Vaccine Info

Shingrix Shingles Vaccine

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Last reviewed
January 9, 2023

Shingrix® Shingles Vaccine

GlaxoSmithKline plc (GSK) Shingrix® is a non-live, adjuvanted recombinant shingles vaccine (zoster) consisting of the varicella-zoster virus glycoprotein E antigen and the AS01B adjuvant system, a proprietary adjuvant containing QS-21 and MPL with liposomes

The Shingrix vaccine has been commercially available in the U.S. since 2017. Shingrix has been found up to 90% effective in various clinical trials, says GSK. In addition, Shingrix works to boost human immune systems as people age, which increases the risk of shingles. On October 19, 2022, GSK confirmed New Shingrix could provide at least ten years of protection against shingles in adults over 50. In addition, the National Institute on Aging says, 'the shingles vaccine is safe and easy, and it may keep people from getting shingles and ongoing pain called postherpetic neuralgia.

On February 25, 2021, U.S. Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP)  Herpes Zoster Work Group presented the results of a comprehensive risk-benefit analysis of Shingrix that included a review of post-marketing data. The analysis of clinical trials, observational studies, and risk-benefit analysis confirm the considerable benefits of Shingrix vaccination in preventing HZ, severe disease, and complications.

GSK announced on July 26, 2021, that the U.S. Food and Drug Administration (FDA) had approved Shingrix to prevent shingles in adults aged 18 years or older who will be at increased risk of shingles due to immunodeficiency or immunosuppression caused by known disease or therapy. And the UK Health Security Agency confirmed in September 2021 that people who are 70 to 79 years of age with weakened immune systems would be offered the Shingrix vaccine to help protect them against shingles. 

On October 20, 2017, the U.S. FDA issued its authorization: STN: 125614. The EMA issued EMEA/H/C/004336 on March 21, 2018. On August 18, 2021, Public Health England announced that GPs should offer the non-live shingles vaccine Shingrix to all eligible for shingles vaccination but are clinically contraindicated to receive the live vaccine Zostavax® due to their immunocompromised status.

London, England-based GlaxoSmithKline is the producer of Shingrix. GSK's top priority is patient safety.

Shingrix Protection

GSK announced on October 19, 2022, interim data from a phase 3 clinical trial demonstrated overall efficacy of greater than 80% over the follow-up period of approximately six to 10 years after the initial vaccination.

On January 21, 2022, the CDC's Morbidity and Mortality Weekly Report confirmed the Advisory Committee on Immunization Practices previously recommended two doses (0.5 mL each) for the prevention of herpes zoster and related complications in immunodeficient or immunosuppressed adults aged ≥19 years. In addition, the U.S. CDC published updated Shingrix vaccination schedules for 2022.

Shingrix Vaccine Price

The majority of patients pay an out-of-pocket cost of less than $50 per dose, says GSK. The U.S. CDC Vaccine Price List - $171 - was last updated in August 2022. Vaccine prices and discount information are posted at InstantRx™.

Shingrix Availability

Shingrix was available in 23 countries in 2022. In December 2022, ET reported that Piyali Mukherjee, GSK's vice president and head of global medical affairs, and vaccines, indicated India's drug regulator might authorize Shingix in 2023.

Shingrix Indication

Shingrix is a non-live vaccine for preventing shingles (herpes zoster) in adults 50 years and older. If you're one of the 99% of adults over 50 years old who have had chickenpox, the virus that causes shingles is inside your body and can reactivate anytime. Shingrix is not used to prevent primary varicella infection (chickenpox). The US FDA approved Shingrix on July 26, 2021, to prevent shingles in adults 18 years and older who will be at increased risk of shingles due to immunodeficiency or immunosuppression caused by known disease or therapy. However, for adults who are or will be immunodeficient or immunosuppressed due to known disease or treatment and who would benefit from a shorter vaccination schedule, the second dose can be administered 1 to 2 months after the first dose.

On June 25, 2021, the CDC's ACIP meeting reviewed 'Zoster Vaccines Session: Burden of Herpes Zoster in Immunocompromised Adults' and GSK's presentation: 'Use of Recombinant Zoster Vaccine in Immunocompromised Populations.'

The American Academy of Dermatology Journal reported that among people who had a first-time shingles attack, approximately 4% had another outbreak later. In addition, those ages 45 to 54 had a recurrence after two years on average, while people ages 55 and older had one three years later on average. Given the recurrence rates, the researchers said that people who'd already had shingles would still benefit from getting the vaccine, stated Harvard Health. And a study published on May 15, 2020, in ACR Open Rheumatology showed that the vaccine did not prompt flares of rheumatoid conditions.

