Recommended Shingles Vaccine for Healthy Adults Over 50
Shingrix (recombinant zoster vaccine, RZV) is the strongly recommended vaccine for preventing shingles in all healthy adults aged 50 years and older, administered as a two-dose series with the second dose given 2-6 months after the first dose. 1, 2
Why Shingrix is Preferred
Shingrix demonstrates superior efficacy compared to the older Zostavax vaccine, with 97.2% effectiveness in preventing shingles in adults aged 50+ years versus only 51-70% for Zostavax. 2, 3 Even more importantly, Zostavax efficacy plummets to just 14.1% by year 10, while Shingrix maintains protection above 83.3% for at least 8 years. 2
The vaccine works across all age groups equally well—maintaining >90% efficacy even in adults over 70 years old, whereas Zostavax effectiveness dropped dramatically with age (70% in ages 50-59 vs. only 18% in those ≥80 years). 2
Vaccination Schedule and Administration
- Administer the first dose immediately upon reaching age 50, followed by the second dose 2-6 months later (minimum interval of 4 weeks if needed earlier). 2
- The vaccine is given intramuscularly (IM). 2
- If the second dose is delayed beyond 6 months, simply give it when the patient returns—effectiveness is not impaired by longer intervals. 2
Key Clinical Advantages
- Prevents postherpetic neuralgia with 88.8% efficacy in adults ≥70 years, addressing the most debilitating complication of shingles. 4
- Safe for immunocompromised patients (unlike Zostavax, which is contraindicated), making it appropriate for patients on immunosuppressive medications, with autoimmune diseases, or other immunodeficiency states. 2, 4
- Can be administered regardless of prior shingles history—having had shingles once does not provide reliable protection, with a 10.3% recurrence risk at 10 years. 2
Special Populations
For patients who previously received Zostavax: They should still receive the full 2-dose Shingrix series, waiting at least 2 months after the last Zostavax dose (though this is easily satisfied if Zostavax was given years ago). 2 The inadequate long-term protection from Zostavax makes revaccination essential.
For immunocompromised adults aged 18+ years: Use a shortened schedule with the second dose at 1-2 months after the first dose. 2, 4
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. 2
- Systemic symptoms (fatigue, myalgia, headache) occur in 11.4% of vaccine recipients versus 2.4% in placebo recipients. 2
- Most side effects resolve within 4 days. 2
- No serious safety concerns have been identified in large clinical trials, with similar rates of serious adverse events between vaccine and placebo groups. 2
Important Clinical Pitfalls to Avoid
- Never use Zostavax in immunocompromised patients—only Shingrix is appropriate for this population. 2, 4
- Do not delay vaccination waiting for "the right time"—the vaccine can be given simultaneously with other inactivated vaccines like influenza without any required spacing. 2
- Do not skip vaccination in patients with prior shingles—natural immunity from a previous episode is insufficient, and vaccination reduces recurrence risk. 2
- Wait until acute illness symptoms resolve before vaccinating (fever, severe malaise), but no specific waiting period is required after minor viral illnesses. 2
Timing After Acute Shingles Episode
If a patient recently had shingles, administer Shingrix once acute symptoms have resolved, typically waiting at least 2 months after the episode to allow for complete symptom resolution and immune system recovery. 2