What are the guidelines for administering the Shingrix (recombinant zoster vaccine) vaccine for shingles prevention?

Shingrix (Recombinant Zoster Vaccine) Guidelines for Shingles Prevention

Shingrix is strongly recommended as the preferred vaccine for prevention of herpes zoster (shingles) and its complications in all adults aged 50 years and older, regardless of prior varicella history or previous zoster vaccination. 1

Vaccination Schedule and Administration

• Standard dosing schedule:

  • Two doses (0.5 mL each) administered intramuscularly 2
  • For immunocompetent adults: First dose at Month 0, second dose 2-6 months later 2
  • For immunocompromised adults: First dose at Month 0, second dose 1-2 months later 1, 2

• Route of administration:

  • Intramuscular injection only 2
  • Cannot be administered subcutaneously or intradermally

Efficacy and Duration of Protection

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

• Overall efficacy by age group:

  • Adults ≥50 years: 97.2% efficacy 3, 1
  • Adults ≥70 years: 91.3% against herpes zoster, 88.8% against postherpetic neuralgia 3, 1

• Duration of protection:

  • Protection maintained above 83.3% for up to 8 years 3
  • Decreases to 73% at 10 years 3
  • Significantly longer protection compared to the live zoster vaccine 1

• Real-world effectiveness:

  • Two-dose effectiveness: 70.1% in Medicare beneficiaries aged >65 years 4
  • Single-dose effectiveness: 56.9% (highlighting importance of completing the series) 4

Special Populations

Immunocompromised Individuals

• Shingrix is indicated for adults aged ≥18 years who are or will be at increased risk of herpes zoster due to immunodeficiency or immunosuppression 2, 5
• Recommended for patients with:
  • Hematologic malignancies 3
  • Solid cancers 3
  • Hematopoietic stem cell transplant recipients 3, 1
  • Autoimmune conditions 1, 4

Previous Zostavax Recipients

• Individuals who previously received Zostavax (ZVL) should still receive the complete Shingrix series 1
• Minimum interval of 8 weeks after ZVL before administering Shingrix 1
• Strongly recommended if it has been more than 5 years since ZVL vaccination 1

Safety Profile and Adverse Events

• Common adverse reactions:

  • Injection site reactions: pain (78%), redness (38%), swelling (26%) 2
  • Systemic reactions: myalgia (45%), fatigue (45%), headache (38%), shivering (27%), fever (21%), gastrointestinal symptoms (17%) 2

• Important safety considerations:

  • Higher incidence of grade 3 injection site reactions (9.5% vs 0.4%) and systemic symptoms (11.4% vs 2.4%) compared to placebo 3
  • Most reactions are transient and mild to moderate in severity 6
  • Increased risk of Guillain-Barré syndrome during the 42 days following vaccination 1, 2
  • Contraindicated in individuals with history of severe allergic reaction to any component of the vaccine or after a previous dose 2

Common Pitfalls and Caveats

1. Incomplete vaccination series:

   • Failing to administer the second dose significantly reduces effectiveness (70.1% for two doses vs. 56.9% for one dose) 4
   • Ensure patients understand the importance of returning for the second dose

2. Delayed second dose:

   • If the second dose is delayed beyond 6 months, administer as soon as possible
   • Effectiveness is maintained even with delayed second doses 4

3. Inappropriate use:

   • Shingrix is NOT indicated for:
     • Prevention of primary varicella infection (chickenpox) 2
     • Treatment of active shingles 1
     • Prevention of postherpetic neuralgia in individuals with active shingles 1
     • Treatment of ongoing postherpetic neuralgia 1

4. Screening for varicella history:

   • No need to screen for history of varicella or conduct laboratory testing before vaccination 1
   • Varicella seroprevalence is high in adults (88-91% have antibodies) 1

5. Co-administration with other vaccines:

   • Can be safely administered with other vaccines, but may increase risk of side effects 1
   • May decrease adherence to influenza vaccination in the following year 1