Shingles and Pneumococcal Vaccine Indications by Age
For adults aged 50 years and older, the shingles vaccine (preferably Shingrix) is recommended, while pneumococcal vaccine (PCV20) is recommended for adults aged 60 years and older or adults aged 18+ with risk factors.
Shingles (Herpes Zoster) Vaccine Recommendations
Age Indications
- Shingrix (recombinant zoster vaccine, RZV) is indicated for prevention of herpes zoster in adults aged 50 years and older 1
- Shingrix is also indicated for adults aged 18 years and older who are or will be at increased risk of herpes zoster due to immunodeficiency or immunosuppression 1
- RZV is recommended as the preferred vaccine for immunocompetent adults aged 50 years and older due to its higher efficacy and longer protection compared to the older Zostavax (ZVL) 2, 3
Dosing Schedule
- Shingrix is administered as a two-dose series with the second dose given 2 to 6 months after the first dose 3, 1
- For immunocompromised adults who would benefit from a shorter vaccination schedule, the second dose can be given 1 to 2 months after the first dose 3, 1
- Complete vaccination with both doses is strongly recommended for optimal protection, as it induces stronger immunogenicity and confers better vaccine effectiveness 2, 4
Efficacy
- Shingrix demonstrates high efficacy in preventing herpes zoster with vaccine efficacy of 97.2% in adults aged 50 years and older 3
- Protection persists for at least 8 years with minimal waning, maintaining efficacy above 83.3% during this period 2
- In real-world settings, two-dose vaccine effectiveness was found to be 70.1%, while single-dose effectiveness was 56.9%, highlighting the importance of completing the series 5
Special Considerations
- For patients who have previously had shingles, vaccination is still recommended once acute symptoms have resolved, typically waiting at least 2 months after the episode 6
- For patients who previously received Zostavax, Shingrix should be administered at least 2 months after ZVL 3
- Adults who don't have a history of varicella or have an unclear history can still receive the shingles vaccine, with RZV being preferred 2
Pneumococcal Vaccine Recommendations
Age Indications
- In Germany, the 20-valent conjugate vaccine (PCV20) is recommended for people over 60 years of age 7
- PCV20 is also recommended for individuals over 18 years of age with risk factors 7
- PCV20 has replaced the 23-valent polysaccharide vaccine (PPV23) previously recommended for those over 60 years of age 7
Risk Groups
- Patients with chronic respiratory diseases such as COPD or asthma are at higher risk for pneumococcal infections and should be prioritized for vaccination 7
Clinical Pitfalls to Avoid
- Failing to complete the two-dose series of Shingrix - approximately 70% complete within six months and 80% within 12 months, but this means 20% of patients miss the second dose 4
- Using live zoster vaccine (Zostavax) in immunocompromised patients, which is contraindicated 6
- Waiting too long after a shingles episode to vaccinate, as patients remain at risk for recurrence (10.3% cumulative recurrence risk at 10 years) 6
- Confusing the waiting period after shingles (minimum 2 months) with the interval between vaccine doses 6
- Missing opportunities to vaccinate older adults who have had shingles, as they remain at risk for recurrence 6