Shingrix (recombinant zoster vaccine) should be administered to immunocompetent adults aged 50 years and older and adults aged ≥19 years who are or will be immunodeficient or immunosuppressed because of disease or therapy as a two-dose series (0.5 ml each), 2 to 6 months apart (0, 2-6 months). However, for persons who are or will be immunodeficient or immunosuppressed and who would benefit from completing the series in a shorter period, the second dose can be administered 1–2 months after the first. For more detailed clinical guidance see https://www.cdc.gov/shingles/vaccination/immunocompromised-adults.html.
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).
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.
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.
CDC general recommendations advise that recombinant and adjuvanted vaccines, such as Shingrix, can be administered concomitantly, at different anatomic sites, with other adult vaccines, including COVID-19 vaccines. Concomitant administration of Shingrix with Fluarix Quadrivalent (influenza vaccine, QIV), 23-valent pneumococcal polysaccharide vaccine (Pneumovax23, PPSV23) and Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine, Adsorbed (Boostrix), and 13-valent pneumococcal conjugate vaccine (PCV13) has been studied, and there was no evidence for interference in the immune response to either vaccine or safety concerns. Coadministration of Shingrix with adjuvanted influenza vaccine (Fluad) and COVID-19 vaccines is being studied.
Shingrix and pneumococcal vaccine can 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 can be administered concomitantly with Shingrix.
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 that should be documented and procedures should be 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 websiteexternal icon. 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 8 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 8 weeks later.
These events should be documented and procedures put in place to prevent this from happening again.