What is the recommended number of doses of the herpes zoster (shingles) vaccine?

From the Guidelines

The recommended shingles vaccination schedule consists of two doses of Shingrix (recombinant zoster vaccine), given 2 to 6 months apart, as stated in the 2020 recommended adult immunization schedule, United States 1. This two-dose series is recommended for adults aged 50 years and older, regardless of previous herpes zoster or history of ZVL (Zostavax) vaccination. The CDC also recommends 2 doses of recombinant zoster vaccine (RZV, Shingrix) 2 to 6 months apart as the preferred vaccine over zoster vaccine live (ZVL, Zostavax) for immunocompetent adults 50 years or older, including patients who are dialysis dependent 1. Key points to consider when administering the shingles vaccine include:

• The minimum interval between doses is 4 weeks, and the second dose should be repeated if administered too soon 1.
• If more than 6 months have passed since the first dose, the second dose should still be received as soon as possible rather than restarting the series.
• Shingrix is highly effective, reducing the risk of shingles by more than 90% in immunocompetent adults. The protection provided by the shingles vaccine is particularly important as we age, since the risk of developing shingles increases substantially after age 50 due to natural decline in immune function.

From the FDA Drug Label

The primary efficacy analysis population (referred to as the modified Total Vaccinated Cohort [mTVC]) included 14,759 subjects aged 50 years and older who received 2 doses (0 and 2 months) of either SHINGRIX (n = 7,344) or placebo (n = 7,415) and did not develop a confirmed case of HZ within 1 month after the second dose. The primary efficacy analysis population (mTVC) included 13,163 subjects aged 70 years and older who received 2 doses (0 and 2 months) of either SHINGRIX (n = 6,541) or placebo (n = 6,622) and did not develop a confirmed case of HZ within 1 month after the second dose.

The recommended number of doses of shingles vaccine is 2 doses, administered 2 months apart, as supported by studies 2 and 2. Key points:

• The vaccine is administered in 2 doses
• The doses are given 2 months apart
• This dosing schedule is supported by clinical studies in subjects aged 50 years and older, as well as those aged 70 years and older.

From the Research

Shingles Vaccine Dosage

• The recommended dosage of the shingles vaccine is 2 doses, given 2-6 months apart, for adults aged 50 years and older 3, 4.
• Studies have shown that completing the 2-dose regimen provides the best protection against herpes zoster and postherpetic neuralgia 3.
• The effectiveness of a single dose of the vaccine is lower than that of the 2-dose regimen, with a vaccine effectiveness of 56.9% compared to 70.1% for 2 doses 3.
• The need for a booster dose is still unknown, but a study showed that a booster dose administered to adults aged 70 years and older who received their first dose of zoster vaccine 10 years previously was immunogenic 5.

Vaccine Effectiveness

• The 2-dose vaccine effectiveness was not significantly lower for beneficiaries aged 80 years and older, or for second doses received at 180 days or more after the first dose 3.
• The vaccine was also effective among individuals with autoimmune conditions and those with immunosuppressive conditions 3, 6.
• Two-dose vaccine effectiveness against postherpetic neuralgia was 76.0% 3.

Vaccine Types

• There are two types of shingles vaccines: a live, attenuated vaccine (Zostavax) and an adjuvanted recombinant vaccine (Shingrix) 7, 4.
• Shingrix is recommended as the preferred vaccine for the prevention of herpes zoster in immunocompetent adults 50 years of age and older 4.