Rx Shorts: Zoster Vaccination Pearls

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By now you are well aware of the increased efficacy of recombinant varicella zoster vaccine (Shingrix) over the formerly favored live vaccine (Zostavax) in preventing shingles. However, you might find the following clinical pearls helpful when a patient is concerned about vaccine cost or has already received Zostavax and now wonders if vaccination with Shingrix is appropriate.

Cost. The complete 2-shot series of Shingrix is only about 25% more expensive than a one-time vaccination with Zostavax. The vaccine will be billed under the patient’s prescription benefit (including Medicare Part D) at the pharmacy so there may be a copay for both doses. Anecdotally, coverage for Shingrix has been fairly broad already with expanding payer coverage expected beginning in April 2018 according to GlaxoSmithKline.

Steroids. Low dose immunosuppressive therapy with <20 mg of prednisone or its equivalent daily is not enough to discourage vaccination with Shingrix.   

Do Over? If more than 6 months has lapsed between the first and second dose of Shingrix, it is not necessary to restart the series. Two doses are required regardless of the interval between vaccinations with optimal timing of the second dose occurring 2 to 6 months after initial vaccination.

Timing. Patients who have already received Zostavax but require the Shingrix series should wait at least 2 months after receiving Zostavax. Studies have only been conducted on the safety and efficacy of receiving Shingrix 5 years post-Zostavax vaccination; however, there is no theoretical contraindication that would rule out receiving Shingrix before the 5-year mark is reached. The 2-month minimum separation is solely based on expert opinion.

Additional Reading

Dooling KL, Guo A, Patel M, et al. Recommendations of the Advisory Committee on Immunization Practices for use of herpes zoster vaccines. MMWR Morb Mortal Wkly Rep 2018;67:103–108. DOI:

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Rx Shorts provides PCPs with brief, timely updates on a wide variety of matters surrounding prescription drugs. Label changes, supplemental NDAs, FDA advisories, recalls, black box additions, patent expirations, off label uses-the topics will be as varied as the pharma news itself. Author Matthew Baker, PharmD, of Lufkin, TX, serves as the Patient Care eyes and ears in the pharmaceutical realm.