Special Indications for Shingrix Under Age 50

Immunocompromised Populations

The Centers for Disease Control and Prevention recommends Shingrix vaccination for adults aged 18 years and older who are or will be immunocompromised due to known disease or therapy, including those with immunodeficiency disease or on immunosuppressive therapy 1
Patients on chronic high-dose glucocorticoids (≥20 mg/day prednisone equivalent) qualify for early vaccination, as recommended by the American College of Rheumatology 2

The Advisory Committee on Immunization Practices recommends a shortened vaccination schedule for immunocompromised adults, with the first dose at Month 0 and the second dose at 1-2 months, as stated in the Clinical Infectious Diseases journal 1

The American Academy of Pediatrics and the Centers for Disease Control and Prevention state that Shingrix is not indicated for prevention of primary varicella (chickenpox), and patients without prior varicella immunity should receive varicella vaccine first if not contraindicated, as noted in the Clinical Infectious Diseases journal 1
The live-attenuated zoster vaccine (Zostavax) remains contraindicated in immunocompromised patients of any age, as recommended by the Infectious Diseases Society of America 1

Common adverse reactions, such as pain, fatigue, myalgia, and headache, are more frequent in transplant recipients aged 18-49 years, with an incidence of 88%, 64%, 58%, and 44%, respectively, as reported in the Autoimmunity Reviews journal 2

The American College of Physicians recommends that patients under age 50 who are currently immunocompromised or will become immunocompromised should receive Shingrix vaccination, as stated in the Diabetes Care journal 3
The International Society for Influenza and other Respiratory Virus Diseases recommends that immunosuppressed patients should be vaccinated against herpes zoster, as noted in the Journal of Microbiology, Immunology and Infection 4

The American College of Physicians recommends Shingrix as the preferred vaccine over Zostavax for adults aged 50 years and older, due to its superior efficacy, with 97.2% vaccine efficacy in adults aged 50+ years and 89.8% efficacy in adults aged 70+ years 5
Shingrix maintains protection above 83.3% for up to 8 years, decreasing to 73% at 10 years, making it a more durable option than Zostavax 5
The vaccine is effective against postherpetic neuralgia, with 88.8% efficacy in adults ≥70 years, reducing the risk of this debilitating complication 5

The Centers for Disease Control and Prevention recommends Shingrix as the only appropriate zoster vaccine for immunocompromised individuals, including those with solid organ malignancies, hematologic malignancies, and HIV/AIDS 5, 6
Shingrix is suggested as the preferred vaccine for patients with hematologic malignancies, including multiple myeloma, due to its demonstrated safety and efficacy 5
The vaccine is also recommended for hematopoietic stem cell transplant recipients and patients on immunosuppressive therapy, including those with autoimmune conditions on chronic glucocorticoids or other immunosuppressants 5, 6

Prior herpes zoster infection is not a contraindication to vaccination, and Shingrix is indicated regardless of previous shingles history, with vaccination recommended at least 2 months after acute symptoms resolve 6
Adults who previously received Zostavax should receive Shingrix, given Zostavax's poor long-term protection, with a minimum interval of 2 months between vaccinations 7