#224 Zoster Vaccine – is newer better than the old new?
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- Herpes Zoster (shingles):
- Adults >50 years old:1 15,411 patients; mean age 62.
- Recombinant: 0.08% versus 2.7% placebo, NNT~40.
- Comparable live vaccine RCT:3,4 NNT~70.
- Adults > 70 years old:2 13,900 patients; mean age 76.
- Recombinant:2 0.4% versus 3.5% placebo, NNT ~40.
- Comparable live vaccine RCT5 (patients ≥ 60 years): NNT~60.
- Adults >50 years old:1 15,411 patients; mean age 62.
- Post-herpetic neuralgia:
- All ages:
- Recombinant:1,2 NNT=333 at 3.8 years or 422 at 3 years.
- Live vaccine:3,5 NNT~360.
- >70 years old:
- Recombinant:1,2 NNT=335.
- Live vaccine:5 NNT=260.
- All ages:
- Serious Adverse Events:1,5
- Recombinant 1.1%, Live 1.9%, Placebo 1.3%.
- Limitations with recombinant studies: blinding questionable.1,2
- Received zoster vaccine, or
- Had shingles.
- Recombinant zoster vaccine differs from live:
- Two doses, 2-6 months apart versus 1 for live.6,7
- Costs ~40% more: ~$250 versus $180 for live.8
- Current recommendations:
- Canada:9 offer recombinant vaccine to patients:
- ≥50 years
- who previously received live vaccine or had a previous episode of shingles.
- United States:7
- 50-59 years: recombinant vaccine regardless of zoster infection or vaccine history.
- >60 years: either vaccine.
- Canada:9 offer recombinant vaccine to patients:
- Neither vaccine recommended in pregnant patients.6,7,9
- Recombinant may be considered in immunocompromised patients.9