On July 23, 2021, the FDA expanded the indication for recombinant zoster vaccine (SHINGRIX) to include adults aged ≥18 years at increased risk for shingles because of immunodeficiency or immunosuppression including people with HIV. The two dose series of recombinant zoster vaccine should be given 2 – 6 months apart and should be given regardless of past episode of herpes zoster or receipt of the older live attenuated zoster vaccine (Zostavax; discontinued in November 2020). Recombinant zoster vaccine can be provided at any CD4 cell count but some clinicians prefer to delay vaccination until there is viral suppression on ART or immune reconstitution if the CD4 count <200 cells/mm³ to maximize immunologic response to the vaccine.

The risk for herpes zoster and related complications is higher in people with HIV. This new recommendation was made after an FDA and an Advisory Committee on Immunization Practices (ACIP) review that highlighted the vaccine's high efficacy and good safety profile. Recombinant zoster vaccine was first approved by the United States Food and Drug Administration in 2017 and is available on the ADAP drug formulary,(https://cdph.magellanrx.com/member/documents). ADAP management requests that you share this information with your clinical leadership team and local prescribers.

If you have any questions regarding the ADAP formulary, please contact James Vo, ADAP Specialist, at (916) 449-5965.

Thank you,

Sharisse Kemp

Sharisse Kemp, MSW

ADAP Branch Chief

California Department of Public Health