Shingrix Use For Immunocompromised Adults

The CDC guideline for recombinant zoster vaccine (RZV) was updated on September 15, 2022. The re-administration dose of RZV should be administered 6-12 months after hematopoietic stem cell transplant (HSCT) if the transplant was allogeneic and should be administered 3-12 months after HSCT if the transplant was autologous. In addition, the CDC stated on Feb. 17, 2022: that the Shingrix vaccine is recommended for persons 19 years old and older who have altered immunocompetence. And vaccination of Contacts of Persons with Altered Immunocompetence Household contacts and other close contacts of persons with altered immunocompetence should receive all age- and exposure-appropriate vaccines, except for the smallpox vaccine.

During the U.S. CDC's Advisory Committee on Immunization Practices (ACIP) meeting on October 20, 2021, Tara Anderson, DVM, MPH, Ph.D., presented: Interpretation of the EtR Regarding Use of RZV in Immunocompromised Adults, Considerations for Use, and Proposed Policy Options. The ACIP's Recommendation is: Two doses of recombinant zoster vaccine are recommended for adults aged ≥19 years who are immunodeficient or immunosuppressed due to disease or therapy to prevent herpes zoster and its complications.

Previously, Camille Nelson Kotton, M.D., Chair, ACIP Herpes Zoster Work Group, presented the Introduction Zoster Vaccines Session on September 29, 2021; Ismael R. Ortega-Sanchez, Ph.D. presented 'Economics of vaccinating immunocompromised 19–49-years-old adults against herpes zoster in the USA; Tara Anderson, DVM, MPH, Ph.D. presented 'Preliminary Evidence to Recommendations Framework Regarding Use of Recombinant Zoster Vaccine in Immunocompromised Adults and Next Steps.'

GSK says people should not receive Shingrix if they are allergic to its ingredients or have had an allergic reaction to a previous dose of Shingrix.

Shingrix and COPD

The peer-review Journal of the COPD Foundation® published Herpes Zoster Awareness and Vaccine Recommendations for Patients with COPD. Conclusions: Significant educational opportunities exist for HCPs related to HZ and its vaccine prevention among patients with COPD, which may be responsive to brief targeted interventions.

Shingrix Dosage

Shingrix is a suspension for intramuscular injection only. It is supplied in 2 vials (0.5 mL each) that must be combined before administration. Two doses are necessary to provide strong protection, up to 90%, the first dose at Month 0, followed by a second dose administered between 2 and 6 months anytime. The Shingrix vaccine series is administered as an injection into the upper arm's muscle. Therefore, it is essential to complete the 2‑dose series to help prevent shingles. The CDC has stated: If more than six months have elapsed since the 1st Shingrix dose, administer the 2nd dose as soon as possible. Do not restart the Shingrix vaccine series.

Shingrix Side Effects

The U.S. FDA Safety Communication issued a notice on March 24, 2021, to inform the public and healthcare providers that FDA has required and approved safety labeling changes to the Prescribing Information for Shingrix (Zoster Vaccine Recombinant, Adjuvanted) based on post-marketing experience. The revised label includes Guillain-Barré Syndrome (GBS) in the "Warnings and precautions" section. In addition, a case series cohort study published by the JAMA Internal Medicine on November 1, 2021, found an increased risk of Guillain-Barré syndrome during the 42 days following RZV vaccination in seniors: about three excess GBS cases per million vaccinations. Therefore, clinicians and patients should be aware of this risk while considering the benefit of decreasing the risk of herpes zoster and its complications through an efficacious vaccine, as a risk-benefit balance remains in favor of vaccination.

Shingles and COVID-19

The Journal of Infectious Diseases published research on June 1, 2022 that concluded RZV vaccination was associated with a 16% lower risk of COVID-19 diagnosis and a 32% lower risk of hospitalization. 

The journal Open Forum Infectious Diseases published a study on March 9, 2022, which found a COVID-19 diagnosis in 50-year-old people (+) was associated with a significantly increased risk (15% higher) of developing HZ. And a previous peer-reviewed study using relative rates estimated that there had been an excess of approximately 5 and 7 cases of hospitalization due to herpes zoster after every 1 million doses of CoronaVac and BNT162b2 vaccination, respectively. And a nested case-control analysis showed similar results. Finally, on February 16, 2022, a study found that mild and infrequent HZ reactions may occur shortly after mRNA COVID-19 vaccination, at a higher frequency than reported with influenza vaccination, especially in patients over 40. 

