Zoster vaccine

Zoster vaccines are two vaccines that have been shown to reduce the rates of herpes zoster (also known as shingles). One type, Zostavax, is essentially a larger-than-normal dose of the chickenpox vaccine, as both shingles and chickenpox are caused by the same virus, the varicella zoster virus (VZV).[3][4] A recombinant version, Shingrix, was approved in the United States in 2017.[5]

Zoster vaccine
Vaccine description
Target diseaseHerpes zoster, postherpetic neuralgia, Ramsay Hunt syndrome type II, chickenpox
TypeLive attenuated (Zostavax), recombinant (Shingrix)
Clinical data
Trade namesZostavax, Shingrix
License data
Pregnancy
category
    Routes of
    administration    		subcutaneous injection (Zostavax), intramuscular injection (Shingrix)
    ATC code
    Legal status
    Legal status
    • AU: S4 (Prescription only)
    • US: ℞-only
    • In general: ℞ (Prescription only)
    Identifiers
    ChemSpider
    • none
      (verify)

    While the recombinant version appears to prevent more cases of shingles, it has greater side effects and requires two doses.[6]

    Medical uses

    Zostavax

    A Cochrane review concluded that "herpes zoster vaccine is effective in preventing herpes zoster disease and this protection can last three years".[7] The duration of protection beyond four years after vaccination with the zoster vaccine is unknown. The need for re-vaccination has not been defined.

    Zostavax was shown to reduce the incidence of shingles by 51 percent in a study of 38,000 adults aged 60 and older who received the vaccine. The vaccine also reduced by 67 percent the number of cases of postherpetic neuralgia (PHN) and reduced the severity and duration of pain and discomfort associated with shingles, by 61 percent.[8][9][10] The FDA originally recommended it for individuals 60 years of age or older who are not severely allergic to any of its components and who meet the following requirements:[11][12]

    • does not have a weakened immune system due to HIV/AIDS or another disease or medications (such as steroids, radiation and chemotherapy) that affect the immune system;
    • does not have a history of cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma; and
    • does not have active, untreated tuberculosis.

    In 2006, the U.S. Advisory Committee on Immunization Practices (ACIP) recommended that the live vaccine be given to all adults age 60 and over, including those who have had a previous episode of shingles,[13] and those who do not recall having had chickenpox, since more than 99 percent of Americans ages 40 and older have had chickenpox.[14]

    Shingrix

    The Advisory Committee on Immunization Practices (ACIP) recommended Shingrix for adults over the age of 50, including those who have already received Zostavax. The Committee voted that Shingrix is preferred over Zostavax for the prevention of zoster and related complications because data showed vaccine efficacy of more than 90% against shingles across all age groups, as well as sustained efficacy over a 4-year follow-up. Unlike Zostavax, which is given as a single shot, Shingrix is given as two intramuscular doses, two to six months apart.[15]

    The absolute decrease in risk of herpes zoster following immunization over three and a half years is 3.3% (3.54% down to 0.28%) while the decrease in the risk of postherpetic neuralgia is 0.3% (0.34% down to 0.06%).[16]

    Side effects

    Zostavax

    The live vaccine (Zostavax) is very safe; one to a few percent of people develop a mild form of chickenpox, often with about five or six blisters around the injection site, and without fever. The blisters are harmless and temporary.[17][18] In one study 64 percent of the Zostavax group and 14 percent of the controls had some adverse reaction. However, the rates of serious adverse events were comparable between the Zostavax group (0.6 percent) and those receiving the placebo (0.5 percent).[19] A study including children with leukaemia found that the risk of getting shingles after vaccination is much lower than the risk of getting shingles for children with natural chicken pox in their history. Data from healthy children and adults point in the same direction.[17]

    Zostavax should not be used in people with compromised immune function.[20][21]

    Shingrix

    Temporary side effects from the Shingrix shots are likely, and can be severe enough in one out of six people to affect normal daily activities for up to three days.[22] Mild to moderate pain at the injection site is common, and some may have redness or swelling.[22] Side effects include fatigue, muscle pain, headache, shivering, fever, and nausea.[22] Symptoms usually resolve in two to three days.[22] Side effects with Shingrix are greater than those with Zostavax and occur more frequently in individuals aged 50 to 69 years compared with those 70 years and older.[23][24]

    Composition

    The Zostavax vaccine contains live attenuated varicella-zoster virus.[17][25] It is injected subcutaneously (under the skin) in the upper arm.[26] The live vaccine was developed using the MRC-5 line of fetal stem cells.[27] This has raised religious and ethical concerns for some potential users, since that cell line was derived from an aborted fetus.[28]

    Shingrix is a suspension for intramuscular injection consisting of a lyophilized recombinant varicella zoster virus (VZV) glycoprotein E (gE) antigen that is reconstituted at the time of use with AS01B suspension as an immunological adjuvant. The antigen is a purified truncated form of the glycoprotein, expressed in Chinese hamster ovary cells. The AS01B adjuvant suspension is composed of 3-O-desacyl-4'- monophosphoryl lipid A (MPL) from Salmonella (Minnesota strain) and a saponin molecule (QS-21) purified from Quillaja saponaria (soap bark tree) extract, combined in a liposomal formulation consisting of dioleoyl phosphatidylcholine (DOPC) and cholesterol in phosphate-buffered saline solution.[29]

