Shingrix vs Zostavax - What's the difference between them?

The main difference is that Shingrix is more effective at preventing shingles (herpes zoster virus) than Zostavax (overall: 97.2% vs. 51%, respectively). Shingrix is an FDA-approved vaccine to help prevent the occurrence of herpes zoster (shingles). Zostavax, a shingles vaccine made by Merck & Co, is no longer available on the U.S. market.

• Shingrix is used to prevent shingles in people age 50 and older, including people who previously received a live zoster vaccine (Zostavax).
• Shingrix is also used in adults 18 years and older at increased risk of shingles due to immunodeficiency or immunosuppression caused by known disease or therapy.

Herpes zoster is caused by the same virus (varicella) that causes chickenpox. When this virus becomes active again in an adult, it can cause herpes zoster (shingles). Shingles can lead to painful lesions on the skin that may persist as nerve pain (post-herpetic neuralgia).

• In placebo-controlled studies, Shingrix (zoster vaccine recombinant, adjuvanted) reduced the risk of developing shingles by 97.2% in subjects 50 years and older. Zostavax (zoster vaccine live) reduced the risk of developing shingles by 51% in those 60 years years old.
• Shingrix reduced the risk of shingles in 97.9% of patients 70 years and older, while Zostavax protected against shingles in 41% of subjects aged 70 to 79 years.
• Zostavax was only 18% effective in preventing shingles in patients 80 years and older.

Shingrix is a recombinant, non-live vaccine, while Zostavax was a live, attenuated vaccine. Live virus vaccines aren't usually recommended in immunocompromised patients.

Which is better - Shingrix or Zostavax?

Due to greater effectiveness, the CDC’s Advisory Committee on Immunization Practices (ACIP) recommended Shingrix vaccine over Zostavax for herpes zoster (shingles) prevention. They also suggest those who received Zostavax in the past should be revaccinated with Shingrix for greater protection.

Zostavax was removed from the U.S. market in November 2020.

Does Shingrix require 2 shots?

Shingrix is an intramuscular (IM) injection requiring 2 injections, with the second dose given 2 to 6 months after the first. In those who are immunodeficient or immunosuppressed and require a shorter vaccination schedule, the second dose can be administered 1 to 2 months after the first dose.

Temporary injection site pain was reported in 78% of those receiving Shingrix, as expected with an intramuscular (IM) injection.

Learn more: Shingrix side effects (in detail)

Does Shingrix cause Guillain-Barré Syndrome?

In March 2021, the FDA required safety label changes for Shingrix warning of the risk for Guillain-Barré Syndrome (GBS) following administration of Shingrix. In an observational study, an increased risk of GBS was found during the 42 days following vaccination with Shingrix. The FDA has not determined if the cause of GBS was due to Shingrix, only that there was an association.

Guillain-Barré syndrome (GBS) is a rare disorder in which the body’s immune system damages nerve cells, causing muscle weakness and sometimes paralysis

Related: FDA Requires a Warning about Guillain-Barré Syndrome (GBS) for Shingrix

This is not all the information you need to know about Shingrix or Zostavax for safe and effective use and does not take the place of talking to your doctor about your treatment. Review the full product information, and discuss this information and any questions you have with your doctor or other health care provider.