Shingrix Vaccination Schedule After Interruption
When the Shingrix (recombinant zoster vaccine) series is interrupted, the series does not need to be restarted regardless of the time that has elapsed between doses.
Recommended Approach
The Shingrix vaccine is administered as a two-dose series with specific timing recommendations:
- Standard schedule: Two doses given 2-6 months apart
- For immunocompromised adults: A shortened interval of 1-2 months between doses is recommended 1
Key Points for Interrupted Schedules
No restart needed: If the second dose is delayed beyond the recommended interval, simply administer the second dose as soon as possible - do not restart the series 2
No maximum interval: There is no maximum time limit between the first and second dose - the series can be completed regardless of how much time has passed since the first dose
Minimum interval: Maintain the minimum interval of 4 weeks (28 days) between doses 2
Effectiveness considerations: While completing the series as scheduled is ideal, a delayed second dose is still effective and better than not receiving it at all
Special Populations
Immunocompromised Patients
- For patients who are immunocompromised, completing the series is particularly important
- The recombinant zoster vaccine (Shingrix) is safe for immunocompromised patients, unlike the live zoster vaccine (Zostavax) which is contraindicated 1, 2
- Consider the shortened 1-2 month interval between doses for immunocompromised adults 1
Post-Chemotherapy Patients
- For patients who have completed chemotherapy, vaccination can be initiated 3 months after completion of chemotherapy 1
- For patients who received anti-CD20 antibody therapy, consider delaying vaccination until at least 6 months after the last dose 1
Post-Transplant Patients
- For patients who underwent autologous hematopoietic stem cell transplant, vaccination can begin 3-12 months post-transplant 1
Vaccine Efficacy
- Complete two-dose series efficacy: 97.2% in adults ≥50 years and 91.3% in adults ≥70 years 1
- Single dose efficacy: Only 56.9% (compared to 70.1% after two doses) 1
- This highlights the importance of completing the series even if delayed
Common Pitfalls to Avoid
Restarting the series unnecessarily: This wastes resources and exposes patients to additional vaccine doses without benefit
Confusing with other vaccine schedules: Unlike some vaccines, Shingrix does not require restarting regardless of time elapsed between doses
Administering too soon: Ensure the minimum interval of 4 weeks between doses is maintained
Missing opportunities: Use any patient encounter as an opportunity to complete the series if the patient is due for their second dose
Confusing with Zostavax: Remember that Shingrix (recombinant) and Zostavax (live) have different safety profiles and recommendations, particularly for immunocompromised patients 1
Bottom Line
When a Shingrix vaccination series is interrupted, simply administer the second dose as soon as possible without restarting the series, regardless of how much time has elapsed since the first dose. This approach maximizes protection while minimizing unnecessary additional doses.