Shingrix Dosing and Administration
Shingrix is administered as a two-dose intramuscular series with the second dose given 2-6 months after the first dose for adults aged 50 years and older. 1, 2, 3, 4
Standard Dosing Schedule
- Each dose is 0.5 mL administered intramuscularly (typically in the deltoid muscle). 3, 4
- The minimum interval between doses is 4 weeks, though the recommended interval is 2-6 months. 1, 2
- If the second dose is administered beyond 6 months, effectiveness is not impaired—real-world data shows second doses given at ≥180 days maintain full effectiveness. 1, 5
Modified Schedule for Immunocompromised Adults
- For immunocompromised adults aged ≥18 years, use a shortened schedule with the second dose at 1-2 months after the first dose. 6, 1, 2
- This accelerated schedule applies to patients with hematologic malignancies, solid organ transplant recipients, autologous hematopoietic stem cell transplant recipients, those on immunosuppressive therapy, and patients with autoimmune diseases requiring immunomodulatory treatment. 7, 2, 3
Special Timing Considerations
After Previous Zostavax Vaccination
- Administer Shingrix at least 2 months after the last Zostavax dose. 1, 2
- All adults who previously received Zostavax should receive the full 2-dose Shingrix series due to Zostavax's poor long-term protection (efficacy drops to 14.1% by year 10). 1
After a Shingles Episode
- Wait at least 2 months after acute symptoms have resolved before administering Shingrix. 1, 2
- Prior herpes zoster infection is not a contraindication—vaccination is recommended regardless of previous shingles history. 1, 7
With Immunosuppressive Therapy
- For patients starting JAK inhibitors or other immunosuppressive therapy, ideally complete the full 2-dose series before initiating treatment. 6
- If urgent therapy initiation is required, administer at least the first dose before starting immunosuppression, though immune response may be somewhat reduced. 6
- Vaccines should preferably be administered when not on corticosteroids or at the lowest tolerable dose, as corticosteroids can reduce vaccine-induced immune responses. 6
Important Clinical Caveats
- Never use live-attenuated Zostavax in immunocompromised patients—only Shingrix is appropriate for this population. 1, 7, 8
- Do not delay vaccination if the patient is already past the recommended 6-month interval for the second dose—simply administer the second dose as soon as possible. 1, 5
- Shingrix can be administered simultaneously with other inactivated vaccines (such as influenza or pneumococcal vaccines) without required spacing intervals. 1
- Common adverse reactions include injection-site pain (22.5%), fever (23.6%), myalgia, and fatigue, with most reactions being transient and mild to moderate in severity. 3, 9, 10