Shingrix Vaccination Guidelines for Immunocompromised Individuals

Introduction to Shingrix Vaccination

The American College of Physicians recommends Shingrix as the preferred vaccine for immunocompromised individuals due to its safety and efficacy, with a non-live recombinant vaccine composition that minimizes the risk of varicella-zoster virus infection 1

The Centers for Disease Control and Prevention (CDC) states that live-attenuated zoster vaccine (Zostavax) is absolutely contraindicated in immunocompromised patients due to the risk of disseminated VZV infection, whereas Shingrix can be safely administered to patients on immunosuppressive therapy 1, 4
The European League Against Rheumatism (EULAR) notes that Shingrix can be safely administered to patients on immunosuppressive therapy, including those on biologics, JAK inhibitors, rituximab, and glucocorticoids, with significant T-cell responses observed in patients with hematologic malignancies on anti-CD20 therapies 5

The National Institute for Health and Care Excellence (NICE) reports that real-world effectiveness demonstrates 70.1% vaccine effectiveness for 2 doses and 56.9% for 1 dose, emphasizing the importance of completing the full series, with protection persisting for at least 8 years with minimal waning 2
The American College of Rheumatology (ACR) states that vaccine effectiveness against postherpetic neuralgia is 76.0%, with the vaccine maintaining effectiveness even in patients on immunosuppressive therapy, though immune response may be somewhat reduced compared to healthy individuals 5

The American Academy of Dermatology recommends that patients on glucocorticoids can receive Shingrix, with concomitant low-dose glucocorticoids (prednisone equivalent <10 mg/day) not adversely impacting vaccine response, and patients on chronic high-dose glucocorticoids (≥20 mg/day prednisone equivalent) qualifying for vaccination starting at age 18 5, 2, 4
The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) notes that TNF-inhibitor treated patients develop significant humoral and cell-mediated responses, approximately half the response of healthy subjects but still clinically meaningful, with no cases of varicella infection or zoster occurring in 600 patients on TNF-inhibitors who received vaccination 5

The Infectious Diseases Society of America (IDSA) recommends vaccination regardless of prior shingles history, with vaccination ideally administered at least 2 months after acute symptoms resolve, and adults who previously received Zostavax should receive Shingrix at least 2 months after the last Zostavax dose 2, 4
The American Society of Clinical Oncology (ASCO) states that Shingrix is not contraindicated during neutropenia in cancer patients, as it is a non-live vaccine, and consider administering between chemotherapy cycles (>7 days after last treatment) when feasible to optimize vaccine response 2

The FDA states that the only contraindication to Shingrix is a history of severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine or after a previous dose 1