Shingrix Delivers Persistent Immune Responses in Seniors

A recent study published in The Journal of Infectious Diseases reports that 2 doses of recombinant herpes zoster (HZ) vaccine, or RZV, (Shingrix) induce “strong and persistent” immune responses in older adults whether they previously received live-attenuated HZ vaccine, or ZVL, (Zostavax) or not.

“Our results further support the US Advisory Committee on Immunization Practices (ACIP) recommendation of Shingrix for immunocompetent adults who previously received Zostavax,” GlaxoSmithKline Vaccines’ Senior Clinical Research and Development Lead Alemnew Dagnew, MD, MSc, told Healio. Agnew added that there were no apparent differences between previous ZVL recipients and ZVL-naive participants in the study.²

Four hundred thirty individuals 65 years or older participated in the study. Eligibility requirements included having no immunocompromising conditions or a previous history of shingles.  Participants were divided evenly into 2 groups. Members of 1 group had been vaccinated with ZVL at least 5 years earlier; the other participants had not. Both groups were vaccinated with RVZ which is given in 2 doses 2 to 6 months apart. One year after the second dose of RVZ was administered, anti-gE antibody concentrations, gE-specific CD4 T-cell frequencies, and activation marker profiles were similar between the 2 groups. Safety outcomes were also similar, and no shingles episodes were confirmed.¹ 

Dagnew said it is encouraging to be able to show that prior vaccination with ZVL does not interfere with the immune responses to RVZ in older adults.²

“RZV induced strong humoral and polyfunctional CMI responses that persisted above prevaccination levels up to 1 year after RZV dose 2 in adults aged ≥65  years, irrespective of previous ZVL vaccination, without clinically significant differences in the RZV safety profile between study groups,” the study concluded.¹ “Therefore, both ZVL-naive individuals and previous ZVL recipients are likely to similarly benefit from RZV vaccination.”

RVZ was approved in 2017 for use in the United States in adults 50 years and older, and is recommended over ZVL by ACIP for the prevention of shingles and related complications like postherpetic neuralgia. 

According to the CDC, differences in efficacy between RVZ and ZVL are most pronounced among older patients. RVZ was proven in clinical trials to be more than 90% effective in adults 50 years and older. Research has shown that ZVL’s effectiveness is lower and wanes substantially over time, leaving recipients with reduced protection against herpes zoster.³

The CDC advises that there is no specific amount of time a provider needs to wait before administering RVZ to patients who have had shingles, but the vaccine should not be given to patients experiencing an acute episode of the infection.³ 

The safety of administering RVZ 5 or more years after ZVL has been studied. “Shorter intervals were not studied, but there are no theoretical or data concerns to indicate that RVZ would be less safe or effective if administered less than 5 years after a patient received ZVL,” noted the CDC.³

For patients who previously received ZVL, the CDC recommends that providers consider the patient’s age and when he or she received ZVL to determine when to vaccinate with RVZ.³ 

References:

1.Dagnew AF, Klein NP, Hervé. The adjuvanted recombinant zoster vaccine in adults aged ≥65 years previously vaccinated with a live-attenuated herpes zoster vaccine. The Journal of Infectious Diseases. 2020. https://doi.org/10.1093/infdis/jiaa083

2. Dreisbach EN. Shingrix induces persistent immune responses in older adults, regardless of Zostavax dose. Healio. April 26, 2020.  https://www.healio.com/news/infectious-disease/20200424/shingrix-induces-persistent-immune-responses-in-older-adults-regardless-of-zostavax-dose

3. CDC. Shingrix Recommendations. CDC; Page last reviewed January 25, 2018. Accessed June 4, 2020. https://www.cdc.gov/vaccines/vpd/shingles/hcp/shingrix/recommendations.html.