Zostavax
Zostavax contains live attenuated varicella-zoster virus. It is injected subcutaneously (under the skin) in the upper arm. The live vaccine is produced using the MRC-5 line of fetal cells. This has raised religious and ethical concerns for some potential users, since that cell line was derived from an aborted fetus. Cost effectiveness
A 2007 study found that the live vaccine is likely to be cost-effective in the U.S., projecting an annual savings of US$82 to US$103 million in healthcare costs with cost-effectiveness ratios ranging from US$16,229 to US$27,609 per quality-adjusted life year gained. In 2007, the live vaccine was officially recommended in the U.S. for healthy adults aged 60 and over, but is now is no longer given out in the United States as of 2020, given the likely superiority of Shingrix.In Canada the cost of Shingrix is about CA$300 for the two doses. This likely represents a more cost effective intervention than the live vaccine given its lower cost and increased effectiveness. History
European Union
In 2006, the European Medicines Agency (EMA) issued a marketing authorization for the zoster vaccine to Sanofi Pasteur for routine vaccination in individuals aged 60 and over. In 2007, the EMA updated the marketing authorization for routine vaccination in individuals aged 50 and over.Shingrix was approved for medical use in the European Union in March 2018, with an indication for the prevention of herpes zoster (HZ) and post-herpetic neuralgia (PHN) in adults 50 years of age or older.
As of 2021 it remained to be confirmed whether a booster dose was required, but the Advisory Committee on Immunization Practices (ACIP) in the United States recommends Shingrix for adults over the age of 50, including those who have already received Zostavax. Shingrix
The ACIP voted that Shingrix is preferred over Zostavax for the prevention of zoster and related complications because data showed vaccine efficacy of more than 90% against shingles across all age groups. Unlike Zostavax, which is given as a single shot, Shingrix is given as two intramuscular doses, two to six months apart. Most of the studies conducted showed efficacy to at least 4 years post-vaccination, but it is possible the vaccine may provide protection for much longer.A large randomized clinical trial showed Shingrix reduced the incidence of shingles 96.6% in the 50–59 age group, and 91.3% in those over age 70. The absolute decrease in risk of herpes zoster following immunization over three and a half years is 3.3% (3.54% down to 0.28%) while the decrease in the risk of postherpetic neuralgia is 0.3% (0.34% down to 0.06%). Zostavax
A Cochrane review concluded that Zostavax is "effective in preventing herpes zoster disease for up to three years". The duration of protection beyond four years after vaccination with the zoster vaccine is unknown. The need for re-vaccination remains to be confirmed.Zostavax was shown to reduce the incidence of shingles by 51% in a study of 38,000 adults aged 60 and older who received the vaccine.