Recombinant versus live zoster vaccine

What it is

Shingles is an acute, unilateral, painful blistering rash caused by reactivation of the Varicella Zoster Virus (VZV), and two vaccines are set against it: the live zoster vaccine (Zostavax) and the recombinant zoster vaccine (Shingrix).

The live vaccine

In 2013 the NHS introduced a vaccine to boost the immunity of elderly people against herpes zoster. It is offered to all patients aged 70-79 years, and it is live-attenuated and given subcutaneously, as one dose.

Because it is live-attenuated the main contraindication is immunosuppression. In the maternal vaccine table the zoster vaccine is listed as live and contraindicated during pregnancy, in the same row as varicella.

Its side-effects are injection site reactions, and less than 1 in 10,000 individuals will develop chickenpox.

The recombinant vaccine, and why it is preferred

The recombinant zoster vaccine is preferred over the live zoster vaccine due to its increased efficacy.

• Efficacy: about 97% effective for preventing shingles, compared to 51% with the live vaccine
• Doses: two intramuscular doses separated by 2-6 months, compared to only one subcutaneous dose with the live vaccine
• Cost: slightly more expensive than the live vaccine
• Immunocompromised patients: although the recombinant vaccine is not a live vaccine, studies are still ongoing as to whether it is safe to give to them