Statement on the Clinical use of Zoster vaccine in older adults in Australia - 8 July 2021

The ATAGI clinical statement provides recommendations for the Zoster vaccine and Shingrix vaccine.

Key Points

• There are two zoster vaccines now available for use in adults aged ≥50 years in Australia to prevent herpes zoster:

• Zostavax (Merck) is a live-attenuated varicella zoster virus vaccine. Zostavax requires a single dose.
• Shingrix (GlaxoSmithKline) is an adjuvanted recombinant varicella zoster virus glycoprotein E (gE) subunit (non-live) vaccine. Shingrix requires two doses, with an interval of 2-6 months between doses.

• Shingrix is preferred over Zostavax from age 50 years and above for prevention of herpes zoster and its complications, due to its higher efficacy. However, availability is expected to be limited, and it needs to be privately prescribed.

• Zostavax remains a readily available and effective alternative vaccine for immunocompetent adults aged ≥50 years who wish to reduce their risk of herpes zoster. It is recommended and funded under the National Immunisation Program (NIP) for immunocompetent people aged 70 years of age (with catch-up for those aged 71-79 years until October 2021).

• In immunocompromised adults, Zostavax is generally contraindicated and Shingrix should be used. However, Zostavax may be given to those with mild immunocompromise where Shingrix is not accessible, after careful assessment of the degree of immunocompromise using the ‘Live shingles vaccine (Zostavax) screening for contraindications’ tool.

• Zostavax recommendations have not changed. For further details regarding the use of Zostavax please refer to the Australian Immunisation Handbook. Providers should also be aware of the recent TGA requirement for a boxed warning in the Zostavax Product Information.

• Shingrix is associated with moderately high rates of local and systemic reactions that generally do not prevent normal activities and resolve within 1-3 days. Providers should counsel recipients on what to expect after vaccination.

• Recipients of Shingrix should be advised that it is necessary to complete the two-dose schedule to ensure an adequate level and duration of protection.