    Society and culture

    Cost effectiveness

    In Canada the cost of Shingrix is about 300 CAD for the two doses.[16]

    A 2007 study found that the live vaccine is likely to be cost-effective in the U.S., projecting an annual savings of $82 to $103 million in healthcare costs with cost-effectiveness ratios ranging from $16,229 to $27,609 per quality-adjusted life year gained.[30] In 2007, the live vaccine was officially recommended in the U.S. for healthy adults aged 60 and over.[31][32]

    Approval

    European Union

    In 2006, the European Medicines Agency (EMA) issued a marketing authorization for the zoster vaccine to Sanofi Pasteur for routine vaccination in individuals aged 60 and over.[33][34] In 2007, the EMA updated the marketing authorization for routine vaccination in individuals aged 50 and over.[35][34]

    Shingrix was approved for medical use in the European Union in March 2018, with an indication for prevention of herpes zoster (HZ) and post-herpetic neuralgia (PHN) in adults 50 years of age or older.[36]

    United Kingdom

    From 2013 the UK National Health Service started offering shingles vaccination to elderly people. People aged either 70 or 79 on 1 September 2013 were offered the vaccine. People aged 71 to 78 on that date would only have an opportunity to have the shingles vaccine after reaching the age of 79.[37] The original intention was for people aged between 70 and 79 to be vaccinated, but the NHS later said that the vaccination programme was being staggered as it would be impractical to vaccinate everyone in their 70s in a single year.[38]

    United States

    Zostavax was developed by Merck & Co. and approved and licensed by the U.S. Food and Drug Administration (FDA) in May 2006,[8] In 2011, the FDA approved the live vaccine for use in individuals 50 to 59 years of age.[10][39] Shingrix is a zoster vaccine developed by GlaxoSmithKline that was approved in the United States in October 2017.[40]

    The Centers for Disease Control and Prevention (CDC) recommends that healthy adults 50 years and older get two doses of Shingrix, at least two months apart. Initial clinical trials only tested a gap of less than six months between doses, but unexpected popularity and resulting shortages caused further testing to validate wider spacing of the two doses.[41][42] Shingrix, which provides strong protection against shingles and PHN, is preferred over Zostavax.[43]

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    gollark: P R I N C I P L E O F E X P L O S I O N
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    gollark: ++delete lyricly's pronouny accouny

    References
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    2. "Zoster vaccine, inactivated (Shingrix) Use During Pregnancy". Drugs.com. 12 March 2018. Retrieved 23 January 2020.
    3. Oxman MN, Levin MJ, Johnson GR, et al. (June 2005). "A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults". The New England Journal of Medicine. 352 (22): 2271–84. doi:10.1056/NEJMoa051016. PMID 15930418.
    4. Oxman MN; Levin MJ; Shingles Prevention Study Group (March 2008). "Vaccination against Herpes Zoster and Postherpetic Neuralgia" (PDF). The Journal of Infectious Diseases. 197 (Suppl 2): S228–36. doi:10.1086/522159. PMC 4017882. PMID 18419402.
    5. "Zoster Vaccine Recombinant, Adjuvanted" (PDF). U.S. Food and Drug Administration (FDA). Retrieved 7 November 2017.
    6. Tricco, AC; Zarin, W; Cardoso, R; Veroniki, AA; Khan, PA; Nincic, V; Ghassemi, M; Warren, R; Sharpe, JP; Page, AV; Straus, SE (25 October 2018). "Efficacy, effectiveness, and safety of herpes zoster vaccines in adults aged 50 and older: systematic review and network meta-analysis". BMJ (Clinical Research Ed.). 363: k4029. doi:10.1136/bmj.k4029. PMC 6201212. PMID 30361202.
    7. Gagliardi, AM; Andriolo, BN; Torloni, MR; Soares, BG (3 March 2016). "Vaccines for preventing herpes zoster in older adults". Cochrane Database Syst Rev. 3: CD008858. doi:10.1002/14651858.CD008858.pub3. PMC 6516976. PMID 26937872.
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    9. "FDA Licenses New Vaccine to Reduce Older Americans' Risk of Shingles" (Press release). U.S. Food and Drug Administration (FDA). 26 May 2006. Retrieved 31 October 2009.
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    40. "BBL approval" (PDF). U.S. Food and Drug Administration (FDA). 20 October 2017. Retrieved 29 April 2018.
    41. Cimons, Marlene (29 July 2018). "Don't panic if you're put on a waiting list for the new shingles vaccine". The Washington Post. Retrieved 24 January 2020. The Centers for Disease Control and Prevention, which issues vaccine recommendations, says patients who wait longer than six months needn’t worry, but they should get that second dose as soon as possible. Be sure not to skip it, because two doses convey the maximum immunity, more than 90 percent.
    42. "Frequently Asked Questions About Shingrix". United States Centers for Disease Control and Prevention. 26 March 2018. Retrieved 23 January 2020. You and patients should make every effort to ensure that two doses are administered within the recommended 2-6 month interval. If more than 6 months have elapsed since the first dose, administer the second dose as soon as possible. Do not restart the vaccine series...
    43. "Shingles (Herpes Zoster) Vaccination". Centers for Disease Control and Prevention (CDC). 25 October 2018. Retrieved 18 January 2019.

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