Shingrix is approved for the prevention of herpes zoster (shingles) and its associated complications, including post herpetic neuralgia (PHN).

Funded Shingrix eligibility

Two doses of Shingrix given two to six months apart are funded at the age of 65 years.
(A second dose is funded before turning 67 years if the first dose was given at 65 years).

From 1 July 2024, two doses are also funded for people 18 years of age or older with any of the following:

• pre- and post- haematopoietic stem cell transplant or cellular therapy
• pre- or post- solid organ transplant
• haematological malignancies
• people living with poorly controlled HIV infection
• planned or receiving disease modifying anti-rheumatic drugs (DMARDs - targeted synthetic, biologic, or conventional synthetic) for:
  • polymyalgia rheumatica
  • systemic lupus erythematosus
  • rheumatoid arthritis
• end stage kidney disease (CKD 4 or 5)
• primary immunodeficiency

‍

Recommended, but not funded use of Shingrix

Two doses of Shingrix are recommended, but not funded for all individuals aged from 50 years, including those aged 66 years and over; and for individuals aged from 18 years who are at increased risk of zoster (excluding the eligible conditions above), including:

• prior to planned, receiving or post immunosuppressive therapy
• living with HIV infection
• with immune-mediated inflammatory disease receiving immunomodulatory agents (eg, inflammatory bowel disease, Crohn’s disease, ulcerative colitis).

Other conditions that can increase risk of zoster in older adults, include:

• diabetes
• chronic obstructive pulmonary disease
• chronic inflammatory skin diseases
• splenectomy
• chronic pancreatitis
• psychiatric disorders, including depression and anxiety
• sleep disorders.

‍

Shingrix after zoster episode

Shingrix may be offered to individuals who previously had Zostavax (live zoster vaccine) and/or have a history of zoster episodes.

Allow 12 months after an episode of zoster has resolved before giving Shingrix. Since the immune system will have been activated against the varicella-zoster virus by these events, there is likely to be little additional short-term benefit in giving it sooner. This may be shortened to at least three months for those who are immunocompromised with the highest risk of zoster recurrence. Those with ophthalmic shingles are advised to wait for 12 months after the disease is completely settled because there are reports of flares after Shingrix vaccine.

‍

Storage and preparation

Store in a refrigerator (2°C – 8°C). Do not freeze. Store in the original package in order to protect from light.

‍

Administration

Give two doses, the second dose is given two to six months after the first. The vaccine should be administered intramuscularly, only. The preferred site is into the deltoid muscle.

Shingrix can be administered concurrently with other vaccines, including all National Immunisation Schedule vaccines, such as 23PPV and Tdap. Separate syringes and different injection sites should be used.

There is data to support the co-administration of Shingrix and Arexvy, both of which contain the same adjuvant. Studies showed no differences in immunogenicity when administered together. Note that mild to moderate reactions can occur more frequently with co-administration, but these are short lived.

The safety and efficacy of administering two different adjuvanted vaccines together is not yet established. Shingrix and Fluad Quad (adjuvanted seasonal influenza vaccine) utilise novel adjuvants to gain a good immune response. Patients should be informed of the possibility of a stronger post-vaccination response, where two or more of these are administered together.

There are currently no recommendations around giving further doses or booster doses of Shingrix.

Shingrix should not be given to:

• Anyone with severe allergy (anaphylaxis) to a previous dose of this vaccine or a component of the vaccine
• Administration of Shingrix should be postponed in individuals suffering from a fever over 38°C. The presence of a minor infection is not a reason to delay immunisation

Specialist advice should be sought for the following groups:

This vaccine is for intramuscular injection only.

For those with bleeding disorders, such as haemophilia or thrombocytopenia, the vaccine should be administered in accordance with the haematologist’s instructions.

The Shingrix datasheet from Medsafe can be found here.

During phase 3 clinical trials (ZOE-50 and ZOE-70), Shingrix had efficacy against both zoster and associated complications of over 90 percent efficacy in adults aged over 50 years, including those aged from 70 years and those with medical conditions that increase their risk of zoster. Pooled vaccine efficacy was 91% (95% CI 87-95) against the incidence of zoster overall and 91% (86-98% against post-herpetic neuralgia across all age groups). No decline was observed in increased age with efficacy of 91% (80-97) against zoster in those aged over 80 years.

