Is the shingles vaccine recommended for a 38-year-old individual with a history of shingles or compromised immune system?

Shingles Vaccine for a 38-Year-Old

The shingles vaccine is NOT routinely recommended for a healthy 38-year-old, as current guidelines recommend vaccination starting at age 50 for immunocompetent adults. 1, 2, 3

Age-Based Recommendations for Immunocompetent Adults

The Advisory Committee on Immunization Practices (ACIP) and international guidelines consistently establish age 50 as the threshold for routine shingles vaccination with Shingrix (recombinant zoster vaccine, RZV) in immunocompetent individuals. 1, 3 This represents a shift from older 2009-2013 guidelines that recommended starting at age 60 with the now-inferior live-attenuated vaccine (Zostavax). 4, 2

• The FDA has approved Shingrix for use starting at age 50, and this is the age at which routine vaccination should begin for healthy adults. 1, 3
• Herpes zoster incidence increases substantially with age, with relatively low risk in individuals under 50 years compared to older adults, which is the primary rationale for the age 50 threshold. 1, 2
• The pivotal ZOE-50 trial that established Shingrix's 97.2% efficacy enrolled adults aged ≥50 years, not younger populations. 1

Exception: Immunocompromised Patients Aged 18 and Older

The only scenario where vaccination before age 50 is recommended is for immunocompromised adults aged ≥18 years. 1, 2, 3 This includes:

• Patients with hematologic malignancies or solid organ cancers 1
• Solid organ or stem cell transplant recipients 1, 3
• HIV infection 1, 3
• Autoimmune diseases requiring immunosuppressive therapy (including JAK inhibitors like tofacitinib, biologics, or high-dose corticosteroids) 1, 3

For a 38-year-old, you must determine if they have any immunocompromising condition or will be starting immunosuppressive therapy. If yes, proceed with the two-dose Shingrix series. If no, defer vaccination until age 50. 1, 3

Special Consideration: Prior Shingles History

If this 38-year-old has a history of shingles, this does NOT change the age recommendation for immunocompetent individuals. 1

• Having had shingles once does not provide reliable protection against future episodes, with a 10-year cumulative recurrence risk of 10.3%. 1, 3
• However, vaccination is still recommended at the standard age threshold of ≥50 years for immunocompetent adults, even with prior shingles history. 1
• The vaccine should be administered at least 2 months after acute shingles symptoms resolve. 1, 3

Critical Pitfall to Avoid

Do not confuse varicella (chickenpox) vaccination with herpes zoster (shingles) vaccination. 1 If this 38-year-old never had chickenpox and is VZV-seronegative, they would need the varicella vaccine (2 doses, 4 weeks apart), not the shingles vaccine. 4, 1 A prior shingles episode confirms VZV seropositivity, so varicella vaccination would not be indicated. 1

Vaccination Schedule When Age-Appropriate

When the patient reaches age 50 (or if they are currently immunocompromised at age 38):

• Administer Shingrix as a two-dose series intramuscularly, with the second dose given 2-6 months after the first dose (minimum interval 4 weeks). 1, 3
• For immunocompromised patients, a shorter schedule with the second dose at 1-2 months is recommended. 1, 3
• Shingrix demonstrates 97.2% efficacy in preventing herpes zoster and maintains efficacy above 83.3% for at least 8 years. 1, 5

Counseling Points

• Inform the patient that routine vaccination begins at age 50 per current guidelines. 2, 3
• Explain that while the vaccine is FDA-approved for ages 50+, it is not part of standard recommendations for healthy adults under 50. 2
• If the patient has specific immunocompromising conditions, vaccination can and should be administered now. 1, 3
• Common side effects include injection-site reactions (67% local symptoms) and systemic symptoms (33%), mostly mild to moderate and resolving within 4 days. 1, 3