Which shingles vaccine for older adults?

Research, doi:10.1136/bmj.k4029

The prevention of shingles in older adults has been augmented with a new option. In addition to the live attenuated herpes zoster vaccine, an adjuvant recombinant subunit vaccine was recently approved by drug regulators in the United States,1 Canada,2 Europe, and Japan.3 In a linked paper, Tricco and colleagues (doi:10.1136/bmj.k4029) addressed the important question of which vaccine is safer and more effective in older adults.4 The authors conducted a comprehensive systematic review of both scientific and grey literature and used network meta-analysis techniques to compare the two vaccines indirectly, in the absence of any head-to-head trials.

Compared with the live attenuated vaccine, the subunit vaccine reduced doctor or laboratory confirmed cases of shingles by 85% (risk ratio 0.15, 95% confidence interval 0.02 to 0.69) and reduced suspected cases by 63% (0.37, 0.20 to 0.57) in adults aged 50 years or older. This increased efficacy comes with a short term cost—participants given the subunit vaccine had a significantly greater …