Shingrix Booster Recommendations
No booster doses of Shingrix are currently recommended after completing the initial two-dose series, regardless of how long ago the series was completed. 1
Current Evidence on Duration of Protection
- Protection from the two-dose Shingrix series persists for at least 8 years with minimal waning, maintaining efficacy above 83.3% during this period. 1
- Long-term follow-up data demonstrates sustained protection up to 10 years, with efficacy decreasing only to 73% at the 10-year mark. 2
- This durability of protection is dramatically superior to the older Zostavax vaccine, which declined to only 14.1% efficacy by year 10. 1
Why No Booster Is Recommended
The American College of Physicians and CDC guidelines explicitly state that no additional booster doses beyond the initial two-dose series are currently recommended. 1 This recommendation is based on:
- The sustained high-level protection demonstrated in clinical trials and real-world effectiveness studies 1, 3
- Absence of evidence showing significant waning immunity that would warrant revaccination 1
- No clinical trials have been conducted to evaluate the safety, immunogenicity, or efficacy of booster doses 1
Important Clinical Context
- The two-dose series provides 70.1% effectiveness in real-world settings, which is lower than the >90% efficacy seen in clinical trials but still represents substantial protection. 3
- Even if the second dose was administered beyond the recommended 6-month window, effectiveness is not impaired—second doses given at ≥180 days maintain full effectiveness. 1, 3
- For patients who received only one dose years ago, they should complete the two-dose series rather than restart, as there is no maximum interval between doses. 1
Special Populations
- Immunocompromised adults who completed the series also have no current booster recommendation, though this population was included in the expanded 2021 FDA approval and 2022 ACIP recommendations for the initial series. 4
- For immunocompromised patients aged ≥19 years who never received Shingrix, the two-dose series (with doses 1-2 months apart) is recommended, but no booster after completion. 5, 4
Common Pitfalls to Avoid
- Do not confuse the lack of booster recommendation with the need to complete the initial two-dose series—patients who received only one dose should receive their second dose. 1
- Do not assume that patients who received Zostavax years ago are adequately protected—these patients should receive the full two-dose Shingrix series (not a "booster"), waiting at least 2 months after the last Zostavax dose. 1
- Do not delay completing the two-dose series in patients who started but never finished—there is no need to restart the series regardless of the interval. 1
Future Considerations
As more long-term data accumulates beyond 10 years, guideline committees may revisit booster recommendations, but currently, the evidence supports a complete two-dose series without subsequent boosters. 1