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

Kathleen L. Dooling, MD; Angela Guo, MPH; Manisha Patel, MD; Grace M. Lee, MD; Kelly Moore, MD; Edward A. Belongia, MD; Rafael Harpaz, MD


Morbidity and Mortality Weekly Report. 2018;67(3):103-108. 

In This Article


RZV Use in Immunocompetent Adults Aged ≥50 Years

With high efficacy among adults aged ≥50 years, and modest waning of protection over 4 years following vaccination, RZV has the potential to prevent substantial herpes zoster disease burden. Vaccinating adults starting at age 50 will prevent disease incidence in midlife, and the vaccine will likely continue to provide substantial protection beyond 4 years as recipients age.

RZV Use in Immunocompetent Adults Who Previously Received ZVL

In separate clinical trials, RZV estimates of efficacy against herpes zoster were higher than ZVL estimates in all age categories. The difference in efficacy between the two vaccines was most pronounced among recipients aged ≥70 years. Studies have shown that ZVL effectiveness wanes substantially over time, leaving recipients with reduced protection against herpes zoster. RZV elicited similar safety, reactogenicity, and immunogenicity profiles regardless of prior ZVL receipt; therefore, ZVL recipients will likely benefit from vaccination with RZV.

Preferential Use of RZV

In separate clinical trials, for all age categories, RZV estimates of efficacy against herpes zoster were higher than those for ZVL. Estimates of efficacy against postherpetic neuralgia are also higher for RZV than for ZVL; however, CIs overlap. ZVL efficacy wanes substantially during the 4 years following receipt. As a result of higher and more long-lasting efficacy, RZV is estimated to prevent more herpes zoster and postherpetic neuralgia compared with ZVL. ACIP acknowledged that several aspects of RZV performance will be further elucidated postlicensure, including the possibility of a rare adverse event related to the vaccine, the long-term duration of protection, the adherence to the 2-dose schedule, and the effectiveness and duration of protection of 1 dose of RZV. Some ACIP members preferred to recommend both vaccines with no preference until real-world data could be accrued, including head-to-head studies. The majority of ACIP members voted to recommend RZV preferentially (Box).