Shingles vaccination recommendations and the role of the Shingrix vaccine

Vaccination against shingles is widely recommended throughout the world.

Internationally, the vaccination against shingles is currently recommended and covered by national insurance in several countries. The majority of countries have included Shingrix in their recommendations. No countries have suspended the implementation of shingles vaccination recommendations.

The Shingrix vaccine is more effective than the Zostavax vaccine in preventing Shingles. 

The effectiveness of the Shingrix vaccine in real-life was 79.3%, whereas the effectiveness of Zostavax was 45.9% in immunocompetent adults aged 50 years and older. In the population with comorbidities, Shingrix vaccine was found to be more effective than Zostavax in preventing shingles (70% versus 50%).

A good safety profile and a favourable benefit-risk of Shingrix. 

The Shingrix vaccine has a good safety profile. When co-administered with other vaccines (PCV13, PPV23, dTpa, seasonal influenza, mRNA-1273 vaccine), a greater proportion of local adverse events and systemic adverse events were reported compared to the control group.

The Advisory Committee on Immunization Practices (ACIP) assessed the benefit-risk balance for Shingrix and determined that Shingrix provided a greater benefit in comparison to the risk of Guillain-Barré syndrome. The vaccination would aid in the prevention of 43,000 to 63,000 cases of shingles and its complications per million individuals who have been vaccinated for each group of age.  

Shingles vaccination with Shingrix could be cost-effective.

The Shingrix vaccine was cost-effective compared to non-vaccination from a societal viewpoint, mainly in individuals aged 60 years and older. When comparing the two vaccines, Shingrix was also cost-effective compared to Zostavax.

The inclusion of healthcare professionals could enhance the acceptance of vaccines among the individuals targeted by these recommendations.

The acceptability rate for amenability to shingles vaccination was 56% among adults aged 50 years and older. The rate of acceptance for the shingles vaccine was higher in the context where it was recommended by healthcare professionals, compared to the cohort who had not received recommendations from a healthcare professional.

Shingles vaccination recommendations and the role of the Shingrix vaccine

• For the purposes of simplifying the vaccination schedule and communication to the general public with a view to improving vaccination coverage, after its assessment, the HAS recommends shingles vac-cination for immunocompetent adults aged 65 years and older, preferentially with the Shingrix vaccine.
• The HAS also recommends shingles vaccination with the Shingrix vaccine for individuals aged 18 years and older who have immune deficiency, due to congenital (e.g. primary immune deficiency) or acquired (e.g. HIV infection-related immunosuppression) disorders or treatment (e.g. long-term cortico-steroid therapy or immunosuppressant treatments). The vaccination of immunosuppressed individuals will be the subject of specific recommendations.
• The primary vaccination schedule of Shingrix consists of administration in two doses, with a two-month interval between each dose. If needed, the interval may be between two and six months. It is also not necessary to restart the vaccination schedule if the six-month interval is exceeded.
• For the individuals targeted by this recommendation who have previous history of shingles or Zostavax vaccination, the HAS recommends a complete Shingrix vaccine schedule, after an interval of at least one year.
• In specific contexts (imminent induction of immunosuppression or recurrent bouts of shingles), the Shingrix vaccine may be administered on recovery from shingles.
• The HAS recommends vaccination with the Shingrix vaccine prior to commencing immunosuppressant therapy. It is recommended to administer the vaccine as early as possible, so that vaccination is complete ideally 14 days prior to commencing treatment. In this context, the interval between the two vaccine doses may be reduced to one month.
• The Shingrix vaccine may be administered at the same time as an inactivated, non-adjuvanted sea-sonal influenza vaccine, pneumococcal vaccine or dTpa (reduced antigen diphtheria-tetanus-acellular pertussis) vaccine, and with an mRNA Covid-19 vaccine. There is no minimum interval required be-tween any of these vaccines and the Shingrix vaccine. The vaccines must be administered at different injection sites.
• To date, the need for a booster dose after primary vaccination with Shingrix has not been established
• Due to the lack of clinical data on the safety profile of the Shingrix vaccine in breastfeeding women, its administration should be assessed on a case-by-case basis, and within the framework of a shared medical decision with the care team.
• The HAS recommends the development of information materials tailored to different audiences.
• Finally, the HAS emphasises that studies on the duration of shingles vaccination protection in immunosuppressed individuals are needed, and that it would also like to see economic evaluations in the French context.
• These recommendations may be updated according to changes in scientific knowledge.