Shingrix Dosing Schedule
Shingrix is administered as a two-dose series, with the second dose given 2 to 6 months after the first dose for immunocompetent adults aged ≥50 years. 1, 2, 3
Standard Dosing Regimen
- Each dose is 0.5 mL administered intramuscularly in the deltoid region of the upper arm. 1
- The FDA-approved schedule consists of a first dose at Month 0 followed by a second dose 2-6 months later. 1, 3
- The minimum interval between doses is 4 weeks—if the second dose is given earlier than this, it should be repeated. 2
- If the second dose is administered beyond 6 months, effectiveness is not impaired, with real-world data showing maintained efficacy even when the second dose is given at ≥180 days. 2, 4
Modified Schedule for Immunocompromised Patients
- For adults aged ≥18 years who are or will be immunodeficient or immunosuppressed, a shorter schedule is recommended: first dose at Month 0 followed by a second dose 1-2 months later. 1, 5, 2
- This accelerated schedule applies to patients with conditions such as hematologic malignancies, solid organ transplants, HIV infection, autoimmune diseases requiring immunosuppressive therapy, or those receiving chemotherapy. 2, 5
Importance of Completing Both Doses
- Two-dose vaccine effectiveness is 70.1% compared to only 56.9% for a single dose, demonstrating the critical importance of completing the full series. 4
- In real-world studies, only 73.2% of patients who received a first dose completed the second dose, representing a significant missed opportunity for optimal protection. 6
- Among patients with inflammatory arthritis on immunomodulatory treatment, vaccine effectiveness was only 50% overall, likely reflecting incomplete vaccination series and immunosuppression. 6
Administration Timing Considerations
- The reconstituted vaccine must be used immediately or stored refrigerated between 2°-8°C (36°-46°F) and used within 6 hours. 1
- Shingrix can be administered simultaneously with other inactivated vaccines (such as influenza) without requiring any waiting period between them. 2
- For patients previously vaccinated with Zostavax, Shingrix should be given at least 2 months after the last Zostavax dose. 2
Common Pitfall to Avoid
- Do not assume a single dose provides adequate protection—the two-dose series is essential for optimal efficacy, with the second dose nearly doubling protection compared to one dose alone. 4
- Concerns about vaccine tolerability are the leading reason patients fail to initiate or complete the series, with 46% of unvaccinated individuals citing side effect concerns. 7