What are the guidelines for administering the Shingrix (zoster vaccine) vaccine?

Shingrix Vaccination Guidelines

Shingrix (recombinant zoster vaccine, RZV) is recommended as a two-dose series for all adults aged 50 years and older, with the second dose administered 2-6 months after the first dose. 1, 2

Standard Recommendations

• Shingrix is administered as a two-dose intramuscular (IM) series with doses given 2-6 months apart for immunocompetent adults aged ≥50 years 1, 2
• The minimum interval between doses is 4 weeks; if administered earlier, the dose should be repeated 1
• Shingrix is preferred over the older live-attenuated Zostavax (ZVL) vaccine due to significantly higher efficacy 1, 3
• Shingrix demonstrates high efficacy (97.2%) in preventing herpes zoster in adults aged ≥50 years with protection persisting for at least 8 years 1, 3
• Prior vaccination with Zostavax is not a contraindication; Shingrix can be administered at least 2 months after Zostavax 1
• Screening for prior varicella infection history or serologic testing is not necessary before administering Shingrix to immunocompetent adults aged ≥50 years 4

Special Populations

• For immunocompromised adults aged ≥18 years, Shingrix is recommended with a modified schedule: two doses administered 1-2 months apart 2, 5
• Shingrix is the first herpes zoster vaccine approved for use in immunocompromised persons 5
• Shingrix can be safely administered to most immunocompromised patients, unlike the live Zostavax vaccine which is contraindicated in this population 1, 5
• For patients with autoimmune inflammatory rheumatic diseases, Shingrix is preferred over the live-attenuated vaccine due to safety considerations 4, 1
• For individuals who are known to be VZV-seronegative, consider immunization with 2 doses of varicella vaccine before Shingrix administration 4

Administration Guidelines

• Shingrix is supplied in 2 vials that must be combined prior to administration:
  • The lyophilized varicella zoster virus glycoprotein E (gE) antigen component (powder)
  • The accompanying AS01B adjuvant suspension component (liquid) 2
• After reconstitution, administer immediately or store refrigerated between 2° and 8°C (36° and 46°F) and use within 6 hours 2
• The preferred site for intramuscular injection is the deltoid region of the upper arm 2

Common Side Effects and Safety

• Injection-site reactions (pain, redness, swelling) are common, with 9.5% experiencing grade 3 injection site reactions compared to 0.4% with placebo 1, 4
• Systemic symptoms (myalgia, fatigue) were reported in 11.4% of vaccine recipients versus 2.4% in placebo recipients 1, 4
• Most solicited adverse reactions are transient and mild to moderate in severity 3
• No serious safety concerns have been identified in large clinical trials, with similar rates of serious adverse events between vaccine and placebo groups 1

Real-World Effectiveness

• Real-world effectiveness of Shingrix has been demonstrated to be 70.1% for two doses and 56.9% for one dose in adults aged >65 years 6
• Two-dose vaccine effectiveness against postherpetic neuralgia was 76.0% 6
• Effectiveness was not significantly lower for adults aged >80 years or for second doses received at ≥180 days 6
• The vaccine was also effective among individuals with autoimmune and immunosuppressive conditions 6

Clinical Considerations

• Shingrix is not indicated to treat acute herpes zoster, to prevent persons with acute zoster from developing postherpetic neuralgia, or to treat ongoing postherpetic neuralgia 7
• For patients transitioning from Zostavax to Shingrix, there is no minimum interval required between the two different vaccines 1
• The efficacy of Shingrix is maintained across all age groups, while Zostavax efficacy decreased significantly with age 1, 7