From the Guidelines
Shingrix is contraindicated in individuals with a history of severe allergic reaction to any component of the vaccine or after a previous dose of Shingrix. The vaccine contains recombinant glycoprotein E antigen and the AS01B adjuvant system, which includes QS-21 (a saponin) and MPL (a bacterial lipid) 1. People who have experienced a life-threatening reaction to these specific components should not receive the vaccine. Additionally, Shingrix is not recommended during acute episodes of herpes zoster (shingles), as vaccination should be delayed until the acute illness resolves.
While pregnancy is not a strict contraindication, there is limited data on Shingrix use in pregnant women, so vaccination is generally postponed until after pregnancy, as designated as “Delay until after pregnancy” (pink) 1. It's essential to note that unlike the older Zostavax vaccine, Shingrix is not a live vaccine, so immunocompromised status is not a contraindication - in fact, Shingrix is specifically recommended for immunocompromised adults aged 19 and older to prevent the increased risk of shingles in this population.
Some key points to consider when administering Shingrix include:
- History of severe allergic reaction to any component of the vaccine or after a previous dose of Shingrix
- Acute episodes of herpes zoster (shingles)
- Pregnancy, where vaccination is generally postponed until after pregnancy
- Immunocompromised status, where Shingrix is recommended for adults aged 19 and older to prevent the increased risk of shingles in this population 1.
From the FDA Drug Label
Do not administer SHINGRIX to anyone with a history of a severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine or after a previous dose of SHINGRIX [see Description (11)].
Shingrix is contraindicated in individuals with a history of:
- Severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine
- A previous dose of Shingrix 2 2
From the Research
Contraindications for Shingrix
- Shingrix is not contraindicated in immunocompromised individuals, and is preferred over a live attenuated HZ vaccine in immunocompetent individuals, according to the US and Canadian guidelines 3.
- However, a live HZ vaccine is contraindicated in persons with certain immunodeficiency states or who are receiving immunosuppressive therapy 4.
- The recombinant zoster vaccine (Shingrix) is nonreplicating and is thus safe in immunocompromised persons 5.
- Shingrix is effective among individuals with immunosuppressive conditions, and its effectiveness is not significantly lower for beneficiaries aged >80 years, or for second doses received at ≥180 days 6.
Special Considerations
- Shingrix is approved for the prevention of herpes zoster (HZ) and postherpetic neuralgia (PHN) in adults aged ≥ 50 years 3.
- The vaccine is more reactogenic than placebo, with injection-site reactions, myalgia and fatigue being the most common solicited adverse reactions, but most solicited adverse reactions are transient and mild to moderate in severity 3.
- Two-dose vaccine effectiveness against postherpetic neuralgia was 76.0% (95% CI, 68.4-81.8) 6.