Expect to Vaccinate More Adults Against Shingles and Hep B

You’ll see changes to which adults should get shingles and hepatitis B vaccines...based on CDC’s 2022 immunization schedule.

Shingles. Continue to give Shingrix recombinant zoster vaccine to adults age 50 and up.

Now also recommend it for most immunocompromised adults 19 and up. More studies suggest that Shingrix is effective in these patients...without increasing risks, such as autoimmune disease flares.

CDC projects that this change will reduce shingles and overall complications...since immunocompromised patients are at higher risk.

But be aware, newer data are mostly for high-level immunosuppression (cancer, transplant, etc)...rather than low-level immunosuppression (chronic prednisone under 20 mg/day, etc).

Generally give 2 IM doses of Shingrix, 2 to 6 months apart. For patients who are or will become immunocompromised, it’s okay to give the doses a minimum of 4 weeks apart if needed.

Before giving Shingrix to an immunocompromised patient, confirm varicella immunity...a history of chicken pox or shingles, documentation of varicella vaccination, or a positive varicella titer. Without one of these, the patient is at risk of chicken pox...not shingles.

Hepatitis B. Previously, hep B vaccination in adults was mainly for those with risks...such as chronic liver disease or HIV.

But now vaccinate ALL adults age 19 to 59 who haven’t previously been vaccinated...AND those 60 and up who are at risk or request it.

Hep B infection rates in adults aren’t going down, despite childhood and risk-based vaccination.

CDC expects that “universal” vaccination in adults 19 to 59 will reduce hep B infections and death. It’s still a risk-based focus for older adults...due to lower rates of hep B in this age group.

Choose any hep B vaccine for adults...there’s no preference.

Heplisav-B is 2 IM doses given at 0 and 1 month...but costs about $270 total. The 3-dose Engerix-B, Recombivax HB, or new PreHevbrio series is usually given IM at 0, 1, and 6 months...and costs about $190 total.

PreHevbrio will be touted as a 3-antigen hep B vaccine...the others have 1 antigen. But this isn’t shown to improve efficacy.

Try to stick with the same product...although you can mix and match any adult hep B vaccine to complete a 3-dose series if needed.

Use our FAQs, Shingles Vaccine and Hep B Vaccination in Adults, for details about use in pregnancy and more patient considerations.

Key References
  • MMWR Morb Mortal Wkly Rep. 2022 Feb 18;71(7):229-233
  • MMWR Morb Mortal Wkly Rep. 2022 Jan 21;71(3):80-84
  • https://www.cdc.gov/shingles/vaccination/immunocompromised-adults.html (3-28-22)
  • https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-09-29/03-hepb-Doshani-508.pdf (3-28-22)
  • https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-11-2-3/02-HepWG-weng-508.pdf (3-28-22)
  • Medication pricing by Elsevier, accessed Mar 2022

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