Should Shingrix Be Repeated in a 63-Year-Old Who Received Shingles Vaccine a Decade Ago?
Yes, this patient should receive the full 2-dose Shingrix series now, regardless of their previous vaccination approximately 10 years ago. 1, 2
Primary Recommendation
The CDC and American College of Physicians explicitly recommend administering the 2-dose Shingrix series to all adults aged 50 years and older, regardless of previous herpes zoster vaccination history, including those who previously received Zostavax. 1, 2
If the patient received Zostavax (the live-attenuated vaccine) a decade ago, Shingrix should be administered at least 2 months after the last Zostavax dose—though given the 10-year interval, this timing requirement is already satisfied. 1, 2
Why Revaccination Is Critical
Waning Efficacy of Previous Vaccine
Zostavax efficacy drops dramatically over time: by year 10, vaccine efficacy against herpes zoster falls to only 14.1%, providing essentially no meaningful protection. 2
Even if efficacy was initially 70% in younger recipients (ages 50-59), it decreased to only 18% in those ≥80 years, demonstrating both age-related and time-related decline. 2
Superior Protection with Shingrix
Shingrix demonstrates 97.2% vaccine efficacy in adults aged 50 years and older, with protection persisting for at least 8 years while maintaining efficacy above 83.3%. 2, 3
Real-world effectiveness studies confirm 70.1% effectiveness for the 2-dose series in Medicare beneficiaries aged >65 years, which remains substantially higher than aged Zostavax protection. 4
The 2-dose vaccine effectiveness against postherpetic neuralgia specifically is 76.0%, addressing the most debilitating complication of shingles. 4
Dosing Schedule
Administer the first dose immediately, followed by the second dose 2-6 months later (minimum interval: 4 weeks). 1, 2
If the second dose is administered beyond 6 months, effectiveness is not impaired—real-world data shows second doses given at ≥180 days maintain full effectiveness. 4
Both doses must be completed for optimal protection; single-dose effectiveness is only 56.9% compared to 70.1% for the complete series. 4
Important Clinical Considerations
No Contraindications Based on Age or Prior Vaccination
At age 63, this patient falls squarely within the recommended age range (≥50 years) and will benefit from the high efficacy demonstrated across all age groups. 1, 2
The 2-dose effectiveness was not significantly lower for beneficiaries aged >80 years, confirming benefit across the entire older adult spectrum. 4
Common Pitfalls to Avoid
Do not assume prior vaccination provides adequate protection—this is the most common error, as clinicians may incorrectly believe previous Zostavax offers lasting immunity. 2, 5
Do not delay vaccination—there is no maximum interval after previous vaccination, and waiting serves no purpose while leaving the patient vulnerable to herpes zoster. 1, 2
Do not use Zostavax for revaccination—only Shingrix is recommended for this scenario, as it is the preferred vaccine with superior efficacy. 1, 5
Patient Counseling on Side Effects
Injection-site reactions (pain, redness, swelling) occur commonly, with 9.5% experiencing grade 3 reactions compared to 0.4% with placebo. 2
Systemic symptoms occur in 11.4% of vaccine recipients versus 2.4% in placebo recipients, but no serious safety concerns have been identified in large clinical trials. 2
Evidence Strength
The recommendation to revaccinate with Shingrix is supported by:
Strong guideline recommendations (Grade A evidence) from the National Advisory Committee on Immunization stating that RZV should be offered to populations/individuals >50 years of age who have previously been vaccinated with LZV. 5
Multiple high-quality guidelines from the CDC, American College of Physicians, and Annals of Internal Medicine all converge on this recommendation. 1, 2
Real-world effectiveness data from large Medicare cohorts (2021) confirming clinical trial efficacy translates to meaningful protection in routine practice. 4