Yes, Shingrix Can and Should Be Given to Patients in Their Late 80s or Older
Shingrix (recombinant zoster vaccine, RZV) is recommended for adults aged 50 years and older with no upper age limit, including those in their late 80s and beyond. 1, 2
Evidence Supporting Use in Older Adults
The FDA label and clinical trial data specifically demonstrate safety and efficacy in the oldest age groups:
Clinical trials included 1,921 subjects (13%) aged 80 years and older who received Shingrix, with no clinically meaningful differences in efficacy across age groups 2
Vaccine efficacy remained high in older adults: The pooled analysis of participants 70 years and older demonstrated 91.3% efficacy against herpes zoster and 88.8% efficacy against postherpetic neuralgia 1
Safety profile was actually more favorable in older adults: The frequencies of solicited local and general adverse reactions in subjects aged 70 years and older were lower than in younger adults (aged 50-69 years) 2
Practical Considerations for Late 80s Patients
Dosing Schedule
- Administer as a 2-dose series, 2-6 months apart (minimum interval 4 weeks) 3, 2
- If the second dose is delayed beyond 6 months, do not restart the series—simply give the second dose when feasible 4
- Real-world data shows second doses administered beyond 180 days did not impair effectiveness 4
Expected Reactions
While older adults generally experience fewer reactions, counsel patients about:
- Grade 3 injection site reactions (9.5% vs 0.4% placebo) 1
- Grade 3 systemic symptoms (11.4% vs 2.4% placebo) 1
- These reactions are not contraindications and do not indicate serious adverse events
Important Safety Note
- No increase in serious adverse events or deaths compared to placebo in any age group 1, 2
- There is a potential signal for Guillain-Barré syndrome (estimated 6 excess cases per million doses in adults ≥65 years) within 42 days of the first dose, though causality is not established 2
Special Populations in Late 80s
Immunocompromised Patients
- Shingrix is safe and effective in immunocompromised adults aged 65 years and older 2
- Among 337 immunocompromised subjects aged ≥65 years, adverse reaction frequencies were similar to or lower than younger adults 2
- Real-world effectiveness was 65% in persons receiving corticosteroids 5
Chronic Medical Conditions
- Patients with chronic conditions may be vaccinated unless contraindicated (pregnancy or severe immunodeficiency) 6
Real-World Effectiveness in Older Adults
Post-licensure surveillance confirms strong performance:
- Two-dose effectiveness: 76% in Medicare beneficiaries aged >65 years 4
- Effectiveness against postherpetic neuralgia: 76% 4
- No significant decrease in effectiveness for beneficiaries aged >80 years 4
- Protection sustained at 73% at 4 years after two doses 5
Common Pitfall to Avoid
Do not withhold vaccination based solely on advanced age. The older live-attenuated vaccine (Zostavax) had markedly reduced efficacy in those ≥80 years (only 18%), but Shingrix maintains high efficacy across all age groups 1. The risk of herpes zoster and its complications increases with age, making vaccination even more important in the late 80s population.