People aged ≥50 years who are immunocompetent are recommended to receive a zoster vaccine
All people aged ≥50 years who are immunocompetent should be offered zoster vaccine. The optimal timing of zoster vaccination from 50 years of age should be determined on a case-by-case basis. See Considerations for timing of zoster vaccination.
People who are immunocompetent are recommended to receive a 2-dose schedule of Shingrix, 2–6 months apart, for the prevention of herpes zoster and associated complications. See Considerations for timing of zoster vaccination.
Both Shingrix and Zostavax have good efficacy in preventing herpes zoster. They have not been directly compared in clinical trials. However, studies of each vaccine against placebo suggest that Shingrix may be substantially more efficacious,1 particularly in the elderly, and may offer longer-lasting protection against herpes zoster.2-7
A single dose of Zostavax is an effective alternative to Shingrix in people who are immunocompetent. The individual’s immune status should be carefully assessed before administering Zostavax, using the Live zoster vaccine (Zostavax) screening for contraindications tool, to confirm that they are not immunocompromised. See Contraindications and precautions. If the person’s immune status is uncertain, do not administer Zostavax, and consult the person’s specialist or an immunisation specialist before proceeding.
See Vaccine information.
Considerations for timing of zoster vaccination
The optimal time to receive zoster vaccination depends on individual circumstances.
Age-related risk of herpes zoster and its complications
Herpes zoster can occur at any age, but the risk increases with age. The risk of herpes zoster in the general population increases from an estimated annual rate of 6 per 1000 in people aged 50–59 years to 15 per 1000 in people aged 70–79 years.8 The likelihood of complications such as post-herpetic neuralgia also increases with age.8
Duration of protection
Shingrix has demonstrated high vaccine efficacy for at least 7 years after vaccination in people without apparent immunocompromise,9 and immunogenicity data suggest that protection may persist for at least 10 years.2-4 Effectiveness of Zostavax appears to wane more quickly, decreasing significantly by 5–10 years after vaccination.5-7
A person vaccinated at a younger age (such as in their 50s or 60s) could possibly have reduced protection from vaccination as they age, when the risk of zoster is higher. This should be balanced with consideration of reduced effectiveness for some zoster vaccines when administered at older age and the risk of zoster while unvaccinated.
There is no current recommendation for boosters for either vaccine.
Individual’s immune status
People who are immunocompromised are at significantly higher risk of herpes zoster and severe complications than those who are immunocompetent.10-12 However, the duration of protection provided by zoster vaccines in people who are immunocompromised is less certain. If there is uncertainty about the optimal timing of vaccination in people who are immunocompromised, this should be discussed with the patient’s specialist. See Vaccination for people who are immunocompromised and See Contraindications and precautions
Individual’s personal preferences
People’s desire to protect themselves from herpes zoster and related complications may vary, and this will influence decision-making on when they should receive zoster vaccination.
See Vaccine information.