Shingrix (Herpes Zoster vaccine Recombinant, adjuvanted)

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Patients who are immunocompromised have an increased risk of shingles and its complications compared to the general population1

Given their risk of severe disease, eligible severely immunocompromised individuals should proactively be offered shingles vaccination with SHINGRIX, the first and only non-live shingles vaccine.2

SHINGLES IN IMMUNOCOMPROMISED (IC) PATIENTS

Following primary Varicella-zoster virus (VZV) infection, VZV lies dormant in the sensory dorsal root ganglia. Reactivation of the latent virus leads to the clinical manifestations of shingles and associated with immune suppression or senescence of the immune system.3

Immunocompromised (IC) patients are at increased risk of shingles and its complications compared to the general population.1 In IC patients, compared with immunocompetent patients:

  • The rash associated with shingles may be more severe and long lasting5
  • Disseminated disease is more likely to occur, a rare but serious complication of shingles with a case fatality of 5-15%4
  • They are more likely to develop recurrent shingles1
  • Multiple dermatomes may be affected by the shingles rash5
Patient's Shingles Rash

From Dworkin RH et al., Clinical Infectious Diseases, 20076

Which of your severely immunocompromised patients should you be offering vaccination to, in line with the Shingles National Immunisation Programme?

Eligible severely immunocompromised patients
(As defined in the Green book)3

  • Individuals receiving stem cell transplant

    • Receiving an allogeneic (cells from a donor) or an autologous (using their own cells) stem cell transplant
    • Receiving CAR-T (chimeric antigen receptor T-Cell) therapy

    • Acute and chronic leukaemias, and clinically aggressive lymphomas (including Hodgkin's lymphoma), who are less than 12 months since achieving cure 
    • Under follow up for chronic lymphoproliferative disorders including haematological malignancies such as indolent lymphoma, chronic lymphoid leukaemia, myeloma, Waldenstrom's macroglobulinemia and other plasma cell dyscrasias (N.B.: this list is not exhaustive)
    • Immunosuppression due to HIV/AIDS with a current CD4 count of below 200 cells/µl.
    • Primary or acquired cellular and combined immune deficiencies - those with lymphopaenia (<1,000 lymphocytes/µl) or with a functional lymphocyte disorder
    • Received an allogenic (cells from a donor) or an autologous (using their own cells) stem cell transplant in the previous 24 months
    • Received a stem cell transplant more than 24 months ago but have ongoing immunosuppression or graft versus host disease

    • Receiving or have received in the past 6 months immunosuppressive chemotherapy or radiotherapy for any indication
    • Receiving or have received in the previous 6 months immunosuppressive therapy for a solid organ transplant
    • Receiving or have received in the previous 3 months targeted therapy for autoimmune disease, such as JAK inhibitors or biologic immune modulators including
      • B-cell targeted therapies (including rituximab but for which a 6 month period should be considered immunosuppressive), this should be monocloncal tumour necrosis factor inhibitors (TNFi), T-cell co-stimulation modulators, soluble TNF receptors, interleukin (IL)-6 receptor inhibitors.
      • IL-17 inhibitors, IL 12/23 inhibitors, IL 23 inhibitors (N.B.: this list is not exhaustive)

    • Moderate to high dose corticosteroids (equivalent ≥ 20mg prednisolone per day) for more than 10 days in the previous month
    • Long term moderate dose corticosteroids (equivalent to ≥10mg prednisolone per day for more than 4 weeks) in the previous 3 months
    • Any non-biological oral immune modulating drugs in the previous 3 months
      • methotrexate >20mg per week (oral and subcutaneous)
      • azathioprine >3.0mg/kg/day
      • 6-mercaptopurine >1.5mg/kg/day
      • mycophenolate >1g/day
    • Certain combination therapies at individual doses lower than stated above, including those on ≥7.5mg prednisolone per day in combination with other immunosuppressants (other than hydroxychloroquine or sulfasalazine) and those receiving methotrexate (any dose) with leflunomide in the previous 3 months

    • equivalent to >40mg prednisolone per day for more than a week, for any reason in the previous month

Learn more about implementing the Shingles National Immunisation Programme

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Ready to vaccinate?

Explore our range of tools to support you implementing the Shingles National Immunisation Programme

IMPLEMENTING THE NATIONAL PROGRAMME

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What is the impact of shingles?

There is an estimated 1 in 4 lifetime risk of developing shingles in the general population.3 Shingles is a painful disease that can have serious and long-lasting complications in some patients1

IMPACT OF SHINGLES

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The efficacy and safety profile of SHINGRIX in IC patients

SHINGRIX has been investigated in a range of immunocompromised (IC) patient populations, including solid tumours, haematologic malignancies, renal transplants and autologous haematopoietic stem cell transplants (auHSCT).7-11

IC EFFICACY AND SAFETY DATA

References

  1. Yanni EA, Ferreira G, Guennec M, et al. BMJ Open 2018;8:e020528.
  2. SHINGRIX. Summary of Product Characteristics (United Kingdom)
  3. UKHSA Green Book: Shingles (herpes zoster): the green book chapter
  4. UK NICE Clinical Knowledge Summaries, 2025. Shingles: What are the complications?
  5. UK NICE Clinical Knowledge Summaries, 2025. Shingles: What are the clinical features?
  6. Dworkin RH, Johnson RW, Breuer J, et al. Clinical Infectious Disease 2007;44 (Suppl 1): S1-26.
  7. Bastidas A, de la Serna J, El Idrissi M, et al.; for the ZOE-HSCT Study Group Collaborators. Effect of recombinant zoster vaccine on incidence of herpes zoster after autologous stem cell transplantation: a randomized clinical trial [suppl]. JAMA. 2019 July;322(2):123-133.
  8. Dagnew AF, Ilhan O, Lee WS, et al.; on behalf of the Zoster-039 Study Group. Immunogenicity and safety of the adjuvanted recombinant zoster vaccine in adults with haematological malignancies: a phase 3, randomised, clinical trial and post-hoc efficacy analysis. Lancet Infect Dis. 2019 September;19(9):988-1000.
  9. Vink P, Torelle JMR, Sanchez Fructuoso A, et al.; for the Z-041 Study Group. Immunogenicity and safety of the adjuvanted recombinant zoster vaccine in chronically immunosuppressed adults following renal transplant: a phase 3, randomized clinical trial. Clin Infect Dis. 2020 January;70(2):181-190.
  10. Vink P, Mignorance ID, Alonso CM, et al.; on behalf of the Zoster-028 Study Group. Immunogenicity and safety of the adjuvanted recombinant zoster vaccine in patients with solid tumors, vaccinated before or during chemotherapy: a randomized trial. Cancer. 2019 April;125(8):1301-1312.
  11. Berkowitz EM, Moyle G, Stellbrink HJ, et al for the Zoster-015 HZ/su Study Group. Safety and immunogenicity of an adjuvanted herpes zoster subunit candidate vaccine in HIV-infected adults: a phase 1/2a randomized, placebo-controlled study. J Infect Dis. 2015 April;211:1279-1287.

Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk/ or search for MHRA Yellowcard in the Google Play or Apple App store. Adverse events should also be reported to GlaxoSmithKline on 0800 221 441 or UKSafety@gsk.com

SHINGRIX is owned by or licensed to the GSK group of companies.
© 2025 GSK group of companies or its licensor.
Trade marks are owned by or licensed to the GSK group of companies.

November 2025 | PM-GB-SGX-WCNT-230019 (V3.0)