Shingrix Dosing Recommendations
Shingrix is administered as a two-dose series with 0.5 mL given intramuscularly per dose, with the second dose given 2 to 6 months after the first dose for adults aged 50 years and older. 1
Standard Dosing Schedule
- Each dose contains 0.5 mL administered intramuscularly (IM), typically in the deltoid region. 2
- The second dose should be given 2-6 months after the first dose for immunocompetent adults aged 50 years and older. 1
- The minimum interval between doses is 4 weeks—if administered earlier than this, the dose should be repeated. 1
- If the second dose is given beyond 6 months, effectiveness is not impaired, so there is no need to restart the series. 1, 3
Vaccine Composition Per Dose
After reconstitution, each 0.5 mL dose contains: 2
- 50 mcg of recombinant varicella zoster virus glycoprotein E (gE) antigen
- 50 mcg of MPL (3-O-desacyl-4'-monophosphoryl lipid A)
- 50 mcg of QS-21 (saponin adjuvant)
- Additional excipients including sucrose, sodium chloride, and lipid components
Modified Schedule for Immunocompromised Adults
- For immunocompromised adults aged 18 years and older, a shortened schedule is recommended with the second dose given 1-2 months after the first dose (rather than 2-6 months). 1, 4
- This includes patients with hematologic malignancies, solid organ transplant recipients, HIV infection, autoimmune diseases on immunosuppressive therapy, or those on chronic high-dose glucocorticoids (≥20 mg/day prednisone equivalent). 4
Age-Specific Recommendations
- Standard indication: Adults aged 50 years and older, regardless of prior herpes zoster history or previous Zostavax vaccination. 1, 4
- Special indication for younger adults: Immunocompromised adults aged 18-49 years who are or will become immunocompromised due to disease or therapy. 4
- The vaccine is not indicated for adults under age 50 who are immunocompetent, even if they have had prior shingles. 4
Important Clinical Caveats
- No booster doses are currently recommended beyond the initial two-dose series, regardless of time elapsed since vaccination. 1
- Shingrix is not indicated for prevention of primary varicella (chickenpox)—patients without prior varicella immunity should receive varicella vaccine first if not contraindicated. 4, 2
- For patients previously vaccinated with Zostavax, administer the full 2-dose Shingrix series at least 2 months after the last Zostavax dose. 1
- After an acute herpes zoster episode, wait until symptoms have resolved (typically at least 2 months) before administering Shingrix. 1
Administration Technique
- The vaccine is supplied as a lyophilized powder (gE antigen) that must be reconstituted with the accompanying AS01B adjuvant suspension immediately before use. 2
- After reconstitution, the vaccine appears as an opalescent, colorless to pale brownish liquid. 2
- Administer the full 0.5 mL dose intramuscularly, preferably in the deltoid muscle. 1, 2
Common Side Effects to Counsel Patients About
- Injection-site reactions (pain, redness, swelling) occur commonly, with 9.5% experiencing grade 3 reactions versus 0.4% with placebo. 1
- Systemic symptoms (fatigue, myalgia, headache) were reported in 11.4% of vaccine recipients versus 2.4% in placebo recipients. 1
- Most side effects are mild to moderate in intensity and resolve within 4 days. 1
- The risk of dropouts (not returning for the second dose) is higher in the vaccine group (RR 1.25) due to tolerability concerns, emphasizing the importance of pre-vaccination counseling about expected side effects. 5