Can the Shingrix (recombinant zoster vaccine) series be repeated?

Repeating the Shingrix Vaccine Series

Yes, the Shingrix (recombinant zoster vaccine) series can be repeated, and revaccination is strongly recommended for individuals who develop shingles after initial immunization. 1

Indications for Repeating Shingrix Series

The Centers for Disease Control and Prevention (CDC) provides clear guidance on when to repeat the Shingrix vaccine series:

1. After previous Zostavax vaccination: Revaccination with Shingrix is recommended after an interval of more than 5 years (strong recommendation) or even within 5 years (weak recommendation) for individuals previously vaccinated with the older live zoster vaccine (Zostavax) 1

2. After breakthrough shingles: Individuals who develop shingles after initial Shingrix immunization should be revaccinated, with vaccination recommended at least 2 months after the acute stage has resolved and symptoms have abated 1

Safety and Efficacy of Revaccination

• Safety profile: Revaccination with Shingrix is well-tolerated without increased safety concerns compared to initial vaccination 1

• Immune response: Shingrix induces strong humoral and cell-mediated immune responses that are non-inferior in patients previously vaccinated with Zostavax compared to those without prior Zostavax vaccination 2

• Clinical evidence: The FDA label for Shingrix specifically addresses revaccination after Zostavax, noting that "There was no evidence for interference in the immune response to SHINGRIX in subjects previously vaccinated with ZOSTAVAX" 2

Dosing Schedule for Revaccination

The standard dosing schedule for Shingrix applies to revaccination:

• Immunocompetent adults: Two doses (0.5 mL each) administered 2-6 months apart 1

• Immunocompromised adults: Two doses with a shortened interval of 1-2 months apart 1

Practical Considerations

1. Complete the full series: Real-world effectiveness studies show that two doses provide significantly better protection (70.1% effectiveness) compared to a single dose (56.9% effectiveness) 3

2. Documentation: Ensure revaccination is properly documented in the patient's immunization record 1

3. Timing with other vaccines: Shingrix can be administered concomitantly with other vaccines, including influenza vaccines, at separate injection sites 2

Special Populations

• Immunocompromised individuals: Shingrix is recommended for adults aged 18 years and older who are immunocompromised, with the shortened dosing interval of 1-2 months between doses 1

• Autoimmune conditions: Two-dose vaccine effectiveness was not significantly lower for individuals with autoimmune conditions in real-world studies 3

Potential Side Effects

The most common adverse reactions to Shingrix (whether initial series or revaccination) include:

• Pain, redness, and swelling at the injection site
• Myalgia
• Fatigue
• Headache 1

These reactions are typically mild to moderate and resolve within a few days.