Shingrix Billing Codes

SHINGRIX has broad insurance coverage for patients. The CPT Code (Product) is 90750. Additional codes are found at this GSK link. In addition, the GSK Vaccines Reimbursement Support Center is a resource for physicians, physician office staff, and pharmacists to address billing, coding, and reimbursement for GSK vaccines.

Shingles Herpes Zoster

Shingles, also known as herpes zoster (HZ), is a painful skin rash caused by reactivation of the varicella-zoster virus, which causes chickenpox, says the U.S. CDC. If you've had chickenpox, you are at risk for shingles. And 

Shingrix Revenues For 2021

Shingrix sales more than doubled to £731 million in 2Q'22, primarily due to demand recovery, strong commercial execution aimed at shifting the shingles vaccination season forward, and earlier-than-expected channel inventory in the US and higher demand in Germany. All regions grew significantly in Q2 2022, with 40% of the growth contributed from outside of the US.

On April 27, 2022, GSK reported vaccine turnover grew 36% AER and 36% CER to £1,669 million, driven primarily by Shingrix (£698, 100%) in the US and Europe. As a result, the global shingles vaccine market is poised to grow by USD 1.08 billion from 2020-2024, progressing at a CAGR of over 7% during the forecast period.

Shingrix News 2018 - 2022

November 26, 2022 - BMC Infectious Diseases published: Willingness to accept herpes zoster vaccines and the influencing factors in China. Vaccine hesitancy is multifaceted and might require multisectoral and multidisciplinary strategies to engage in conversations addressing public concerns. 

October 19, 2022 - Sabine Luik, Chief Medical Officer & SVP of Global Medical Regulatory & Quality, GSK, said in a press release: "The findings from ZOE-LTFU demonstrate that (Shingrix) can provide a decade of protection against the pain, debilitating impact and potentially severe complications that shingles can cause in people aged 50 and over."

April 13, 2022 - The global shingles vaccine market size is expected to reach USD 6.35 billion by 2028 and expand at a CAGR of 9.9% from 2021 to 2028.

March 14, 2022 - Australia's Shingrix became available on the private market to prevent shingles and postherpetic neuralgia in adults at increased risk of shingles.

March 10, 2022 - The U.S. FDA confirmed Recall Number: B-0264-2022 of 130,500 doses of Shingrix has been closed. The company issued the voluntary recall early last year after one customer reported an empty antigen vial, and another customer said there was an "abnormal appearance of the antigen powder in a vial," a GSK spokesperson told Fierce Pharma.

February 17, 2022 - The U.S. CDC added the Zoster vaccine to the list of vaccines for which altered immunocompetence is an indicated recommendation for vaccination in persons 19 years old and older.

December 28, 2021 - The Swiss Medical Weekly published an ORIGINAL ARTICLE - Complications and cost estimations in herpes zoster – a retrospective analysis at a Swiss tertiary dermatology clinic. CONCLUSION: In this herpes zoster population at a university hospital, one in three patients was affected by herpes zoster-related complications. Age and cancer were independently associated with a high complication rate, suggesting a need to vaccinate cancer patients. Herpes zoster-related complications and the need for inpatient treatment escalated the costs per case.

December 22, 2021 - In a global survey of adults aged 50 and above, only 7% believe they are at high risk of developing shingles.

December 9, 2021 - AARP published: Common but Misunderstood: 6 Myths About Shingles.

December 1, 2021 - Harvard Health reported unvaccinated people who get shingles for the first time should still receive Shungrix to reduce their risk of future attacks, says a study published Sept. 1, 2021, in the Journal of the American Academy of Dermatology.

November 25, 2021 - GlaxoSmithKline Inc. announced that the SHINGRIX vaccine had been approved in Canada to prevent shingles in adults aged 18 years and older who are or will be at increased risk of shingles due to immunodeficiency or immunosuppression caused by known disease or therapy. Immunocompromised individuals are at greater risk of shingles and associated complications than immunocompetent individuals. 

November 24, 2021 - Local media in Canada reported the Shingrix vaccine would be available to Prince Edward Islanders who are 65 and older for free beginning in January 2022.

