The shingles vaccine is recommended to prevent shingles (herpes zoster), reduce pain during an outbreak, and lower the risk of postherpetic neuralgia, a complication that affects the nerves and skin, causing burning pain that can last for up to six months.

This vaccine is sold under the brand name Shingrix. It is a recombinant vaccine that contains proteins from the varicella-zoster virus, which stimulate the immune system to produce antibodies that protect against shingles.

The shingles vaccine is available and can be administered at most pharmacies and can also be given in clinics or hospitals. It can also be given to people who have already had shingles.

older adult getting a vaccine from a younger nurse

Indications for use

The shingles vaccine is recommended to:

Prevent shingles from developing;
Reduce the risk of shingles recurrence in people who have already had the infection.

The vaccine is routinely recommended for adults aged 50 and older, as this is when people who had chickenpox in childhood are more likely to develop shingles.

The varicella-zoster virus, which causes chickenpox, can stay dormant in the body for many years and reactivate later when the immune system becomes weaker.

In addition, the shingles vaccine (Shingrix) is also recommended for adults 19 years and older who are or will be immunocompromised due to disease or therapy.

How it works

The recombinant shingles vaccine (Shingrix) contains a protein called glycoprotein E (gE), which is produced using recombinant DNA technology.

This protein helps stimulate the immune system to produce antibodies against the varicella-zoster virus, preventing the virus from reactivating and causing shingles.

Dosing schedule

The following table provides dosing information for the shingles vaccine based on indication:

Indications	Dose and schedule
Adults aged 50 and older or adults 19 and older who are immunocompromised	1st dose: On a date chosen by the healthcare provider; 2nd dose: 2 to 6 months after the first dose. The vaccine should be administered intramuscularly, usually in the upper arm. For people who are or will become immunocompromised, the second dose may be given 1 to 2 months after the first.
Adults who have received a bone marrow (stem cell) transplant	Autologous transplant: 2 doses given 3 to 12 months after the transplant, preferably about 2 months before stopping antiviral therapy. Allogeneic transplant: 2 doses given 6 to 12 months after the transplant, preferably when the person is on a lower dose of immunosuppressants.
Adults with solid organ transplants	It is preferable to vaccinate before the transplant. If vaccination cannot be completed before, give the 2-dose series 6 to 12 months after the transplant when the graft is stable and immunosuppression has decreased.
Adults with cancer	Administer 2 doses, preferably before starting chemotherapy, radiotherapy, immunosuppressive therapy, or spleen removal. If this is not possible, the vaccine can be given when the immune system is stronger during treatment, under medical supervision.
Adults receiving monoclonal antibody or anti-B-cell therapy (e.g., rituximab)	Administer 2 doses, with the first dose given at least 4 weeks before the next monoclonal antibody or anti-B-cell therapy dose.
Adults with autoimmune diseases	Administer 2 doses, preferably before starting immunosuppressive treatment.
Adults who have had shingles	Administer 2 doses once the shingles rash has resolved and the person has recovered. There is no minimum waiting period required.

For people with HIV or AIDS, the shingles vaccine can be given under medical supervision regardless of CD4 count, although better responses are expected when CD4 counts are higher and viral load is controlled.

If recommended by a healthcare provider, Shingrix can be administered at the same time as other vaccines such as the inactivated flu shot, COVID-19 vaccine, pneumococcal polysaccharide vaccine (PPSV23), or the reduced-antigen diphtheria-tetanus-acellular pertussis vaccine (Tdap), provided that each is injected in a different site using separate syringes.

Shingles vaccine side effects

The most common side effects of the shingles vaccine include:

Headache;
Nausea, vomiting, diarrhea, or abdominal pain;
Muscle pain, joint pain, or pain in the arms or legs;
Fatigue, fever, chills, or general discomfort.

Injection site reactions may include pain, redness, swelling, itching, bruising, firmness, or warmth, as well as swollen lymph nodes near the injection area.

Although rare, anaphylactic reactions can occur. For this reason, the vaccine should be administered only in hospitals, pharmacies, or clinics by healthcare professionals who can provide immediate medical care if necessary.

Contraindications to use

The shingles vaccine (Shingrix) should not be given in the following situations:

Severe allergic reaction to a previous dose or any component of the vaccine;
Moderate or severe acute illness;
Active shingles episode.

The vaccine should generally be delayed during pregnancy and may be given during breastfeeding if indicated by a healthcare provider.

People with bleeding or clotting disorders should inform their doctor before vaccination, as extra care may be needed for the intramuscular injection.

The shingles vaccine is not recommended for individuals under 19 years of age.

Shingles Vaccine: Indications, Dosing Schedule & Side Effects

Indications for use

How it works

Dosing schedule

Shingles vaccine side effects

Contraindications to use

References