Shingrix Vaccination Schedule
Shingrix is 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
Standard Dosing Schedule
- The recommended schedule is 2 doses administered intramuscularly, with the second dose given 2-6 months after the first dose. 1, 2
- The minimum interval between doses is 4 weeks; if administered earlier than this minimum interval, the dose should be repeated. 1
- Second doses administered beyond the recommended 6-month window (even at ≥180 days) do not impair vaccine effectiveness, so patients who miss the 6-month deadline should still complete the series. 3
Age-Based Recommendations
- Vaccination is recommended for all adults aged 50 years and older, regardless of whether they report a prior episode of herpes zoster. 4, 1
- The vaccine should be given even if patients previously received the older Zostavax vaccine, with no minimum interval required between switching from Zostavax to Shingrix. 1
Special Populations: Immunocompromised Adults
- For immunocompromised adults aged ≥18 years, a shorter schedule with the second dose given 1-2 months after the first dose is recommended. 1
- This includes patients with hematologic malignancies, solid cancers, or those on immunosuppressive therapy. 1
- For autologous hematopoietic stem cell transplant recipients specifically, Shingrix should be given 50-70 days post-transplantation. 1
Vaccination After a Shingles Episode
- Patients who have had shingles should still receive the vaccine, as prior infection does not provide reliable protection against recurrence (10.3% cumulative recurrence risk at 10 years). 1
- Wait at least 2 months after the acute shingles episode has resolved before administering the first dose. 1
- The standard 2-dose schedule (2-6 months apart) then applies. 1
Important Clinical Considerations
- No booster doses beyond the initial two-dose series are currently recommended, as protection persists for at least 8 years with minimal waning (maintaining efficacy above 83.3%). 1
- Real-world data shows that 70% of patients complete the two-dose series within 6 months and 80% within 12 months of the initial dose. 5
- The vaccine demonstrates 97.2% efficacy in preventing herpes zoster in adults aged 50 years and older, which is vastly superior to the older Zostavax vaccine. 1
Common Pitfalls to Avoid
- Do not delay vaccination waiting for the "perfect" 2-6 month window—if patients present late, complete the series anyway as delayed second doses remain effective. 3
- Do not confuse Shingrix with the older live-attenuated Zostavax, which required only a single dose but had significantly lower efficacy (51.3% vs 97.2%) and is no longer preferred. 4, 6
- Do not skip vaccination in patients with prior shingles—they remain at risk for recurrence and benefit from vaccination. 1