November 1, 2021 - The JAMA Network published an Original Research: Risk of Guillain-Barré Syndrome Following Recombinant Zoster Vaccine in Medicare Beneficiaries. In an observational study of Medicare beneficiaries, a medical record-based, self-controlled analysis of GBS cases after RZV vaccination identified a rate ratio of 2.84 between the risk and control windows, resulting in an attributable risk of 3 cases per million RZV (Shingrix) doses. This means these findings suggest an increased risk of developing GBS following vaccination with RZV.

October 27, 2021 - GSK announced Shingrix revenues reached £502 million, representing a +41% CER.

October 20, 2021 - GlaxoSmithKline plc announced that the US CDC Advisory Committee on Immunization Practices voted unanimously to recommend two doses of Shingrix for the prevention of shingles and its complications in adults 19 years of age and older who are or will be immunodeficient or immunosuppressed due to disease or therapy.

October 20, 2021 - The U.S. CDC vaccine committee presented a Herpes Zoster Introduction and Workgroup Recommendation.

September 29, 2021 - The U.S. CDC ACIP committee presented various overview slides during its meeting.

September 2, 2021 - Shingrix has been licensed in the UK to prevent shingles in adults aged 50 years and older and in adults 18 years of age or older who are at increased risk of shingles. The vaccine will be available for eligible adults to purchase via pharmacy chains, private GP clinics, and other healthcare settings in the UK. In addition, GPs should offer the non-live shingles vaccine Shingrix to all eligible for shingles vaccination but who are clinically contraindicated to receive the live vaccine Zostavax due to their immunocompromised status.

September 1, 2021 - Karen Mullen, Medical Director UK & Ireland, GSK, stated: "The risk of shingles increases with age as the immune system gradually becomes less effective in mounting a strong response to infection. Shingrix was developed to overcome this decline in immune function and help protect people as they age. We are pleased that people in the UK will now have access to this vaccine to help reduce the burden of this painful disease."

July 28, 2021 - GSK reported its financial results. Shingrix declined by 9% AER but grew 1% CER to £295 million. Growth from launches in the UK and China was mostly offset by a decline in Germany, where COVID-19-related restrictions and prioritization of COVID-19 mass vaccination limited Shingrix uptake. In the US, increased market demand in the current quarter was offset by favorable prior period returns, rebates movements, and channel stocking in the comparator quarter.

July 26, 2021 - GSK announced that Shingrix is now U.S. FDA-approved to prevent shingles in immunocompromised adults. In a press statement, Thomas Breuer, Chief Medical Officer, GSK Vaccines, stated, "Older age and being immunocompromised are the most common risk factors for shingles disease. GSK is committed to this important patient population at increased risk for shingles disease and its complications by bringing them a vaccine option to help prevent this painful condition."

June 25, 2021 - Grace Lee, M.D., MPH, led the ACIP Herpes Zoster Work Group overview presentation; Zoster Vaccines Session: Burden of Herpes Zoster in Immunocompromised Adults: Policy question: "Should vaccination with RZV be recommended for immunocompromised adults 19 years of age and older?" Then, Robyn Widenmaier, GSK's Global Medical Portfolio Lead, Zoster Vaccine, led this discussion regarding the Use of Recombinant Zoster Vaccine in Immunocompromised Populations.

April 28, 2021 - GSK reported quarterly sales of Shinrix decreased by about 47%.

March 24, 2021 - The FDA required GlaxoSmithKline, the manufacturer of Shingrix, to revise the Prescribing Information to include the following language in the Warnings and Precautions section: In a post-marketing observational study, an increased risk of Guillain-Barré syndrome was observed during the 42 days following vaccination with Shingrix. In addition, the association between vaccination with Shingrix and GBS was evaluated among Medicare beneficiaries aged 65 years or older.

February 25, 2021 - U.S. CDC ACIP Meeting presentation: Summary of the Herpes Zoster Work Group's Interpretation of Recombinant Zoster Vaccine Safety Data.

February 9, 2021 - WebMD reported searches for the term "covid shingles" were recently searched. "There is no scientific evidence of this [association]," says Aaron Glatt, MD, chief of infectious diseases at Mount Sinai South Nassau in Oceanside, NY, and a spokesperson for the Infectious Diseases Society of America.

February 4, 2021 - GlaxoSmithKline plc reported fourth-quarter 2020 sales from the Vaccines segment were up 16% at CER, driven by the strong recovery in demand for Shingrix: sales rose 23% reported quarter, driven by strong demand in Europe.

