Shingrix (Recombinant Zoster Vaccine) Administration While on Glucocorticoids
Yes, you can safely receive your second dose of Shingrix while taking a glucocorticoid dose pack. The recombinant zoster vaccine (Shingrix) is not a live vaccine and is considered safe for patients on glucocorticoid therapy 1, 2.
Safety of Shingrix with Glucocorticoids
- Shingrix is a non-live recombinant vaccine, making it safe for patients on immunosuppressive medications including glucocorticoids 2
- Studies have shown that low-dose glucocorticoids do not adversely impact vaccine response, with similar response rates between patients taking corticosteroids versus those not taking corticosteroids 3
- Concomitant low-dose glucocorticoids (prednisone equivalent <10 mg/day) did not adversely impact vaccine response in studies examining immune responses 3
Efficacy Considerations
- Shingrix demonstrates high efficacy in preventing herpes zoster (shingles) with vaccine efficacy of 97.2% in adults aged 50 years and older 1
- The vaccine maintains its effectiveness even in patients on immunosuppressive therapy, though the immune response may be somewhat reduced compared to healthy individuals 3
- Studies of patients with autoimmune conditions taking glucocorticoids showed only mild disease flares (4-17%) after Shingrix vaccination, with no serious adverse events 3
Administration Guidelines
- Shingrix is administered as a two-dose series with the second dose given 2 to 6 months after the first dose 1
- For immunocompetent adults, the standard schedule should be followed with the second dose 2-6 months after the first 1
- For immunocompromised adults, a shorter schedule with the second dose given 1-2 months after the first dose may be considered 1
Important Clinical Considerations
- Unlike the older live zoster vaccine (Zostavax), Shingrix does not carry a risk of vaccine-induced infection, even in immunocompromised patients 2, 4
- Shingrix is the preferred vaccine for patients on immunosuppressive therapy due to its safety profile and higher efficacy 4, 5
- Common side effects include injection-site reactions (pain, redness, swelling), fatigue, and myalgia, which are generally mild to moderate and transient 1, 4
Potential Concerns
- There has been theoretical concern that the adjuvant in Shingrix may cause a flare of underlying inflammatory disease, but large database studies found no statistically significant increase in flares following vaccination 3
- A study using two claims databases from the USA found no statistically significant increase in flares for any autoimmune disease following either dose of recombinant vaccine 3
Conclusion
- The recombinant zoster vaccine (Shingrix) can be safely administered to patients taking glucocorticoids 3, 2
- Completing the two-dose regimen is important for optimal protection, with real-world effectiveness of 70.1% for two doses compared to 56.9% for a single dose 6
- No additional booster doses beyond the initial two-dose series are currently recommended 1