What is the shingles vaccine (Shingrix) and how many doses are required?

Shingrix is the Shingles Vaccine and Requires Two Doses

The shingles vaccine is called Shingrix (recombinant zoster vaccine or RZV), and it requires two doses administered 2-6 months apart for most adults, or 1-2 months apart for immunocompromised individuals. 1, 2

Shingrix Vaccine Details

Shingrix is a non-live recombinant vaccine that contains:

• Varicella zoster virus glycoprotein E (gE) antigen component
• AS01B adjuvant suspension component
• Administered as a 0.5 mL intramuscular injection, preferably in the deltoid region 1

Dosing Schedule

The dosing schedule varies based on immune status:

• Standard schedule (immunocompetent adults):

  • First dose at Month 0
  • Second dose 2-6 months later 1, 3

• Immunocompromised schedule:

  • First dose at Month 0
  • Second dose 1-2 months later 1, 2

Eligibility

Shingrix is indicated for:

• Adults aged 50 years and older (standard recommendation)
• Adults aged 18 years and older who are or will be at increased risk of herpes zoster due to immunodeficiency or immunosuppression 1

Effectiveness

Shingrix demonstrates superior efficacy compared to the older live vaccine (Zostavax):

• 97.2% efficacy in adults 50+ years
• 91.3% efficacy in adults 70+ years 2
• Real-world effectiveness of 70.1% with two doses and 56.9% with one dose 4

Importance of Second Dose

Completing the two-dose series is crucial for optimal protection:

• Two doses provide significantly better protection than a single dose
• In real-world studies, two doses showed 70.1% effectiveness compared to 56.9% for one dose 4
• About 80% of people complete the two-dose series within 12 months of the first dose 5

Common Side Effects

The most common reactions include:

• Injection site reactions (pain, redness)
• Systemic reactions (fatigue, myalgia, headache)
• Most side effects are mild to moderate and resolve within 2-3 days 1, 6

Special Considerations

• Previous vaccination with Zostavax is not a contraindication for receiving Shingrix
• No need to wait after a shingles episode before receiving Shingrix
• Can be administered with other vaccines such as influenza or pneumococcal vaccines 2
• Safe for patients with autoimmune conditions 4

Practical Tips

• The vaccine must be reconstituted before administration by combining the lyophilized component with the adjuvant suspension
• After reconstitution, administer immediately or store refrigerated and use within 6 hours 1
• Ensure patients understand the importance of returning for the second dose to achieve optimal protection

Shingrix represents a significant advancement in shingles prevention with its high efficacy and favorable safety profile, making it the preferred vaccine for shingles prevention in eligible adults.