January 13, 2021 - The UK's Public Health England update stated: People aged 70 are eligible for the vaccine. By having the vaccination, you will significantly reduce your chance of developing shingles. In fact, in the first three years since the vaccine was introduced, there were about 17,000 fewer GP consultations for shingles. And, if you do go on to have shingles, the symptoms are likely to be milder and the illness shorter than if you had not had the vaccination. Like all licensed vaccines, the shingles vaccine has been thoroughly tested and meets the UK and European safety and licensing requirements. It has been used extensively in several countries, including the United States of America and Canada. In the first four years of the shingles vaccination program, more than 2.3 million people were vaccinated in England.

December 14, 2020 - Most Medicare beneficiaries who received an initial dose of the Shingrix vaccine received the second dose within six months. Still, follow-up rates were lower among beneficiaries in communities of color, those younger than age 65 with long-term disabilities, and low-income beneficiaries. Most (74%) Medicare beneficiaries who received an initial dose of Shingrix between January and June 2018 received the second dose within six months. Conversely, 1 in 4 beneficiaries (26%) who received an initial dose of Shingrix between January and June 2018 did not receive the second dose within the recommended timeframe. An additional 6% of beneficiaries received the second dose after the 6-month timeframe but no later than the end of 2018. This analysis is based on 2018 Medicare Part D prescription drug event claims data from a 20% sample of Medicare beneficiaries from the Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse. Our analysis includes 0.8 million Part D enrollees enrolled for the entire 2018 calendar year and received an initial shot of Shingrix between January and June 2018.

January 4, 2021 - The U.S. CDC updated its Shingrix frequently asked questions webpage for health care providers with guidance on shingles vaccination during the COVID-19 pandemic. Shingles vaccination is an essential preventive care service for older adults that should not be delayed or discontinued because of the COVID-19 pandemic unless a patient is suspected or confirmed to have COVID-19.

November 23, 2020 - Updated study: Recombinant Zoster Vaccine Is Efficacious and Safe in Frail Individuals. The relatively nonrestrictive inclusion/exclusion criteria in the parent ZOE studies resulted in a range of participants, including frail and pre‐frail older adults. RZV significantly reduced the risk of herpes zoster across all frailty subgroups.

May 22, 2019 - China's National Medical Product Administration (NMPA) announced the 'conditional approval' for Shingrix.

July 9, 2019 - GSK Herpes Zoster Vaccine Shingrix reduced the incidence of herpes zoster in autologous stem cell transplant recipients. Among adults who had undergone autologous HSCT, a 2-dose course of recombinant zoster vaccine compared with placebo significantly reduced the incidence of herpes zoster over a median follow-up of 21 months.

January 26, 2018 - Recommendations of the CDC's Advisory Committee on Immunization Practices for the Use of Herpes Zoster Vaccines.

Shingrix Clinical Trials 

ZOSTER-049 is an open-label, long-term follow-up study from two pivotal phase III randomized clinical trials (ZOE-50, ZOE-70). The study is evaluating the efficacy, safety, and immunogenicity for six additional years after the completion of the ZOE-50 and ZOE-70 studies. In the interim analysis conducted over the >4 years of long-term follow-up, representing up to 10 years since immunization (mean: from 5.6 (±0.3) to 9.6 (±0.3) years post-vaccination), vaccine efficacy was 81.6%. From 1 month post-second dose in those initial studies up to year 10 post-vaccination (mean: 9.6 (±0.3) years post-vaccination), vaccine efficacy was 89.0%. The safety profile observed in this extension study is consistent with the established safety profile of the vaccine. No new safety concerns were identified. The incidence of serious adverse events was consistent with the age of the study population. No deaths or other Safety Adverse Events (SAE) considered related to vaccination were reported. Five cases of HZ-related complications (PHN - 3 cases and HZ disseminated disease - 2 cases) were reported.

A total of 7,413 participants were enrolled in the study's Safety cohort. The participants were 60.7% female. Participants were 76% White-Caucasian/European heritage, 18.7% Asian, and 5.3% Other.

ZOSTER-049 is being conducted in 18 countries/regions, including Australia, Brazil, Canada, Czech Republic, Estonia, Finland, France, Germany, Hong Kong, Italy, Japan, Republic of Korea, Mexico, Spain, Sweden, Taiwan, the United Kingdom and the U.S.

Clinical Trials