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Shingles (Zoster) Vaccines

24/27 total

Three Phase 3 trials evaluated live-attenuated and recombinant subunit shingles vaccines.

Zostavax — Shingles Prevention Study (SPS)

Oxman et al., NEJM 2005

9/9
Sample size N = 38,546
Follow-up 3.1 years
Reported efficacy 51.3% against shingles; 66.5% against postherpetic neuralgia (PHN)
Funding VA, NIAID, NIH, and Merck (government-led co-funding)
9/9 criteria met (100%)
Criterion Met
Control Group ✅
Randomized ✅
Double-Blind ✅
Placebo-Controlled ✅
Large Sample (1,000+) ✅
Long Follow-up (1yr+) ✅
Independent Funding ✅
Peer-Reviewed ✅
Results Reproduced ✅

Efficacy waned below 50% by years 6–7. Zostavax no longer recommended over Shingrix.

Shingrix Phase 3 — ZOSTER-006

Lal et al., NEJM 2015

8/9
Sample size N = 15,411
Follow-up 3.2 years
Reported efficacy 97.2% against shingles (adults 50+)
Funding GlaxoSmithKline (manufacturer)
8/9 criteria met (89%)
Criterion Met
Control Group ✅
Randomized ✅
Double-Blind ✅
Placebo-Controlled ✅
Large Sample (1,000+) ✅
Long Follow-up (1yr+) ✅
Independent Funding ❌
Peer-Reviewed ✅
Results Reproduced ✅

Higher reactogenicity than typical vaccines: arm soreness, fever, fatigue in ~80% of recipients.

Shingrix in Immunocompromised Adults — ZOSTER-028

Dagnew et al., NEJM 2022

7/9
Sample size N = 1,846
Follow-up 1.8 years (21 months)
Reported efficacy 68.2% against shingles (vs. 97.2% in immunocompetent adults)
Funding GlaxoSmithKline (manufacturer)
7/9 criteria met (78%)
Criterion Met
Control Group ✅
Randomized ✅
Double-Blind ✅
Placebo-Controlled ✅
Large Sample (1,000+) ✅
Long Follow-up (1yr+) ❌
Independent Funding ❌
Peer-Reviewed ✅
Results Reproduced ✅

Substantially lower efficacy in immunocompromised populations vs. healthy adults.

Side-by-Side Comparison

Criterion ZostavaxShingrix Phase 3Shingrix in Immunocompromised Adults
Control Group✅✅✅
Randomized✅✅✅
Double-Blind✅✅✅
Placebo-Controlled✅✅✅
Large Sample (1,000+)✅✅✅
Long Follow-up (1yr+)✅✅❌
Independent Funding✅❌❌
Peer-Reviewed✅✅✅
Results Reproduced✅✅✅
Total score 9/98/97/9
Methodology note: A lower score does not mean a vaccine is unsafe or ineffective. It means the published evidence has methodological gaps — shorter follow-up, manufacturer funding, or non-standard controls. We evaluate methodology only. Consult your healthcare provider about vaccination decisions.
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