Absolute Contraindications to Shingrix (Recombinant Zoster Vaccine)
The only absolute contraindication to Shingrix is a history of severe allergic reaction (such as anaphylaxis) to any component of the vaccine or after a previous dose of Shingrix. 1
Components of Shingrix
Shingrix is a non-live, recombinant subunit vaccine that contains:
- Varicella zoster virus glycoprotein E antigen
- AS01B adjuvant system
Key Points About Shingrix Contraindications
What is NOT a Contraindication
- Unlike Zostavax (the older live zoster vaccine), Shingrix is not contraindicated in:
Special Populations Where Shingrix Can Be Used
- Adults aged ≥18 years who are or will be immunocompromised due to disease or therapy 3
- Patients with rheumatoid arthritis, systemic lupus erythematosus, and inflammatory bowel disease 2, 3
- Patients on JAK inhibitors, TNF inhibitors, or other biologics 2
- Patients on low-dose methotrexate (≤0.4 mg/kg/week), azathioprine (≤3.0 mg/kg/day), or 6-mercaptopurine (≤1.5 mg/kg/day) 2
Administration Considerations
Temporary Precautions
- Consider delaying vaccination in individuals with:
- Moderate or severe acute illness with or without fever
- Current herpes zoster outbreak (wait until acute phase has resolved)
Monitoring Requirements
- As with any vaccine, appropriate medical treatment and supervision must be available to manage possible anaphylactic reactions 4
- Observe patients for 15 minutes after vaccination, particularly those with a history of allergic reactions to other substances
Safety Profile
- Shingrix has a clinically acceptable safety profile 5
- Most common adverse reactions are:
- Injection site reactions (pain, redness, swelling)
- Systemic reactions (myalgia, fatigue, headache, fever)
- Most reactions are mild to moderate and resolve within 2-3 days 1
- Post-licensure safety surveillance has not detected sustained increased risk of serious adverse events 6
Common Pitfalls to Avoid
Confusing with Zostavax contraindications: Unlike the older live zoster vaccine (Zostavax), Shingrix is not contraindicated in immunocompromised patients.
Delaying vaccination unnecessarily: Many conditions commonly perceived as contraindications (such as mild acute illness, current antibiotic therapy, or recent exposure to an infectious disease) are not contraindications to Shingrix.
Failing to complete the series: Shingrix requires 2 doses, 2-6 months apart, for optimal protection. A single dose provides insufficient protection.
Mismanaging expectations about side effects: Patients should be informed that Shingrix commonly causes temporary local and systemic reactions, which should not be confused with contraindications for the second dose.
By understanding the limited contraindications to Shingrix, healthcare providers can ensure this highly effective vaccine is appropriately offered to all eligible patients, including those who may have been ineligible for the previous live zoster vaccine.