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On January 26, 2018, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) published formal recommendations regarding use of the recombinant zoster vaccine (RZV, previously abbreviated HZ/su) Shingrix (Dooling et al, 2018). Key elements of the recommendations include the following:

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  1. RZV is recommended for use in immunocompetent adults age 50 years and older for the prevention of herpes zoster infection and its complications. The two doses should be administered 2–6 months apart.

  2. RZV is recommended preferentially over zoster vaccine live (ZVL), or Zostavax.

  3. RZV is recommended for use in individuals who have previously received ZVL (although it should not be given within 2 months of receiving ZVL).

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The recommendations also address use of ZVL in special populations. For immunocompromised individuals, ACIP recommends ZVL for those on low-dose immunosuppressive therapy or those “who had recovered from an immunocompromising illness.” However, since the phase 3 trials of RZV excluded individuals on higher-dose immunosuppressants, ACIP did not extend their recommendation of RZV to this group.

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The recommendations also address the reactogenicity observed with ZVL administration in pivotal trials. ACIP advises pre-counseling of recipients about local and systemic reactions, as well as anticipatory guidance that reactions to the first dose do not necessarily predict similar responses the second dose.

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A complete summary of the recommendations and underlying evidence is available on the CDC website (www.cdc.gov/shingles/vaccination.html).

References

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Centers for Disease Control and Prevention: Shingles (Herpes Zoster) Vaccination. 2018. Available at www.cdc.gov/shingles/vaccination.html.
[PubMed: 25144544]
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Dooling  KL  et al: Recommendations of the Advisory Committee on Immunization Practices for use of herpes zoster vaccines. MMWR Morb Mortal Wkly Rep 67:103, 2018.
[PubMed: 29370152]