A Clinician’s Handbook for Childhood & Adult Immunizations in Georgia

Recombinant Zoster Vaccine (RZV) Shingrix

Pathophysioloy

  • A manifestation of the reactivation of varicella zoster virus which, as a primary infection, produces chickenpox (varicella). Following initial infection, the virus remains latent in the dorsal root or cranial sensory ganglia until it reactivates, producing zooster.
  • Zoster is characterized by a unilateral, painful, vesicular cutaneous eruption with a dermatomal distribution.

Vaccine Description

Recombinant zoster vaccine, adjuvanted

Dose & Route

  • 0.5 mL single dose unit given IM.
  • Reconstituted with the accompanying vial ofASO1B adjuvanted suspension component

Administration Schedule & Minimum Intervals

Dose          Minimum Age

Dose 1……….50 years and older
Dose 2……….2 to 6 months after dose 1; minimum interval 4 weeks; repeat dose if administered too soon regardless of previous herpes zoster or history of zoster vaccine live (ZVL, Zostavax) vaccination 

  • RZV is recommended for the prevention of herpes zoster and related complications for immunocompetent adults aged ≥ 50 years.

  • RZV is recommended for prevention of herpes zoster and related complications for immunocompetent adults who previously received zoster vaccine live (ZVL).

  • RZV may be used in adults aged ≥ is preferred over ZVL for the prevention of herpes zoster and related complications.

  • RZV may be used in adults aged ≥ 50 years irrespective of prior receipt of varicella vaccine or ZVL and does not require screening for a history of chickenpox (varicella).

Contraindications

  • History of severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine or after a previous dose of SHINGRIX.

Precautions

  • Moderate or severe acute illness.

Special Considerations

  • Consider delaying RZV until after pregnancy if RZV is otherwise indicated

  • Sever immunocompromising conditions (including HIV infection regardless of CD4 count**): 2-dose series recombinant zoster vaccine (RZV, Shingrix) 2-6 months apart; minimum interval 4 weeks; repeat dose if administered too soon.

  • If there is no documented history of varicella, varicella vaccination, or herpes zoster providers should refer to the clinical considerations for use of RZV in immunocompromised adults aged ≥ 19 years and the ACIP varicella vaccine recommendations for further guidance; Use of Recombinant Zoster Vaccine in Immunocompromised Adults Aged ≥19 Years: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022 | MMWR (cdc.gov)

  • This vaccine is not a substitute for varicella vaccine and should never be administered to children.

  • Not indicated for treatment of herpes zoster (shingles) or postherpetic neuralgia

  • The duration of protection after vaccination is unknown.

  • RZV is stored in the refrigerator at 36˚F to 46˚F (2˚C to 8˚C)

  • After reconstitution, administer immediately or store refrigerated and use within 6 hours. Discard reconstituted vaccine if not used within 6 hours.

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