At what age should you get the shingles (herpes zoster) vaccine?

Shingles Vaccine Recommendations

The shingles vaccine (Shingrix) is strongly recommended for all adults aged 50 years and older to prevent herpes zoster and its complications. 1

Age-Based Recommendations

• Primary recommendation: Adults ≥50 years should receive the Shingrix vaccine, as supported by the American College of Physicians, American Academy of Family Physicians, and CDC 1
• Shingrix has demonstrated superior efficacy compared to the older Zostavax vaccine:
  • 97.2% efficacy in adults ≥50 years
  • 91.3% efficacy in adults ≥70 years 1
• While the FDA approved Zostavax for adults 50-59 years in 2011, the ACIP maintained its recommendation for routine vaccination only for those ≥60 years due to supply concerns and limited data on long-term protection 2

Vaccine Administration

• Shingrix requires two doses for optimal protection
  • Standard interval: 2-6 months between doses
  • Single dose effectiveness: 56.9%
  • Two-dose effectiveness: 70.1% 1
• If a patient previously received Zostavax, they should still receive the complete Shingrix series with a minimum interval of 8 weeks after Zostavax 1

Special Populations

Immunocompromised Patients

• Shingrix (recombinant subunit vaccine) is safe for immunocompromised patients as it cannot cause infection 1
• Zostavax (live vaccine) is contraindicated in immunosuppressed patients 1
• For immunocompromised adults, a shortened dosing interval of 1-2 months between Shingrix doses is recommended 1

Post-Treatment Timing

• After chemotherapy: Initiate Shingrix 3 months after completion 1
• After anti-CD20 antibody therapy: Consider delaying vaccination until at least 6 months after the last dose 1
• After autologous hematopoietic stem cell transplant: Begin vaccination 3-12 months post-transplant 1

Common Pitfalls and Considerations

1. Vaccine confusion: Pneumococcal vaccines (e.g., Prevnar) do not protect against shingles; ensure patients understand the difference 1

2. Incomplete protection: Many patients fail to receive the second dose of Shingrix, resulting in suboptimal protection (56.9% vs. 70.1% effectiveness) 1

3. Side effect expectations: Shingrix has a higher incidence of injection site reactions and systemic symptoms compared to placebo, but these are typically transient and mild to moderate in severity 1

4. Co-administration considerations: While safe to administer with other vaccines like influenza, co-administration may increase side effects and decrease adherence to future vaccinations 1

5. Temporary deferrals: Active, severe acute infection with high fever may require temporary deferral until fever resolves 1

The need for a booster dose beyond the initial two-dose series is still unknown, but studies have shown that a booster dose administered to adults aged ≥70 years who received their first dose ≥10 years previously was immunogenic 3. Improved uptake of shingles vaccination is needed to better protect the population 4.