Recombinant Herpes Zoster Vaccine
Overview
Recombinant Herpes Zoster Vaccine, also known as zoster vaccine recombinant, adjuvanted, is a preventive immunization designed to protect against herpes zoster (shingles) and its most common complication, post‑herpetic neuralgia. The vaccine contains a purified recombinant varicella‑zoster virus glycoprotein E antigen combined with an adjuvant system that enhances the immune response without using live virus. This mechanism stimulates the body’s immune system to recognise and respond more effectively to reactivation of the varicella‑zoster virus, which lies dormant after initial infection with chickenpox. Administered by intramuscular injection, the vaccine is particularly effective in older adults whose immune responses may decline with age as well as in certain adults with weakened immunity. Recombinant Herpes Zoster Vaccine has demonstrated high efficacy in preventing clinical shingles and significantly reducing the risk of post‑herpetic neuralgia, making it a key intervention in reducing the burden of this painful viral disease in at‑risk populations.
Background and Date of Approval
The first regulatory approval of Recombinant Herpes Zoster Vaccine occurred in the United States in 2017, when the Food and Drug Administration authorised it for the prevention of shingles in adults aged 50 years and older after pivotal clinical trials showed strong protective efficacy. The European Medicines Agency granted marketing authorisation in 2018, followed by updates to include adults aged 18 years and older at increased risk of herpes zoster due to immunosuppression or underlying disease. These approvals were based on clinical data demonstrating that the vaccine significantly reduced the incidence of herpes zoster and post‑herpetic neuralgia compared with placebo. Since its approval, the vaccine has been recommended by immunisation advisory bodies as the preferred option for shingles prevention in appropriate age and risk groups.
Uses
Recombinant Herpes Zoster Vaccine is indicated for the prevention of herpes zoster (shingles) and related complications, such as post‑herpetic neuralgia, in adults aged 50 years and older. It is also indicated for adults aged 18 years and older who are or will be at increased risk for herpes zoster due to immunodeficiency or immunosuppression from known disease or therapy. The vaccine is not intended to treat active herpes zoster infection or to prevent primary varicella (chickenpox). Recommendations support use regardless of previous history of shingles or prior receipt of older shingles vaccines.
Administration
Recombinant Herpes Zoster Vaccine is administered as two intramuscular injections of 0.5 millilitres each. The recommended schedule consists of the first dose followed by the second dose two to six months later. For adults aged 19 years and older who are immunocompromised, the second dose may be given one to two months after the first dose based on clinical judgement. The vaccine is typically administered in the upper arm muscle, and healthcare providers should monitor patients for immediate adverse reactions for a short period after injection.
Side Effects
Common side effects of Recombinant Herpes Zoster Vaccine include pain, redness, swelling, or itching at the injection site, muscle pain, fatigue, headache, shivering, fever, nausea, and gastrointestinal symptoms such as stomach pain, vomiting, or diarrhea. Many recipients experience transient systemic reactions shortly after vaccination, and symptoms generally resolve within a few days.
Warnings
Serious adverse events after vaccination are uncommon but may include severe allergic reactions such as anaphylaxis and rare neurologic or autoimmune events. Patients with a history of severe hypersensitivity to any component of the vaccine should not receive it. Recombinant Herpes Zoster Vaccine should be used with caution in individuals with moderate or severe acute illness until they recover, and clinicians should weigh risks and benefits in pregnant or breastfeeding individuals due to limited specific safety data. Monitoring during and after vaccination allows prompt identification and management of rare serious events.
Precautions
Prior to administering Recombinant Herpes Zoster Vaccine, clinicians should assess patients for history of allergic reactions to vaccines or vaccine components and current health status. Patients with moderate or severe acute illness should defer vaccination until recovery. There are no clinically significant drug interactions that typically contraindicate vaccination; however, clinicians should consider timing in relation to immunosuppressive therapies, as enhanced immune response may be reduced under heavy immunosuppression. Live vaccines may be considered separately if indicated, but Recombinant Herpes Zoster Vaccine contains no live virus and can be given concomitantly with other non‑live vaccines at different injection sites.
Expert Tips
When offering Recombinant Herpes Zoster Vaccine, confirm age and risk status according to current immunisation guidelines. Educate patients about the two‑dose schedule and emphasise completion of the series for optimal protection. Advise patients that local and systemic reactions are common but generally mild and transient, and reassure them regarding the high efficacy in preventing shingles and post‑herpetic neuralgia. Ensure proper vaccine storage and handling according to manufacturer guidance, and monitor for immediate adverse events after injection. Coordination with primary care and immunisation records supports adherence and timely administration.