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

Medically reviewed by Last updated on Oct 29, 2020.

Official Answer


There are several differences between Zostavax (zoster vaccine live) and Shingrix (zoster vaccine recombinant, adjuvanted). Most importantly, Shingrix has shown greater effectiveness at preventing shingles than Zostavax.

In the U.S., Zostavax and Shingrix are FDA-approved vaccines to help prevent the occurrence of shingles. In studies, compared with placebo, Shingrix significantly reduced the risk of developing shingles by 90 to 97% in subjects 50 years and older. Merck's Zostavax, compared to placebo, significantly reduced the risk of developing zoster by 69.8% in those 50 to 59 years old, and by 51% in subjects 60 and older overall. However, in patients 80 years and older, Zostavax was only 18% effective while Shingrix was 89.1% effective in preventing shingles in this older, at-risk, age group. There are no head-to-head studies.

Merck's Zostavax is a subcutaneous, one-time injection, while Shingrix is an intramuscular (IM) injection requiring 2 injections, with the second dose given 2 to 6 months after the first. Pain due to injection was reported in roughly 40% of patients receiving Zostavax compared to 78% with Shingrix, as expected with an IM injection. Shingrix is a recombinant, non-live vaccine, while Zostavax is a live, attenuated vaccine. Live virus vaccines aren't usually recommended in immunocompromised patients.

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), which can lead to painful lesions on the skin, that may persist as nerve pain (post-herpetic neuralgia).

Due to greater efficacy, the CDC’s Advisory Committee on Immunization Practices (ACIP) now recommends Shingrix vaccine over Zostavax and suggests those who received Zostavax in the past should be revaccinated with Shingrix for greater protection against shingles.

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