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Administering Shingrix

One of the Recommended Vaccines by Disease

Shingrix Dosage and Schedule

Shingrix (recombinant zoster vaccine) should be administered to adults age 50 years and older as a two-dose series (0.5 ml each), 2 to 6 months apart (0, 2-6 months).

If more than 6 months have elapsed since the first dose of Shingrix, you should administer the second dose as soon as possible. However, you do not need to restart the vaccine series.

If the second dose is given less than 4 weeks after the first dose, the second dose should be considered invalid. A valid second dose should be administered 2 months after the invalid dose (minimum acceptable interval is 4 weeks following invalid dose).

Reconstituting Shingrix

Prepare Shingrix by reconstituting the antigen component with the adjuvant suspension component. Either administer it immediately, or store it in the refrigerator and use it within 6 hours of reconstitution. Otherwise, discard it.

Intramuscular Shingrix Vaccination Infographic

You Call The Shots – Intramuscular Shingrix vaccination (recombinant zoster vaccine).
This infographic promotes safe vaccination practices by educating and reminding providers about proper intramuscular (IM) vaccine administration technique for Shingrix.

Administering Shingrix

Shingrix should be injected intramuscularly in the deltoid region of the upper arm.  Subcutaneous injection is a vaccine administration error and should be avoided. However, if you inadvertently administer Shingrix subcutaneously, that dose is considered valid and does not need to be repeated. If a subcutaneous vaccine administration error occurs on the first dose of Shingrix, a second dose is still required after 2 – 6 months.

Shingrix should be administered immediately after reconstitution or stored in the refrigerator. Do not freeze Shingrix. Do not use if exposed to temperatures below 36⁰F.

Administration with Other Vaccines

CDC general recommendations advise that recombinant and adjuvanted vaccines, such as Shingrix, can be administered concomitantly, at different anatomic sites, with other adult vaccines. Concomitant administration of Shingrix with Fluarix Quadrivalent (influenza vaccine) (QIV) has been studied, and there was no evidence for interference in the immune response to either vaccine or safety concerns. Evaluation of co-administration of Shingrix with 23-valent pneumococcal polysaccharide vaccine (Pneumovax23) (PPSV23) and Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine, Adsorbed (Boostrix) is ongoing. The safety and efficacy of administration of two adjuvanted vaccines (e.g., Shingrix and adjuvanted influenza vaccine (Fluad), either concomitantly or at other intervals, have not been evaluated.

Shingrix and pneumococcal vaccine may be administered at the same visit if the person is eligible for both. When both pneumococcal conjugate vaccine PCV13 and PPSV23 are recommended for an adult, PCV13 should always be administered first and may be administered concomitantly with Shingrix.

Vaccine Administration Errors

Shingrix should not be used for children, and should not be used in place of varicella vaccine. Also, varicella vaccine should not be used in place of Shingrix. Administration of Shingrix to a child who was supposed to be vaccinated with varicella vaccine is a vaccine administration error, and the event should be documented and procedures put in place to prevent this from happening again. This event should be reported to the Vaccine Adverse Event Reporting System (VAERS) by phone 1-800-822-7967 or through the website. VAERS is maintained jointly by CDC and the U.S. Food and Drug Administration.

If you accidently administered Zostavax® (zoster vaccine live) to an adult when Shingrix was indicated, you may initiate the Shingrix series no less than eight weeks later.

If you accidently administered varicella vaccine to an adult when Shingrix was indicated, no specific safety concerns exist, but the dose should not be considered valid. You should administer a dose of Shingrix to the patient during that same visit. If the error is not immediately detected, you may initiate the Shingrix series no less than eight weeks later.

These events should be documented and procedures put in place to prevent this from happening again.

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