Reconstitute recombinant zoster vaccine (RZV, Shingrix, GSK) using only the adjuvant solution provided with the vaccine antigen. After reconstitution, administer Shingrix immediately by the intramuscular route or store the reconstituted vaccine refrigerated between 2° and 8°C (36° and 46°F) and use within 6 hours. Discard reconstituted vaccine if not used within 6 hours or if frozen. If Shingrix is reconstituted with other than the supplied adjuvant solution, it should be repeated. The dose can be repeated immediately. There is no interval that must be met between these doses.
Ask the Experts: Zoster (Shingles): Administering Vaccines
Shingrix has been shown to be immunogenic when given by the subcutaneous route. A dose erroneously given by this route does not need to be repeated.
The Shingrix adjuvant solution may contain up to 0.75 mL of liquid. The entire volume of the adjuvant solution should be withdrawn and used to reconstitute the lyophilized vaccine. After mixing, withdraw the recommended dose of 0.5 mL. Discard any reconstituted vaccine left in the vial.
According to the American Pharmacist Association, all states allow pharmacists to administer zoster vaccine. Not all pharmacists provide vaccination services, and of those who do, not all administer zoster vaccine. It is best to call the pharmacy ahead of time to find out if they have Shingrix to administer to your patients. The vaccine must be administered in the pharmacy. Do NOT instruct the patient to transport the vaccine from the pharmacy back to your office. This could damage the potency of the vaccine.
CDC recommends that if a provider mistakenly administers varicella vaccine to a person for whom zoster vaccine is indicated, no specific safety concerns exist, but the dose should not be considered valid. You should administer a dose of Shingrix to the patient during that same visit (same day). If the error is not detected and corrected on the same day, Shingrix should be administered at least 8 weeks after receipt of the varicella vaccine. However, if Shingrix is administered less than 8 weeks after the varicella vaccine, it does not need to be repeated. A second dose of Shingrix should be given 2–6 months after the first dose of Shingrix.
These events should be documented and procedures put in place, such as checking the vial label 3 times to be sure you are administering the product you intend, to prevent this from happening again.
There is no waiting period. The varicella vaccine dose can be given at any time after the Shingrix dose. Review your procedures to prevent this from happening again. Always check the label 3 times to ensure you are administering the product intended. Such an error also should be reported to the Vaccine Adverse Event Reporting System (VAERS) by phone 1-800-822-7967 or online at https://vaers.hhs.gov.
No. The Shingrix vaccine does not count as a vaccination against primary varicella infection (chickenpox). The first varicella vaccine dose can be given at any time after the Shingrix dose. The second dose of varicella vaccine should be given 4 to 8 weeks after the first dose. You should always check the label 3 times to ensure you are administering the product intended.
A dose less than the full 0.5 mL dose is generally not considered valid and should generally be repeated. If the patient is still in the office the dose can be repeated immediately. If the repeat dose cannot be given on the same day CDC recommends that it should be given 4 weeks after the invalid dose. The provider does have discretion as to whether the amount of vaccine lost is negligible, to make a decision not to repeat the dose of vaccine.
The CDC zoster subject matter experts recommend that in this situation you should wait 4 weeks before giving a repeat dose.
Any Shingrix, either antigen or diluent, that is exposed to freezing temperature should not be used. If a dose exposed to freezing temperature is given to a patient the dose should be considered invalid and should be repeated 4 weeks after the invalid dose.