Coadministering Shingrix and Influenza Vaccines

Several important adult immunizations are currently recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP), including influenza and herpes zoster (HZ) to protect against shingles. Conveniently for pharmacists and their patients, both the flu shot and Shingrix (RZV) can be administered during the same clinical visit.

“CDC’s general best practice guidelines for immunization advise that recombinant and adjuvanted vaccines, such as RZV, can be administered concomitantly, at different anatomic sites, with other adult vaccines,” states the ACIP’s recommendations for use of herpes zoster vaccines. “Concomitant administration of RZV with Fluarix Quadrivalent (QIV) has been studied, and there was no evidence for interference in the immune response to either vaccine or safety concerns.”

The CDC stipulates that Shingrix should be administered in a different limb from other vaccines when possible. Pharmacists should also inform patients of potential side effects related to the vaccine, which is more reactogenic than some. 

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Local reactions include pain, redness, and swelling at the injection site. Patients should be advised that systemic reactions like myalgia, fatigue, and headache may also occur. About one out of six people who get Shingrix experience side effects that prevent them from engaging in their regular activities for several days after receiving the shot, according to the CDC.

Since Shingrix is given in two doses administered two to six months apart to build full protection against shingles, patients should be reminded of the importance of receiving the second dose even if they experience side effects after the first.

Shingrix earned a preferred status recommendation from the CDC after it was approved by the FDA in 2017 for the prevention of shingles and its complications, including postherpetic neuralgia (PHN). It is recommended for use in immunocompetent adults 50 and older. 

Shingrix’s efficacy rates against HZ and PHN in clinical trials were higher than those for Zostavax (ZVL). In general usage, Shingrix has been over 90% effective in all 50-plus age groups. 

Shingrix can be used in adults regardless of prior receipt of the varicella vaccine or ZVL, and it does not require screening for a history of chickenpox. 

Evaluation of coadministration of Shingrix with other adult immunizations on ACIP’s list-including PPSV23, Pneumovax23,Tdap, and Boostrix-is ongoing.