What is the recommended vaccine protocol for herpes zoster (shingles) prevention in adults?

Recommended Vaccine Protocol for Shingles Prevention in Adults

For adults aged 50 years and older, the recombinant zoster vaccine (Shingrix) is strongly recommended as a two-dose series for prevention of herpes zoster (shingles), with doses administered 2-6 months apart. 1, 2

Vaccine Options and Recommendations

Recombinant Zoster Vaccine (Shingrix)

• FDA approved for adults aged 50 years and older 2
• Also approved for adults aged 18 years and older who are or will be at increased risk of herpes zoster due to immunodeficiency or immunosuppression 2
• Standard dosing schedule: Two doses (0.5 mL each) administered intramuscularly
  • First dose at Month 0
  • Second dose 2-6 months later 2
• Modified schedule for immunocompromised individuals:
  • First dose at Month 0
  • Second dose 1-2 months later 1, 2

Vaccine Effectiveness

• Shingrix demonstrates superior effectiveness compared to the older live vaccine (Zostavax):
  • 97.2% efficacy in adults ≥50 years
  • 91.3% efficacy in adults ≥70 years 1
  • 70.1% real-world effectiveness for the complete two-dose series 3
  • 56.9% effectiveness with a single dose 3

Special Populations

Immunocompromised Patients

• Shingrix is safe for immunocompromised patients as it is a non-live vaccine 1
• For patients who have completed chemotherapy, vaccination can begin 3 months after completion 1
• For patients who received anti-CD20 antibody therapy, consider delaying vaccination until at least 6 months after the last dose 1
• For autologous hematopoietic stem cell transplant recipients, vaccination can begin 3-12 months post-transplant 1

Previously Vaccinated with Zostavax

• Patients who previously received Zostavax should still receive the complete Shingrix series
• Minimum interval of 8 weeks after Zostavax is recommended 1

Series Completion and Adherence

• Real-world data shows approximately 70% of patients complete the two-dose series within 6 months and 80% within 12 months 4
• Second doses administered beyond the recommended 6-month window still provide effective protection 3

Common Side Effects

• Local reactions: Pain (78%), redness (38%), and swelling (26%)
• Systemic reactions: Myalgia (45%), fatigue (45%), headache (38%), shivering (27%), fever (21%), and gastrointestinal symptoms (17%) 2
• Most reactions are transient and mild to moderate in severity 1, 2

Important Considerations and Pitfalls

Contraindications

• History of severe allergic reaction to any component of the vaccine or after a previous dose of Shingrix 2

Precautions

• In post-marketing surveillance, an increased risk of Guillain-Barré syndrome was observed during the 42 days following vaccination 2
• Syncope (fainting) can occur; procedures should be in place to avoid falling injury 2
• Active, severe acute infection with high fever may require temporary deferral until fever resolves 1

Common Pitfalls to Avoid

1. Incomplete vaccination: Ensure patients understand the importance of receiving both doses for optimal protection
2. Improper timing in immunocompromised patients: Follow the shortened interval (1-2 months) for these patients
3. Missing vaccination opportunities: Adults aged 50+ should be assessed for vaccination eligibility at routine visits

The recombinant zoster vaccine represents a significant advancement in shingles prevention with high efficacy across all age groups, including older adults who are at highest risk for herpes zoster and its complications.