SHINGRIX INJ 1`S

Shingrix is a vaccine used to protect adults aged 50 years and older against herpes zoster (shingles) and its most common complication, post-herpetic neuralgia (PHN) — a prolonged, often severe nerve pain that can persist for months or years after a shingles rash.

Shingles is caused by the reactivation of the varicella-zoster virus (VZV) — the same virus that causes chickenpox — which lies dormant in nerve tissue after the initial infection. The risk of shingles and its complications increases significantly with age and in individuals with weakened immune systems.

Shingrix is also recommended for immunocompromised adults aged 18 years and older (e.g. those with HIV, haematological malignancies, or those receiving immunosuppressive therapy), based on its non-live, adjuvanted formulation which is safe even in these populations.

Shingrix is given as two separate intramuscular (IM) injections into the deltoid (upper arm) muscle, administered by a healthcare professional. The second dose is given 2–6 months after the first dose. In immunocompromised patients, the second dose may be given 1–2 months after the first.

The vaccine must be reconstituted immediately before use by combining the antigen component (lyophilised powder) with the AS01B adjuvant suspension. Gently swirl — do not shake vigorously. The reconstituted vaccine should be used within 6 hours.

Shingrix can be given to immunocompromised individuals — it is a non-live vaccine. Minor illness (e.g. cold) is not a contraindication; defer only for significant acute illness with fever.

•       Concomitant influenza vaccine: may be given at the same time at different sites; no significant interaction.

•       Concomitant pneumococcal vaccine (PPSV23): clinical data show Shingrix can be co-administered with PPSV23.

•       Immunosuppressive therapy: may reduce immune response but Shingrix is still recommended and preferred over live zoster vaccine (Zostavax) in immunocompromised patients.

•       Antivirals (aciclovir, valaciclovir, famciclovir): these may reduce vaccine response — ideally avoid within 24 hours before and 14 days after vaccination if possible.

Store at 2–8°C (refrigerate). Do not freeze. The lyophilised antigen vial and adjuvant vial must both be stored refrigerated until use. Once reconstituted: administer within 6 hours at room temperature. Discard any unused reconstituted vaccine.

Shingrix is highly effective — clinical trials show 97% efficacy against shingles in adults 50–69 years and 91% in adults 70 years and older, maintained for at least 10 years of follow-up data available to date. This is substantially better than the older live vaccine (Zostavax).

The AS01B adjuvant in Shingrix is what makes it so effective — it strongly activates the immune system. This is also why reactogenicity (arm pain, fatigue, fever, muscle ache) is more pronounced than with many other vaccines, especially after the second dose. These reactions, while uncomfortable, are signs that your immune system is responding well. They typically last 1–3 days.

Plan to receive the vaccine at a time when temporary fatigue or mild flu-like symptoms for 1–2 days would be manageable (e.g. not immediately before an important event).

Shingrix is the preferred zoster vaccine in all eligible adults — it is superior to Zostavax (live vaccine) in efficacy, duration of protection, and suitability in immunocompromised patients. The 2-dose schedule is mandatory for full protection; the interval may be shortened to 1–2 months in immunocompromised adults.

Efficacy against post-herpetic neuralgia (the most debilitating complication of shingles) exceeds 88%. Reactogenicity, especially systemic reactions after dose 2, is significantly higher with Shingrix than with most adult vaccines — counsel patients thoroughly to improve adherence to the second dose. Reconstitution: use only the supplied adjuvant — do not reconstitute with saline or water for injection.

Can I get shingles from this vaccine?

No — Shingrix is a non-live, recombinant subunit vaccine. It contains only a protein from the virus surface (glycoprotein E) and an adjuvant. It cannot cause shingles or chickenpox.

I already had shingles — do I still need this vaccine?

Yes — a past episode of shingles does not reliably protect against future recurrence. Shingrix is recommended even if you have previously had shingles.

Why do I feel so unwell after the injection?

The AS01B adjuvant system in Shingrix is designed to produce a powerful immune response. The short-term flu-like symptoms (fatigue, muscle ache, fever, arm pain) are a normal result of immune activation — they typically resolve within 1–3 days and confirm the vaccine is working.

Is Shingrix covered by insurance / free on the national programme?

Coverage varies by country and health system. Your pharmacist or GP can advise on current local funding arrangements.

Does Shingrix also protect against chickenpox?

Shingrix is designed to boost immunity against VZV reactivation (shingles) — it is not licensed or indicated for primary chickenpox prevention. Separate chickenpox vaccines exist for that purpose.