprotein E antigen that is attained by cultured hamster ovary cells. 

    This causes a targeted immune response to the varicella-zoster virus.  In addition, this vaccine also carries a liposomal adjuvant to enhance the immune response.

    Some good things about Shingrix in comparison to Zostavax is that it is NOT contraindicated in immunocompromised patients.  It also does not need to be frozen before use.

    One of the significant differences between Zostavax and Shingrix is that the new Shingrix is supplied in two separate doses, separated by 2-6 months.

    In terms of long-term efficacy of Shingrix, in those 70 years and older who receive the vaccine series, it was shown to be 85.1% effective after four years.  Data proposes that Shingrix efficacy will persist for at least nine years after vaccination.

    shingrix vaccine

    In comparison, protection from shingles in those who received Zostavax at 70 years of age or older reduced to 4 percent within eight years of vaccination.

    Unfortunately, the efficacy of a person who only gets one dose of Shingrix, instead of the full two doses, is unknown.

    The adverse effects of Shingrix are similar to that of Zostavax, but they have been shown to occur less frequently with the Shingrix series.

    Adverse effects such as fatigue, myalgia, headache, fever, GI distress, and injection site reaction are the most common.

    Lastly, the Advisory Committee on Immunization Practices (ACIP) has now advocated for the use of Shingrix in adults over 50 years of age, including those who have already received Zostavax. 

    Those previously vaccinated with Zostavax, or those that are vaccine naïve, should both be given the 2-dose series of Shingrix. 

    This committee voted that Shingrix is preferred over Zostavax for prevention of herpes zoster infection.

    Resources

    Shingrix – An Adjuvanted, Recombinant Herpes Zoster Vaccine, The Medical Letter, Volume 59, Issue 1535.

    https://www.cdc.gov/vaccines/vpd/shingles/hcp/index.html. Accessed: December 3, 2017.

    Am Fam Physician. Herpes Zoster and Post Herpetic Neuralgia: Prevention and Management.  2017 Nov 15;96(10):656-663.

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    Clay Walker
    Clay Walker is a board-certified physician assistant practicing in family medicine and urgent care in rural southern Illinois. He is a graduate of Southern Illinois University School of Medicine Physician Assistant Program - class of 2016. Prior to going to PA school, Clay worked as a histology technician in southern Illinois.  From an early age, he has been interested in medicine. Clay was diagnosed as a type 1 diabetic in the first grade. He began learning about his condition and teaching others about T1DM; since then, he began to have a passion to learn medicine and make a difference in the lives of others. In his free time, Clay enjoys watching sports and going to sporting events, specifically the Chicago Cubs and Philadelphia Eagles.