Does Your Patient Need Another Shingles Shot?
Your patient needs to receive the recombinant zoster vaccine (RZV/Shingrix) as a 2-dose series, regardless of their previous shingles vaccination, because current guidelines recommend RZV for all adults aged 50 years and older, even if they previously received the older live zoster vaccine.
Understanding the Vaccine Landscape
The shingles vaccine landscape has fundamentally changed. The older guidelines from 2009-2013 recommended a single dose of the live attenuated zoster vaccine (ZVL/Zostavax) for adults aged 60 years and older 1, 2. However, the most recent 2020 guidelines clearly state that adults aged 50 years or older should receive a 2-dose series of RZV (Shingrix) given 2-6 months apart, regardless of previous herpes zoster history or prior ZVL vaccination 3.
Key Recommendation Details
For Adults Aged 50 and Older:
- RZV is now the preferred vaccine over the older live vaccine (ZVL)
- Two doses are required, administered 2-6 months apart (minimum interval: 4 weeks)
- If your patient received ZVL previously, they should still get the 2-dose RZV series, waiting at least 2 months after their ZVL dose 3
- The 2-dose series provides approximately 70% effectiveness in real-world settings, compared to only 57% for a single dose 4
For Adults Aged 60 and Older:
- Same 2-dose RZV recommendation applies
- RZV is explicitly preferred over ZVL 3
Why This Matters for Your Patient
The evidence strongly supports completing the full 2-dose series:
- Real-world effectiveness data shows 70.1% protection with 2 doses versus only 56.9% with 1 dose 4
- Series completion rates are approximately 70% within 6 months and 80% within 12 months 5
- Even if the second dose is delayed beyond 6 months, effectiveness is not significantly impaired 4
- A single additional dose given 5-6 years after primary vaccination elicits strong anamnestic responses 6
Special Populations
Immunocompromised Patients:
If your patient has autoimmune conditions, is on immunosuppressive therapy, or has other immunocompromising conditions, RZV is still recommended and effective 4. In fact, CDC now recommends RZV for immunocompromised adults as young as 18 years old 7, 8.
Dialysis Patients:
For patients on dialysis, CDC specifically recommends 2 doses of RZV (Shingrix) 2-6 months apart as the preferred vaccine 7.
Common Pitfalls to Avoid
- Don't assume one dose is sufficient - The older single-dose ZVL recommendation no longer applies with RZV
- Don't delay unnecessarily - While the recommended interval is 2-6 months, delays beyond 6 months don't significantly reduce effectiveness 4
- Don't skip vaccination in those with prior ZVL - Previous live vaccine recipients should still receive the 2-dose RZV series 3
- Don't withhold from immunocompromised patients - RZV (unlike ZVL) is not a live vaccine and is safe and effective in this population 4, 8
Bottom Line
Your patient should receive the complete 2-dose RZV (Shingrix) series. If they received the older live vaccine (Zostavax) previously, they should wait at least 2 months and then start the 2-dose RZV series. The second dose should ideally be given 2-6 months after the first, though delays don't significantly compromise protection 3, 4.