Can Shingrix (zoster vaccine) be administered on the same day as COVID-19 and pneumococcal vaccines?

Shingrix Can Be Safely Co-administered with COVID-19 and Pneumococcal Vaccines

Yes, Shingrix (recombinant zoster vaccine, RZV) can be safely and effectively administered on the same day as COVID-19 and pneumococcal vaccines. 1, 2

General Principles for Vaccine Co-administration

• Inactivated vaccines like Shingrix (RZV) may be administered concomitantly with, or at any time before or after, other inactivated vaccines or live vaccines protecting against different diseases. 1
• Simultaneous administration of multiple vaccines is an effective approach to increase immunization rates and reduce missed vaccination opportunities. 1, 2
• When administering multiple vaccines simultaneously, they should be given at separate anatomic sites. 2

Specific Evidence for Shingrix Co-administration

With Pneumococcal Vaccines

• RZV can be given concomitantly with pneumococcal vaccines (both pneumococcal conjugate vaccine [PCV] and 23-valent pneumococcal polysaccharide vaccine [PPSV23]). 1
• Clinical trials have demonstrated that co-administration of RZV with PCV13 results in non-inferior immune responses compared to sequential administration, with an acceptable safety profile. 3
• Although immune responses are adequate when vaccines are given on the same day, adverse reactions may be more frequently reported when PPSV23 is co-administered with RZV. 1, 4

With COVID-19 Vaccines

• COVID-19 vaccines can be safely co-administered with other vaccines, including RZV, at different anatomical sites. 2
• The Centers for Disease Control and Prevention recommends that COVID-19 vaccines can be administered without regard to timing of other vaccines. 1, 2
• When administering vaccines with increased reactogenicity (like RZV and certain COVID-19 vaccines), they should be injected into different limbs to minimize local reactions. 2

Safety and Efficacy Considerations

• A review of five randomized clinical trials showed that vaccine response rates to RZV were similar for co-administration (95.8-99.1%) and sequential administration (95.1-99.1%). 4
• Immune responses to both RZV and co-administered vaccines were generally non-inferior when given simultaneously compared to sequential administration. 4, 3
• The overall incidence of adverse events was similar after co-administration or sequential administration, though some systemic reactions like myalgia, shivering, and fever may be more common with certain combinations. 4

Clinical Approach

• For patients due for multiple vaccines, administer all eligible vaccines during the same visit at different anatomic sites. 1, 2
• If possible, administer vaccines when patients are not on corticosteroids or at the lowest tolerable dose, as concomitant corticosteroids may diminish immune responses. 1
• Do not delay appropriate vaccination to administer vaccines separately when they can be given simultaneously. 2

Common Pitfalls to Avoid

• Do not mix different vaccines in the same syringe unless specifically approved for mixing. 2
• Do not confuse Shingrix (RZV, which is an inactivated vaccine) with Zostavax (ZVL, which is a live vaccine). The timing restrictions that apply to multiple live vaccines do not apply to Shingrix. 1
• Do not unnecessarily delay vaccination, as this may lead to missed opportunities and leave patients unprotected. 2

By following these evidence-based guidelines, healthcare providers can efficiently administer Shingrix alongside COVID-19 and pneumococcal vaccines, improving vaccination coverage and protecting patients against multiple preventable diseases.