Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines

On October 20, 2017, Zoster Vaccine Recombinant, Adjuvanted (Shingrix, GlaxoSmithKline, [GSK] Research Triangle Park, North Carolina), a 2-dose, subunit vaccine containing recombinant glycoprotein E in combination with a novel adjuvant (AS01B), was approved by the Food and Drug Administration for the prevention of herpes zoster in adults aged ≥50 years. The vaccine consists of 2 doses (0.5 mL each), administered intramuscularly, 2–6 months apart (1). On October 25, 2017, the Advisory Committee on Immunization Practices (ACIP) recommended the recombinant zoster vaccine (RZV) for use in immunocompetent adults aged ≥50 years.

Herpes zoster is a localized, usually painful, cutaneous eruption resulting from reactivation of latent varicella zoster virus (VZV). Herpes zoster is common: approximately one million cases occur each year in the United States (2). The incidence increases with age, from five cases per 1,000 population in adults aged 50–59 years to 11 cases per 1,000 population in persons aged ≥80 years (2). Postherpetic neuralgia, commonly defined as persistent pain for at least 90 days following the resolution of the herpes zoster rash, is the most common complication and occurs in 10%–13% of herpes zoster cases in persons aged >50 years (3,4). Among persons with herpes zoster, the risk for developing postherpetic neuralgia also increases with age (3–5).

Zoster Vaccine Live (ZVL) (Zostavax, Merck and Co., Inc., Whitehouse Station, New Jersey), a 1-dose live attenuated strain of VZV, is licensed for the prevention of herpes zoster in immunocompetent adults aged ≥50 years and is recommended by the ACIP for use in immunocompetent adults aged ≥60 years (6). Since licensure, vaccine coverage has increased each year, and by 2016, 33% of adults aged ≥60 years reported receipt of the vaccine (CDC, provisional unpublished data). ACIP considered use of RZV, as well as existing recommendations, to develop vaccination policy which would be safe and reduce disease burden. This report serves as a supplement to the 2008 Prevention of Herpes Zoster Recommendations of ACIP for the use of ZVL in adults aged ≥60 years and subsequent updates (6–8); it outlines recent ACIP recommendations as well as guidance for use of RZV and ZVL in adults.