Shingles Vaccine Recommendations
Shingrix (recombinant zoster vaccine) is strongly recommended as the preferred vaccine for prevention of herpes zoster in adults aged 50 years and older, including those who have previously received Zostavax or experienced herpes zoster. 1
General Recommendations
Shingrix is recommended for:
Zostavax (live zoster vaccine) may be considered only when Shingrix is contraindicated, unavailable, or inaccessible 2
Vaccine Efficacy and Effectiveness
Shingrix demonstrates superior efficacy compared to Zostavax across all age groups:
| Vaccine | Age Group | Efficacy/Effectiveness |
|---|---|---|
| Shingrix (2 doses) | 50+ years | 97.2% efficacy [1] |
| Shingrix (2 doses) | 70+ years | 91.3% efficacy [1] |
| Shingrix (2 doses) | Real-world | 70.1% effectiveness [4] |
| Shingrix (1 dose) | Real-world | 56.9% effectiveness [4] |
| Zostavax | 50-59 years | 70% efficacy [1] |
| Zostavax | 60-69 years | 64% efficacy [1] |
| Zostavax | 70-79 years | 41% efficacy [1] |
| Zostavax | 80+ years | 18% efficacy [1] |
The effectiveness of Shingrix against postherpetic neuralgia (PHN) is 76.0% in real-world settings 4, making it highly effective at preventing this debilitating complication.
Dosing Schedule
- Standard schedule: Two doses of Shingrix administered 2-6 months apart 1
- For immunocompromised adults: A shortened interval of 1-2 months between doses is recommended 1
- Real-world data shows that second doses administered beyond the recommended 6 months still provide effective protection 4
Special Populations
Immunocompromised Patients
- Shingrix is safe for immunocompromised patients as it is a non-live recombinant subunit vaccine 1, 3
- Zostavax (live vaccine) is contraindicated in immunocompromised patients due to risk of serious infection 1
Patients with Prior Zostavax Vaccination
- Shingrix should be administered to those previously vaccinated with Zostavax 1, 2
- Consider a minimum interval of 8 weeks after Zostavax before initiating Shingrix 1
- Re-immunization with two doses of Shingrix may be considered one year after Zostavax 2
Patients with History of Herpes Zoster
- Shingrix should be offered to individuals with a previous episode of herpes zoster 1, 2
- Consider vaccination with Shingrix at least one year after the herpes zoster episode 2
Cancer Patients
- For patients who have completed chemotherapy: Initiate Shingrix 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: Begin Shingrix 3-12 months post-transplant 1
Practical Considerations
Vaccine Completion Rates
Real-world data shows that approximately 70% of individuals complete the two-dose Shingrix series within 6 months, and 80% complete it within 12 months 5. This indicates good adherence to the recommended schedule.
Side Effects
- Shingrix has a higher incidence of injection site reactions and systemic symptoms compared to placebo 1
- Most reactions are transient and mild to moderate in severity 1, 3
- The higher reactogenicity should be discussed with patients but should not deter vaccination given the substantial benefits
Co-administration with Other Vaccines
- Co-administration with other vaccines (e.g., influenza) is safe but may increase the risk of side effects 1
- This may decrease adherence to influenza vaccination in the following year 1
Common Pitfalls and Caveats
Incomplete vaccination series: A single dose of Shingrix provides only 56.9% effectiveness compared to 70.1% with two doses 4. Emphasize the importance of completing the series.
Delaying vaccination in eligible individuals: The risk of herpes zoster increases with age, and vaccine effectiveness remains high even in older adults. Don't delay vaccination in eligible individuals.
Using Zostavax in immunocompromised patients: Zostavax is contraindicated in immunocompromised patients due to the risk of serious infection 1. Always use Shingrix in this population.
Failing to revaccinate patients who received Zostavax: Patients previously vaccinated with Zostavax should still receive the complete Shingrix series for optimal protection 1, 2.
Temporary contraindications: Active, severe acute infection with high fever may require temporary deferral of vaccination until fever resolves 1. Bone infection is not a contraindication for Shingrix 1.