Ongoing long-term follow-up of these trial participants found efficacy against zoster plateaued after four to six years and was sustained overall at 84 percent for at least seven years post-vaccination.

Post-hoc analysis found the efficacy of Shingrix against zoster remained over 90% in participants with select medical conditions (eg. hypertension, diabetes, coronary heart disease, respiratory disorders). Other studies have investigated the use of Shingrix in participants aged from 18 years with severely immunocompromising conditions. Vaccine efficacy of 68.2% (95% CI 55.6-77.5%) was seen for HSCT recipients, 87.2% (44.3-98.6%) in patients with haematological malignancies and 90.5% (73.5-97.5%) for immune-mediated diseases (including psoriasis, rheumatoid arthritis and spondyloarthropathy). Efficacy against post herpetic neuralgia was 89% (22-100%) and against zoster-related hospitalisation was 85% (32-97%) in patients following HSCT.

Real world effectiveness of two doses of Shingrix against zoster of 70.1% (68.6-71.5) was shown in an observational study in the US in Medicare beneficiaries aged 65 years or older. Similar effectiveness was seen for those aged over 80 years, from six or more months after vaccination and for those with autoimmune conditions. Effectiveness of two doses against post herpetic neuralgia was 76.0% (68.4-84.8). The lower effectiveness compared with clinical trials was likely due to how zoster was notified in clinical notes as ‘suspected cases’ rather than being PCR-confirmed as in clinical trials.

• Cunningham AL, Lal H, Kovac M, Chlibek R, Hwang SJ, Diez-Domingo J, et al. Efficacy of the herpes zoster subunit vaccine in adults 70 years of age or older. NEJM. 2016;375(11):1019-32.
• Oostvogels L, Heineman TC, Johnson RW, Levin MJ, McElhaney JE, Van den Steen P, et al. Medical conditions at enrolment do not impact efficacy and safety of the adjuvanted recombinant zoster vaccine: a pooled post-hoc analysis of two parallel randomized trials. Hum Vacc Immunother. 2019;15(12):2865-72.
• Lal H, Cunningham AL, Godeaux O, Chlibek R, Diez-Domingo J, Hwang SJ, et al. Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. NEJM. 2015;372(22):2087-96.
• Boutry C, Hastie A, Diez-Domingo J, Tinoco JC, Yu CJ, Andrews C, et al. The adjuvanted recombinant zoster vaccine confers long-term protection against herpes zoster: Interim results of an extension study of the pivotal phase III clinical trials (ZOE-50 and ZOE-70). Clin Inf Dis. 2021.
• Anderson TC, Masters NB, Guo A, Shepersky L, Leidner AJ, Lee GM, et al. Use of recombinant zoster vaccine in Immunocompromised adults aged ≥19 Years: recommendations of the Advisory Committee on Immunization Practices - United States, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(3):80-4.
• Racine E, Gilca V, Amini R, Tunis M, Ismail S, Sauvageau C. A systematic literature review of the recombinant subunit herpes zoster vaccine use in immunocompromised 18-49 year old patients. Vaccine. 2020;38(40):6205-14.
• Izurieta HS, Wu X, Forshee R, et al. Recombinant Zoster Vaccine (Shingrix): Real-world effectiveness in the first 2 years post-licensure. Clin Infect Dis. 2021;73(6):941-8.
• Health New Zealand | Te Whatu Ora, Immunisation handbook [Internet]. Available from: https://www.tewhatuora.govt.nz/for-health-professionals/clinical-guidance/immunisation-handbook
• Schwarz TF, Aggarwal N, Moeckesch B, Schenkenberger I, Claeys C, Douha M, et al. Immunogenicity and Safety of an Adjuvanted Herpes Zoster Subunit Vaccine Coadministered With Seasonal Influenza Vaccine in Adults Aged 50 Years or Older. J Infect Dis. 2017;216(11):1352-61.