Shingrix Dosing and Administration
Shingrix is administered as a two-dose series (0.5 mL each dose) given intramuscularly in the deltoid region, with the second dose administered 2 to 6 months after the first dose for immunocompetent adults aged ≥50 years. 1
Standard Dosing Schedule
- For immunocompetent adults aged ≥50 years: Administer the first dose at Month 0, followed by the second dose 2 to 6 months later 2, 1
- The minimum interval between doses is 4 weeks; if the second dose is given earlier than this minimum, it should be repeated 2
- If the second dose is delayed beyond 6 months, effectiveness is not impaired—real-world data demonstrates that second doses given at ≥180 days maintain full effectiveness 3
Modified Schedule for Immunocompromised Patients
- For adults aged ≥18 years who are or will be immunocompromised: A shortened schedule is recommended with the second dose given 1 to 2 months after the first dose 2, 4, 1
- This applies to patients with immunodeficiency disease, those on immunosuppressive therapy, patients with hematologic malignancies, solid organ transplant recipients, and those on chronic high-dose glucocorticoids (≥20 mg/day prednisone equivalent) 4
Administration Details
- Route: Intramuscular injection only, with the deltoid region of the upper arm as the preferred site 1
- Preparation: After reconstitution, administer immediately or store refrigerated between 2°C and 8°C (36°F and 46°F) and use within 6 hours 1
- Use a separate sterile needle and syringe for each individual 1
Key Clinical Considerations
- Age threshold: FDA-approved for adults aged ≥50 years (immunocompetent) or ≥18 years (immunocompromised) 4, 5
- Prior vaccination with Zostavax: Adults who previously received the live-attenuated vaccine should still receive the full 2-dose Shingrix series, with a minimum interval of 2 months after the last Zostavax dose 2
- Prior herpes zoster infection: Vaccination is recommended regardless of previous shingles history, ideally waiting at least 2 months after acute symptoms resolve 2
- Vaccine efficacy: Clinical trials demonstrated >90% efficacy against herpes zoster in adults aged ≥50 years, with real-world effectiveness of 70.1% for the 2-dose series and 56.9% for a single dose 3, 6
Common Pitfalls to Avoid
- Do not delay the second dose unnecessarily—while the recommended window is 2-6 months, doses given beyond 6 months remain fully effective 3, 7
- Do not use Zostavax in immunocompromised patients—only Shingrix (RZV) is appropriate for this population as it is non-live 2, 4
- Do not confuse with varicella vaccine—Shingrix is not indicated for prevention of primary varicella (chickenpox) 4