Can an adult who has only received the live‑attenuated shingles vaccine (Zostavax) receive the recombinant zoster vaccine (Shingrix) now?

Can Adults Who Received Zostavax Now Receive Shingrix?

Yes, adults who previously received Zostavax should absolutely receive the full 2-dose Shingrix series, regardless of how long ago they received Zostavax. 1

Primary Recommendation

All adults who received the older live-attenuated Zostavax vaccine should be revaccinated with the recombinant Shingrix vaccine because Zostavax provides inadequate long-term protection. 1 The CDC and American College of Physicians explicitly recommend administering the 2-dose Shingrix series to all adults aged 50 years and older, regardless of previous herpes zoster vaccination history, including those who previously received Zostavax. 1

Why Revaccination Is Essential

• Zostavax efficacy declines dramatically over time, dropping to only 14.1% by year 10 post-vaccination, leaving patients essentially unprotected. 1
• Shingrix demonstrates superior efficacy of 97.2% in adults aged 50 years and older, with protection persisting for at least 8 years while maintaining efficacy above 83.3%. 1
• Real-world data shows that additional vaccination with Shingrix after prior Zostavax lowered the incidence rate of herpes zoster from 7.54 to 2.39 per 1,000 person-years. 1

Timing Between Zostavax and Shingrix

• The minimum interval between Zostavax and Shingrix is 2 months (or 8 weeks). 1
• For patients who received Zostavax years ago, this timing requirement is already satisfied, so administer the first Shingrix dose immediately. 1
• There is no maximum interval after previous Zostavax vaccination—waiting serves no purpose while leaving the patient vulnerable to herpes zoster. 1

Shingrix Dosing Schedule

• Administer the 2-dose series with the second dose given 2-6 months after the first dose for immunocompetent adults. 1
• The minimum interval between Shingrix doses is 4 weeks; if administered earlier than this, the dose should be repeated. 1
• For immunocompromised adults aged ≥18 years, a shorter schedule with the second dose given 1-2 months after the first dose is recommended. 1

Evidence from FDA-Approved Studies

The FDA label specifically addresses this scenario: In an open-label clinical study, subjects aged 65 years and older who had been previously vaccinated with Zostavax more than 5 years prior received 1 dose of Shingrix at Months 0 and 2. 2 The anti-gE antibody concentration measured 1 month following 2 doses of Shingrix in subjects who had previously been vaccinated with Zostavax was non-inferior to that of subjects who had never been vaccinated with Zostavax. 2 There was no evidence for interference in the immune response to Shingrix in subjects previously vaccinated with Zostavax. 2

Important Clinical Considerations

• Complete both doses of Shingrix for optimal protection—the 2-dose vaccine effectiveness is 70.1% compared to 56.9% for a single dose in real-world studies. 3
• Do not use Zostavax for revaccination—only Shingrix is recommended for this scenario, as it is the preferred vaccine with superior efficacy. 1
• Do not delay vaccination to obtain serologic testing or for any other reason, as this contradicts guideline recommendations and leaves patients unnecessarily exposed. 1
• For patients on immunosuppressive therapy, ideally complete the full 2-dose Shingrix series before initiating or resuming highly immunosuppressive therapy to ensure maximal protective immunity. 1

Special Populations

• Shingrix is safe for immunocompromised patients, unlike the live-attenuated Zostavax which is contraindicated in immunocompromised individuals. 1
• For patients with inflammatory bowel disease receiving immunomodulators or advanced therapies, recombinant zoster vaccination (Shingrix) should be considered in all patients aged 50 or over, and patients aged 18 and over starting JAK inhibitors. 4
• Live vaccines (including Zostavax) are contraindicated in patients receiving immunosuppressive therapy, which includes corticosteroids (prednisolone ≥20 mg/day or equivalent for 2 weeks or more), purine analogues, methotrexate, and biologic therapies. 4

Common Pitfalls to Avoid

• Do not restart the Shingrix series if the second dose is delayed beyond 6 months—there is no maximum allowable interval, and the series should be completed with a single second dose regardless of elapsed time. 1
• Do not confuse the waiting period after Zostavax with the interval between Shingrix doses—these are separate considerations. 5
• Do not give a third dose under any circumstance—the Shingrix series consists of only two doses. 1