Shingrix (Herpes Zoster Vaccine) Schedule and Recommendations for Missed Second Dose
The recommended schedule for Shingrix is a 2-dose series with doses administered 2-6 months apart. If the second dose is missed, it should be administered as soon as possible, with no need to restart the series regardless of the time elapsed since the first dose. 1, 2
Standard Dosing Schedule
- Shingrix (recombinant zoster vaccine, RZV) is administered as a 2-dose series with the second dose given 2-6 months after the first dose 1
- The minimum interval between doses is 4 weeks; if administered earlier than this minimum interval, the dose should be repeated 1
- The vaccine is recommended for adults aged 50 years and older regardless of previous herpes zoster history or prior vaccination with Zostavax (ZVL) 1, 2
Management of Missed Second Dose
- If the second dose is delayed beyond the recommended 6-month window, administer it as soon as possible without restarting the series 2, 3
- There is no maximum interval between doses; the series does not need to be restarted regardless of how much time has passed since the first dose 3
- Real-world data shows that second doses administered beyond the recommended 6 months did not significantly impair vaccine effectiveness 4
Vaccine Effectiveness by Dosing
- Two doses of Shingrix provide significantly better protection than a single dose 4
- Real-world effectiveness studies show:
- Complete the full two-dose series for optimal protection against herpes zoster and postherpetic neuralgia 4
Special Populations
- For immunocompromised adults aged ≥18 years, a shorter schedule is allowed with the second dose given 1-2 months after the first dose 1
- In autologous hematopoietic stem cell transplant recipients, Shingrix demonstrated 68.2% efficacy against herpes zoster when administered as a 2-dose series 3
- For patients who previously received Zostavax (ZVL), Shingrix should be administered at least 2 months after ZVL 1
Completion Rates and Barriers
- Real-world data shows approximately 70% of individuals complete the two-dose series within 6 months of the initial dose, and 80% within 12 months 5
- Concerns about vaccine tolerability are a significant barrier to both initiation and completion of the vaccine series 6
- Individuals concerned about side effects are 1.83 times more likely to receive only one dose than to complete the full series 6
Important Considerations
- If a patient has recently experienced herpes zoster (shingles), vaccination should be delayed until the acute stage has resolved and symptoms have abated, with a minimum waiting period of 2 months 7
- Shingrix is preferred over Zostavax due to higher efficacy across all age groups and stronger immune response 2, 8
- Shingrix can be safely administered to most immunocompromised patients, unlike the live Zostavax vaccine which is contraindicated in immunocompromised individuals 1
Remember that completing the full two-dose series is essential for optimal protection against herpes zoster and its complications, particularly postherpetic neuralgia, so patients should be encouraged to receive their second dose even if they've missed the recommended timeframe.