The recombinant zoster vaccine (RZV, Shingrix) is an adjuvanted subunit vaccine containing varicella-zoster virus glycoprotein E combined with the AS01B adjuvant system. Why does RZV provide superior protection to the live attenuated zoster vaccine (Zostavax) in elderly recipients?

• A RZV contains live attenuated virus that replicates to higher titres in the elderly
• B The live attenuated vaccine causes subclinical shingles in elderly recipients
• C RZV is given orally, mimicking natural infection and inducing mucosal immunity
• D The AS01B adjuvant powerfully boosts cell-mediated immunity to glycoprotein E, overcoming immunosenescence ✓

Explanation

RZV is a recombinant subunit vaccine containing VZV glycoprotein E with the liposome-based AS01D adjuvant (containing MPL and QS-21). AS01D strongly activates both innate immunity and CD4+ T-cell responses, making it effective in elderly recipients whose immunosenescence would otherwise blunt response to subunit antigens. Zostavax, a live attenuated vaccine, carries a small risk of vaccine-strain reactivation and generates weaker cell-mediated responses in older adults.

Reference: Plotkin's Vaccines, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.