What is the recommended vaccination schedule for SHINGRIX (zoster vaccine) + AS01B (adjuvant system) in adults?

SHINGRIX Vaccination Schedule for Adults

The recommended vaccination schedule for SHINGRIX (recombinant zoster vaccine with AS01B adjuvant) is two doses administered intramuscularly 2 to 6 months apart for adults aged 50 years and older. 1

Recommended Schedule and Administration

• SHINGRIX is administered as a two-dose series with the second dose given 2 to 6 months after the first dose 1
• The vaccine is administered intramuscularly (IM) 1
• The recommended age for vaccination is 50 years and older 1
• The vaccine is also recommended for adults aged ≥18 years who are or will be immunocompromised due to disease or therapy 2

Efficacy and Protection

• SHINGRIX demonstrates high efficacy in preventing herpes zoster (shingles) with vaccine efficacy of:
  • 97.2% in adults aged 50 years and older in the ZOE-50 trial 1
  • 89.8% in adults aged 70 years and older in the ZOE-70 trial 3
  • 91.3% in pooled analyses of adults 70 years and older 3
• Protection against postherpetic neuralgia (PHN) is 88.8% in adults 70 years and older 3
• Vaccine efficacy remains well-preserved across all age groups, including those 80 years and older (89.1%) 3
• Protection persists for at least 8 years with minimal waning, maintaining efficacy above 83.3% during this period 1

Advantages Over Previous Zoster Vaccine

• SHINGRIX (RZV) offers significantly higher efficacy compared to the older live-attenuated Zostavax (ZVL) vaccine 1, 4
• Unlike Zostavax, SHINGRIX is not contraindicated in immunocompromised individuals as it is a non-live recombinant vaccine 4, 2
• SHINGRIX maintains high efficacy across all age groups, while Zostavax efficacy decreased significantly with age (70% in ages 50-59 vs. 18% in those ≥80 years) 1

Special Populations

• For immunocompromised adults, SHINGRIX is now recommended for those aged ≥19 years who are or will be immunodeficient or immunosuppressed due to disease or therapy 2
• For patients with autoimmune inflammatory rheumatic diseases, SHINGRIX is preferred over the live-attenuated vaccine due to safety considerations 1
• Real-world effectiveness studies show that SHINGRIX maintains effectiveness in adults with autoimmune conditions and those with immunosuppressive conditions 5

Common Side Effects

• Injection-site reactions (pain, redness, swelling) are common, with 9.5% experiencing grade 3 injection site reactions compared to 0.4% with placebo 1
• Common systemic reactions include myalgia, fatigue, and headache 6
• Systemic symptoms were reported in 11.4% of vaccine recipients versus 2.4% in placebo recipients 1
• Despite higher reactogenicity compared to placebo, most adverse reactions are transient and mild to moderate in severity 4

Important Considerations

• If the second dose is delayed beyond the recommended 6-month interval, it should still be administered as soon as possible; real-world data shows that delayed second doses maintain effectiveness 5
• The complete two-dose series is important for optimal protection, as single-dose effectiveness (56.9%) is lower than two-dose effectiveness (70.1%) in real-world studies 5
• No serious safety concerns have been identified in large clinical trials, with similar rates of serious adverse events between vaccine and placebo groups 1, 3

Practical Implementation

• SHINGRIX should be stored refrigerated between 2°C to 8°C (36°F to 46°F) 6
• The vaccine requires reconstitution before administration 6
• For patients transitioning from Zostavax to SHINGRIX, there is no minimum interval required between the two different vaccines 1