Two vaccines are licensed and recommended to prevent shingles in the U.S.. Zoster vaccine live (ZVL, Zostavax) has been in use since 2006. Recombinant zoster vaccine (RZV, Shingrix), has been in use since 2017 and is recommended by ACIP as the preferred shingles vaccine.
For the recommendations of the Advisory Committee on Immunization Practices (ACIP), see Shingrix (recombinant zoster vaccine) Recommendations
Routine Vaccination of People 50 Years Old and Older
CDC recommends Shingrix (recombinant zoster vaccine) as preferred over Zostavax® (zoster vaccine live) for the prevention of herpes zoster (shingles) and related complications. CDC recommends two doses of Shingrix separated by 2 to 6 months for immunocompetent adults age 50 years and older:
Everything You Need to Know About Shingrixexternal icon
Dr. Kathleen Dooling discusses storage, administration, and patient counseling for the new shingles vaccine
- Whether or not they report a prior episode of herpes zoster
- Whether or not they report a prior dose of Zostavax
- Who have chronic medical conditions (e.g., chronic renal failure, diabetes mellitus, rheumatoid arthritis, chronic pulmonary disease), unless a contraindication or precaution exists. Similar to Zostavax, Shingrix may be used for adults who are
- are taking low-dose immunosuppressive therapy
- are anticipating immunosuppression
- have recovered from an immunocompromising illness
- Who are getting other adult vaccines in the same doctor’s visit, including those routinely recommended for adults age 50 years and older, such as influenza and pneumococcal vaccines. The safety and efficacy of concomitant administration of two adjuvanted vaccines, such as Shingrix and Fluad, have not been evaluated.
- It is not necessary to screen, either verbally or by laboratory serology, for evidence of prior varicella infection.
Zostavax may still be used to prevent shingles in healthy adults 60 years and older. For example, you could use Zostavax if a person is allergic to Shingrix, prefers Zostavax, or requests immediate vaccination and Shingrix is unavailable. Learn more about Zostavax.
Clinical Guidance During the Shingrix Backorder
There are currently ordering limits and intermittent shipping delays for GlaxoSmithKline’s Shingrix vaccine (Recombinant Zoster Vaccine) due to high demand.
Until demand can be met, it is particularly important that vaccine providers educate patients about the importance of completing the series. In addition, CDC reminds health care professionals of proven strategies to help patients receive all their needed vaccinations on time, including Shingrix:
- Implement a vaccine reminder and recall system using phone, e-mail, or text messages to contact patients when you have Shingrix supply. Give first consideration to patients due for their second dose of Shingrix. (https://www.thecommunityguide.org/findings/vaccination-programs-client-reminder-and-recall-systemsexternal icon)
- If you are out of Shingrix and a patient needs a second dose, refer the patient to another provider in the community (e.g., a pharmacy) that has Shingrix so the patient can complete the series. The immunization program at your state or local health department or vaccine finderexternal icon can help identify other immunization providers.
- Be sure to enter your patients’ current vaccination information into your state’s immunization information system (IIS). This will ensure that every provider can access your patients’ immunization record, and it may help facilitate patient reminders to complete the Shingrix series.
- As supply becomes less constrained, be sure to notify eligible patients so they can come in to get their first dose of Shingrix.
For patients who previously had herpes zoster
There is no specific amount of time you need to wait before administering Shingrix to patients who have had herpes zoster. However, you should not give Shingrix to patients who are experiencing an acute episode of herpes zoster.
For patients who previously received Zostavax
Consider the patient’s age and when he or she received Zostavax to determine when to vaccinate with Shingrix. Studies examined the safety of Shingrix vaccination five or more years after Zostavax vaccination. Shorter intervals were not studied, but there are no theoretical or data concerns to indicate that Shingrix would be less safe or effective if administered less than five years after a patient received Zostavax.
You may consider an interval shorter than five years between Zostavax and Shingrix based on the age at which the patient received Zostavax. Differences in efficacy between Shingrix and Zostavax are most pronounced among older patients. Studies have shown that the effectiveness of Zostavax wanes substantially over time, leaving recipients with reduced protection against herpes zoster. For example, the vaccine efficacy among adults age 70 to 79 years and adults age 80 years and older is 41% and 18%, respectively, on average during the first three years following Zostavax vaccination.
You should wait at least 8 weeks after a patient received Zostavax to administer Shingrix.
For patients who do not report a prior episode of varicella
When vaccinating adults age 50 years and older, there is no need to screen for a history of varicella (chickenpox) infection or to conduct laboratory testing for serologic evidence of prior varicella infection. More than 99% of adults age 50 years and older worldwide have been exposed to varicella zoster virus, and the Advisory Committee on Immunization Practices (ACIP) considers people born in the United States prior to 1980 immune to varicella. Therefore, even if a person does not recall having chickenpox, serologic testing for varicella immunity is not recommended. It is often a barrier to herpes zoster vaccination, and false negatives are common. However, if serologic evidence of varicella susceptibility becomes available to the healthcare provider, providers should follow ACIP guidelines for varicella vaccination. Shingrix has not been evaluated in persons who are seronegative to varicella, and it is not indicated for the prevention of varicella.
Shingrix should not be administered to:
- A person with a history of severe allergic reaction, such as anaphylaxis, to any component of a vaccine or after a previous dose of Shingrix
- A person who is known to be seronegative for varicella
- It is not necessary to screen (either verbally or via laboratory serology) for a history of varicella. However, if a person is known to be varicella-negative via serologic testing, providers should follow ACIP guidelines for varicella vaccination.
- A person experiencing an acute episode of herpes zoster. Shingrix is not a treatment for herpes zoster or postherpetic neuralgia (PHN). The general guidance for any vaccine is to wait until the acute stage of the illness is over and symptoms abate.
Shingrix has not been studied in pregnant women or women who are breastfeeding. Providers should consider delaying Shingrix vaccination for these women.
Adults with a minor acute illness, such as a cold, can receive Shingrix. Adults with a moderate or severe acute illness should usually wait until they recover before getting the vaccine. This includes anyone with a temperature of 101.3°F or higher.
To learn more, see Contraindications and Precautions, General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP).