Is Shingrix a Live Vaccine?
No, Shingrix is not a live vaccine—it is a recombinant subunit vaccine containing only a viral glycoprotein fragment, making it safe for immunocompromised patients. 1, 2
Vaccine Composition and Mechanism
Shingrix is a non-live recombinant zoster vaccine (RZV) that contains only the varicella zoster virus glycoprotein E (gE) antigen combined with the AS01B adjuvant system. 2, 3
The gE antigen is produced by genetically engineered Chinese Hamster Ovary cells and does not contain any live or attenuated virus particles. 2
Each 0.5-mL dose contains 50 mcg of recombinant gE antigen, 50 mcg of MPL (monophosphoryl lipid A), and 50 mcg of QS-21 saponin in a liposomal adjuvant formulation. 2
Critical Clinical Distinction from Live Vaccines
Because Shingrix contains no live virus, it cannot cause varicella-zoster virus infection under any circumstances, including in immunocompromised patients or after exposure to active shingles. 4, 5
This fundamental difference makes Shingrix the only appropriate zoster vaccine for immunocompromised individuals, whereas the older live-attenuated vaccine (Zostavax) is absolutely contraindicated in this population due to risk of disseminated VZV infection. 1, 6
Safety Profile in Immunocompromised Patients
Shingrix is specifically recommended for immunocompromised adults aged ≥18 years, including those with hematologic malignancies, solid organ transplant recipients, HIV infection, and patients on chronic immunosuppressive therapy. 6
The vaccine can be safely administered to patients on biologics, JAK inhibitors, high-dose glucocorticoids (≥20 mg/day prednisone), and other disease-modifying antirheumatic drugs (DMARDs). 1, 7
Guidelines from EULAR explicitly state that Shingrix may replace the live-attenuated vaccine in patients with autoimmune inflammatory rheumatic diseases because it is non-live. 1
Common Pitfall to Avoid
Never confuse Shingrix with Zostavax—Zostavax is the live-attenuated vaccine that carries restrictions for immunocompromised patients, while Shingrix is the recombinant vaccine that is safe in these populations. 1, 5
Do not delay vaccination in immunocompromised patients due to concerns about live virus—Shingrix's non-live composition eliminates this concern entirely. 1, 6