People aged ≥18 years who are immunocompromised or shortly expected to be immunocompromised are recommended to receive a zoster vaccine

People aged ≥18 years who are immunocompromised or shortly expected to be immunocompromised are recommended to receive a 2-dose schedule of Shingrix, 1–2 months apart, for the prevention of herpes zoster and associated complications. A shorter interval can be chosen should an immunocompromised person need to be protected earlier. This includes people who are currently or soon to be immunocompromised because of a primary or acquired medical condition, or medical treatment (including treatment that has recently ceased).

Compared with immunocompetent people, people who are immunocompromised have higher rates of herpes zoster and of complications such as post-herpetic neuralgia (PHN).^4,5 Herpes zoster can occur at a younger age in people who are immunocompromised, and there is also a higher risk of recurrence.^6-9

Shingrix provides good protection against herpes zoster and associated complications in severely immunocompromised people aged ≥18 years,^10,11 including people with a history of haematopoietic stem cell transplantation or haematologic malignancies.

The optimal time to receive Shingrix in immunocompromised individuals aged ≥18 years depends on individual circumstances:

• Age-related risk of herpes zoster and its complications: Herpes zoster can occur at any age, but the risk increases with age similar to in immunocompetent people. The likelihood of complications such as PHN also increases with age. While the risk will be elevated compared to a similarly aged immunocompetent person, the risk in a young person with an immunocompromising condition may still be lower than an older immunocompetent individual.^4,12
• Individual’s immune status and duration of protection: People who are immunocompromised are at significantly higher risk of herpes zoster and severe complications than those who are immunocompetent.^13-15 However, the extent of immunocompromise and risk of zoster will vary by the person’s underlying condition and the type and duration of immunocompromising medical treatment. Ideally vaccination should occur prior to onset or initiation of immunosuppression. If vaccination prior to becoming immunocompromised is not possible, then further guidance on timing of vaccination should be sought from the Vaccination for people who are immunocompromised chapter.
• Individual’s personal preferences: People’s desire to protect themselves from herpes zoster and related complications may vary, and this will influence decision-making on when they should receive zoster vaccination.

Shingrix is funded through the NIP for people aged ≥18 years with moderate and severe immunocompromise that put them at the highest risk of herpes zoster. Table. Risk conditions and immunosuppressive therapies for zoster vaccination and eligibility for NIP funding provides a detailed list of NIP-funded immunocompromising conditions and therapies. Other immunocompromised people can receive Shingrix, obtained by private prescription.