What is the recommended vaccination regimen for a patient over 50 to prevent shingles?

Shingrix (Recombinant Zoster Vaccine) Patient Education

What is Shingrix?

Shingrix is a highly effective, non-live vaccine that prevents shingles (herpes zoster) and its complications in adults aged 50 years and older, with over 97% effectiveness that remains above 83% for at least 8 years. 1, 2

• Shingrix contains a single protein from the varicella zoster virus (not live virus) combined with a powerful adjuvant that boosts your immune response 2, 3
• Unlike the older Zostavax vaccine, Shingrix maintains high effectiveness across all age groups and does not significantly decline with age 1, 3

Who Should Receive Shingrix?

Standard Recommendations

• All adults aged 50 years and older should receive Shingrix, regardless of whether you've had shingles before or previously received Zostavax 1, 2
• Adults aged 18-49 years who are immunocompromised due to disease or medications (such as cancer, HIV, organ transplant, or chronic immunosuppressive therapy) should also receive Shingrix 4, 2

You Should Get Vaccinated Even If:

• You've already had shingles—having shingles once does not provide reliable protection against future episodes (10.3% recurrence risk over 10 years) 1
• You previously received Zostavax—that vaccine's protection drops to only 14.1% by year 10, so you need Shingrix for adequate protection 1
• You're on medications like prednisone, methotrexate, or biologics—Shingrix is safe and effective even with these medications 1, 4

Vaccination Schedule

Standard Two-Dose Series

• First dose: Given at your initial visit 1, 2
• Second dose: Given 2-6 months after the first dose 1, 2
• Both doses are required for optimal protection—completing the full series is essential 1

Shortened Schedule for Immunocompromised Patients

• If you are immunocompromised or about to start immunosuppressive therapy, the second dose can be given 1-2 months after the first dose 1, 2
• Ideally, complete both doses before starting medications like JAK inhibitors (tofacitinib) or other strong immunosuppressants 1

Important Timing Notes

• If you recently had shingles, wait at least 2 months after symptoms resolve before getting vaccinated 1
• If you received Zostavax, wait at least 2 months before starting Shingrix 1
• If the second dose is delayed beyond 6 months, you should still complete it—effectiveness is not impaired 1, 5

How Well Does Shingrix Work?

Effectiveness Against Shingles

• 97.2% effective in preventing shingles in adults aged 50-69 years 1, 3
• 89.8% effective in adults aged 70 years and older 1, 3
• Real-world effectiveness: 70.1% for the complete two-dose series and 56.9% for one dose only 5

Effectiveness Against Postherpetic Neuralgia (PHN)

• 88.8% effective in preventing the chronic nerve pain that can follow shingles in adults aged 70+ years 1
• 76.0% effective against PHN in real-world studies 5

Duration of Protection

• Protection remains above 83.3% for at least 8 years 1
• No booster doses are currently recommended after completing the two-dose series 1

What to Expect: Side Effects

Very Common Side Effects (Most People Experience These)

Injection site reactions: 2

• Pain at injection site (78% of people) 2
• Redness (38%) and swelling (26%) 2

Systemic symptoms: 2

• Muscle aches (45%) 2
• Fatigue (45%) 2
• Headache (38%) 2
• Shivering (27%) 2
• Fever (21%) 2
• Gastrointestinal symptoms like nausea (17%) 2

Important Reassurance

• Most side effects are mild to moderate and resolve within 2-4 days 1, 3
• These reactions indicate your immune system is responding to the vaccine 3
• Serious adverse events occur at similar rates to placebo 1, 3

Rare Serious Side Effects

• Guillain-Barré syndrome: An increased risk was observed in the 42 days following vaccination, though this remains very rare 2
• Severe allergic reactions: Extremely rare but possible—do not receive Shingrix if you had a severe allergic reaction to any component or a previous dose 2

Managing Side Effects

• Take over-the-counter pain relievers (acetaminophen or ibuprofen) as needed 1
• Apply a cool compress to the injection site 1
• Rest if you feel fatigued 1
• Stay hydrated 1

Special Situations

If You're on Immunosuppressive Medications

• Shingrix is safe for patients on glucocorticoids, DMARDs, biologics, and other immunosuppressants 1, 4
• The vaccine may cause mild disease flares (4-17%) in patients with autoimmune conditions, but no serious adverse events 1
• Your immune response may be somewhat reduced compared to healthy individuals, but vaccination still provides meaningful protection 1, 5

If You're Starting JAK Inhibitors (like tofacitinib)

• Ideally, complete both Shingrix doses before starting the medication to maximize immune response 1
• If urgent treatment is needed, get at least the first dose before starting, then complete the second dose 1-2 months later 1
• Never receive the live Zostavax vaccine if you're on or about to start these medications 1

If You Have Cancer or Are Receiving Chemotherapy

• Shingrix is the only appropriate shingles vaccine for immunocompromised patients—Zostavax is contraindicated 1, 4
• For stem cell transplant recipients, give Shingrix 50-70 days post-transplantation 1
• Consider timing doses between chemotherapy cycles when feasible (>7 days after last treatment) 1

If You're on Low-Dose Steroids

• Prednisone <10 mg/day does not adversely impact vaccine response 1
• You can safely receive Shingrix without adjusting your steroid dose 1

Why Shingrix is Superior to Zostavax

• Much higher effectiveness: Shingrix 97% vs. Zostavax 46-70% initially, declining to 14.1% by year 10 1, 3
• Maintains effectiveness with age: Zostavax drops from 70% in ages 50-59 to only 18% in those ≥80 years 1
• Longer-lasting protection: Shingrix remains >83% effective for at least 8 years 1
• Safe for immunocompromised patients: Shingrix can be given to immunocompromised individuals, while Zostavax cannot 1, 4

Common Questions

Can I get shingles from the vaccine?

• No. Shingrix contains only a protein fragment, not live virus, so it cannot cause shingles under any circumstances 1, 2

Do I need a booster after the two doses?

• No. No additional booster doses are currently recommended beyond the initial two-dose series 1

Can I get Shingrix with other vaccines?

• Yes. Shingrix can be given at the same time as flu vaccine or other inactivated vaccines 1
• Wait until acute illness symptoms (fever, severe malaise) have resolved before vaccination 1

What if I'm under 50 but had shingles?

• Having had shingles does not justify earlier vaccination unless you are immunocompromised 1
• The vaccine is only approved for adults ≥50 years (or ≥18 years if immunocompromised) 4, 2

Can I get vaccinated if I'm pregnant?

• Shingrix has not been studied in pregnant women—discuss with your healthcare provider 2

What Shingrix Does NOT Do

• Does not treat active shingles—if you have shingles now, you need antiviral medication like valacyclovir 6
• Does not prevent chickenpox—if you've never had chickenpox or the chickenpox vaccine, you need varicella vaccine, not Shingrix 1, 2
• Does not eliminate all risk—about 8 out of 100 vaccinated people might still develop shingles, but usually with milder symptoms 1, 5

Bottom Line

Shingrix is the most effective vaccine available to prevent shingles and its complications, with over 97% effectiveness that lasts for at least 8 years. 1, 3 While side effects like injection site pain and fatigue are common, they are temporary and mild to moderate in severity. 2, 3 Completing both doses 2-6 months apart is essential for optimal protection. 1, 2