Shingrix Dosing Schedule
Shingrix (recombinant zoster vaccine) should be administered as a two-dose series with the second dose given 2 to 6 months after the first dose for adults aged 50 years and older. 1, 2
Standard Dosing Schedule
- For immunocompetent adults aged 50 years and older, Shingrix is administered as a two-dose series with the second dose given 2 to 6 months after the first dose 3, 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 administered intramuscularly (IM) 1
- If the second dose is administered outside the recommended 2-6 month window, there is no need to restart the series 4
Special Population Considerations
- For immunocompromised adults aged ≥18 years, a shorter schedule is recommended with the second dose given 1-2 months after the first dose 3, 1
- For patients who previously received Zostavax (live-attenuated zoster vaccine), Shingrix should be administered at least 2 months after the Zostavax dose 3, 1
- For patients who have recently experienced shingles, vaccination should be administered once acute symptoms have resolved, typically waiting at least 2 months after the episode 5
Efficacy and Protection
- Shingrix demonstrates high efficacy in preventing herpes zoster with vaccine efficacy of 97.2% in adults aged 50 years and older in clinical trials 1
- Real-world effectiveness studies show approximately 70.1% effectiveness for the two-dose series and 56.9% for a single dose 4
- Protection persists for at least 8 years with minimal waning, maintaining efficacy above 83.3% during this period 1
- Two-dose vaccine effectiveness against postherpetic neuralgia is approximately 76.0% 4
Completion Rates and Adherence
- Real-world data shows that approximately 70% of patients complete the two-dose series within six months of the initial dose, and 80% complete it within 12 months 6
- Among patients with inflammatory arthritis, only 73.2% of those who received the first dose completed the second dose, with 83.8% of those receiving it within the recommended 2-6 month timeframe 7
Safety Considerations
- Common side effects include injection-site reactions (pain, redness, swelling), pyrexia (fever), myalgia, and fatigue 2, 8
- Most adverse reactions are transient and mild to moderate in severity 9
- Grade 3 reactions (interfering with normal activity) occur in approximately 17% of recipients 8
- Serious adverse events are rare and occur at similar rates to placebo in clinical trials 8
Important Clinical Considerations
- No additional booster doses beyond the initial two-dose series are currently recommended 1
- For patients with delayed second dose (beyond 6 months), effectiveness is not significantly impaired 4
- Shingrix is preferred over the older live-attenuated Zostavax vaccine due to higher efficacy and stronger immune response 3, 1
- Unlike the live Zostavax vaccine, Shingrix can be safely administered to most immunocompromised patients 3, 1