I have a patient who is 52 years old and is immigrating to the U.S. She received a dose of recombinant zoster vaccine at age 50. The immigration requirements state she should receive 2 doses of varicella vaccine. Does she need additional varicella vaccine?

Recombinant zoster vaccine (RZV, Shingrix, GSK) does not count as the first of two doses of varicella vaccine. Shingrix is not licensed and has not been evaluated for the prevention of primary varicella infection. To meet the immigration requirements, you should give a dose of varicella vaccine now and a second dose at least 4 weeks later. The varicella vaccine doses will not be harmful and will allow your patient to meet the regulatory requirement.