Shingrix Vaccination at Age 50
Yes, 50 years is the recommended age to begin Shingrix (recombinant zoster vaccine) vaccination for all immunocompetent adults. 1, 2
Standard Age Recommendation
- The FDA approved Shingrix for adults aged 50 years and older in October 2017, and this remains the standard indication for immunocompetent individuals 2, 3
- The Advisory Committee on Immunization Practices (ACIP) recommends vaccination starting at age 50, superseding older guidelines that recommended starting at age 60 for the previous live-attenuated vaccine 1
- The American Geriatrics Society, American College of Physicians, and ophthalmology guidelines all support age 50 as the appropriate starting point 4, 1
Clinical Rationale for Age 50
- The ZOE-50 pivotal trial demonstrated 97.2% vaccine efficacy against herpes zoster in adults aged 50 years and older 1, 5, 6
- Shingrix maintains high efficacy (>90%) across all age groups 50 and older, unlike the older Zostavax which showed declining efficacy with age (70% in ages 50-59 vs. only 18% in those ≥80 years) 1
- Protection persists for at least 8 years with minimal waning, maintaining efficacy above 83.3% during this period 1
Dosing Schedule at Age 50
- Administer as a two-dose series with the second dose given 2 to 6 months after the first dose 1, 2
- The minimum interval between doses is 4 weeks; if administered earlier, the dose should be repeated 1
- The vaccine is administered intramuscularly 1, 2
Exceptions: Vaccination Before Age 50
- Adults aged 18 years and older who are or will be immunocompromised due to known disease or therapy qualify for early vaccination 7, 2, 3
- Patients on chronic high-dose glucocorticoids (≥20 mg/day prednisone equivalent) qualify for vaccination before age 50 7
- For immunocompromised adults under 50, use a shortened schedule with the second dose given 1-2 months after the first dose 7
Important Clinical Considerations
- Shingrix is strongly preferred over the older Zostavax vaccine, which demonstrated poor long-term protection with efficacy declining to only 14.1% by year 10 1
- Prior herpes zoster infection is not a contraindication—vaccinate regardless of previous shingles history 1
- For patients who previously received Zostavax, administer Shingrix at least 2 months after the last Zostavax dose 1
Common Pitfalls to Avoid
- Do not delay vaccination beyond age 50 waiting for "higher risk" years—efficacy is excellent at age 50 and protection is durable 1, 6
- Do not use the live-attenuated Zostavax in any immunocompromised patient—only Shingrix is appropriate for this population 7, 6
- Do not confuse Shingrix with varicella (chickenpox) vaccine—Shingrix is not indicated for prevention of primary varicella infection 7, 2