Shingles Vaccine (Shingrix): A Primary Care NP Guide

Shingles (herpes zoster) is more than just a rash — it can cause weeks of pain, post-herpetic neuralgia, and even vision loss. As a new nurse practitioner in primary care, you’ll frequently get asked: Who needs the shingles vaccine?Here’s a quick, practical guide you can use in clinic.

Who Should Get the Shingles Vaccine?

• All adults ≥50 years old (even if they’ve had shingles before).

• Adults ≥19 years old who are immunocompromised (HIV, cancer treatment, transplant, autoimmune disease on immunosuppressives).

📌 Clinical Pearl: Prior history of shingles or prior Zostavax does not eliminate the need for Shingrix.

Vaccine Details: Shingrix (RZV)

• Type: Recombinant, non-live vaccine.

• Dosing: 2-dose series:

  • First dose at time 0.

  • Second dose at 2–6 months.

• Administration: IM injection (deltoid preferred).

• Efficacy: >90% protection, durable for years.

Common Side Effects

• Sore arm, redness, swelling.

• Fatigue, headache, low-grade fever, myalgias (especially after 2nd dose).

• Usually resolve in 2–3 days.

📌 Counseling Tip: Warn patients about possible flu-like symptoms so they can plan around important events/work.

Contraindications & Precautions

• Severe allergic reaction to a prior dose or component.

• Delay if patient has acute illness with fever.

• Safe in patients with chronic diseases and those who are immunocompromised.

Why It Matters in Primary Care

• 1 in 3 adults in the U.S. will develop shingles in their lifetime.

• Risk increases with age and immune suppression.

• Prevents painful complications like post-herpetic neuralgia.

• Strong recommendation from CDC and ACIP for routine use.

Takeaway for New Nurse Practitioners

The shingles vaccine (Shingrix) is one of the most effective tools we have for preventing a debilitating illness.

• Give it to all adults ≥50.

• Don’t forget immunocompromised patients ≥19.

• Counsel patients on side effects so they’re prepared.

Building vaccine updates into your preventive care workflow will make your practice safer and more efficient.

✉️ Want more plug-and-play vaccine workflows? Join my NP mentorship program for real-world tools designed for new nurse practitioners in primary care.