Shingrix Dosing Interval Recommendations
The standard interval between the two Shingrix doses is 2–6 months, with a minimum of 4 weeks; for immunocompromised adults aged ≥18 years, a shorter interval of 1–2 months is recommended. 1
Standard Dosing Schedule for Immunocompetent Adults
Administer the second Shingrix dose 2–6 months after the first dose for all immunocompetent adults aged ≥50 years. 1
The minimum interval between doses is 4 weeks; if the second dose is given earlier than this, it must be repeated. 1
There is no maximum interval after the first dose—if the second dose is delayed beyond 6 months, simply administer it as soon as possible without restarting the series. 1
Real-world data confirm that second doses given at ≥180 days maintain full effectiveness, with vaccine effectiveness of 70.1% for the complete two-dose series. 2
Modified Schedule for Immunocompromised Patients
For immunocompromised adults aged ≥18 years, give the second dose 1–2 months after the first dose to achieve earlier protection in this high-risk population. 3, 1
This shortened schedule applies to patients with hematologic malignancies, solid organ or stem cell transplant recipients, HIV infection, autoimmune diseases requiring immunosuppressive therapy, and those on JAK inhibitors or other biologic agents. 1
The 4-week minimum interval still applies; high-risk patients may receive the second dose as early as 4 weeks after the first if urgent protection is needed. 1, 4
Interval After Prior Zostavax Vaccination
If a patient previously received Zostavax (live-attenuated zoster vaccine), administer Shingrix at least 2 months after the last Zostavax dose. 3, 1
This 2-month interval is the minimum waiting period; longer intervals are acceptable and do not require any adjustment to the Shingrix dosing schedule. 1
Complete the full 2-dose Shingrix series regardless of how long ago Zostavax was given, as Zostavax efficacy declines to only 14.1% by year 10. 1, 5
Evidence Supporting the Dosing Intervals
The pivotal ZOE-50 trial established 97.2% efficacy for the 2-dose series given 2 months apart in adults aged ≥50 years. 1
Protection persists for at least 8 years with efficacy remaining ≥83.3%, and approximately 73% at 10 years. 1
In patients with hematologic malignancies, the table from the European Myeloma Network consensus shows the adjuvanted recombinant zoster vaccine was studied with doses given 1–2 months apart, demonstrating 87.2% vaccine efficacy. 3
Critical Implementation Points
Never restart the series if the second dose is delayed—one delayed dose does not invalidate the first dose. 1
Do not give a third dose under any circumstance; Shingrix is a 2-dose series only. 1
Do not use live-attenuated Zostavax in immunocompromised patients—only Shingrix is appropriate for this population. 3, 1
For patients about to start immunosuppressive therapy (e.g., JAK inhibitors, high-dose corticosteroids), prioritize completing both Shingrix doses before therapy initiation when feasible, using the 1–2 month interval to expedite protection. 1
Special Timing Considerations
After a shingles episode: Wait at least 2 months after complete symptom resolution before giving the first Shingrix dose, then follow the standard 2–6 month interval (or 1–2 months for immunocompromised patients) for the second dose. 6, 4
Autologous HSCT recipients: Administer the first dose 50–70 days post-transplantation, with the second dose 1–2 months later. 1, 4
Allogeneic HSCT recipients: Wait 6–12 months post-transplantation before starting the series. 4