Question: Can Shingrix (recombinant zoster vaccine) be given to a patient also receiving an influenza vaccine?

Answer: Shingrix (GlaxoSmithKline) is a recombinant zoster vaccine that contains an adjuvant. According to the CDC’s general best practice guidelines, recombinant and adjuvanted vaccines can be administered concomitantly with other vaccines.  They should be administered at different anatomical sites.¹

While these are general recommendations, one study was completed in over 800 patients who also received the quadrivalent inactivated influenza vaccine (IIV4).  The influenza vaccine brand used in the study was Fluarix (GlaxoSmithKline).  It should be noted that Fluarix does not contain an adjuvant. Half of the patients in the study received the IIV4 with their first dose of RZV, in different arms, on the same visit.  The other half of patients (control group) received a dose of IIV4 at month 0, followed by the RZV series starting at month 2.  Anti-varicella zoster virus gE antibodies were assessed throughout the study period and found to be similar between the control and coadministration groups, indicating a noninferiority in zoster protection.  The geometric mean titers for the hemagglutination inhibition antibodies were similar for each group as well, indicating a noninferiority in influenza protection.  There were no safety concerns identified in this study.²

The use of RZV concomitantly with an adjuvanted influenza vaccine, such as Fluad (Seqirus), or any other brand of influenza vaccine has not been studied, and therefore, the ACIP says that, “the safety and efficacy of concomitant administration of two adjuvanted vaccines [such as Shingrix and Fluad] either concomitantly or at other intervals, have not been evaluated.”¹

Of note, a similarly designed study administering RZV with pneumococcal polysaccharide vaccine (PPSV23) found a noninferiority in immunogenicity between the coadministration and control groups.  Solicited general adverse effects were higher in the group receiving dose 1 of RZV with PPSV23.  Myalgia was the most frequent solicited general symptom in that group.³

Sources:

1. Dooling KL, Guo A, Patel M, Lee GM, et al. Recommendations of the Advisory Committee on Immunization Practices for use of herpes zoster vaccines. Morb Mortal Wkly Rep. 2018;67(3):103-8. 
2. Schwarz TF, Aggarwal N, Moeckesch B, Schenkenberger I, Claeys C, et al. Immunogenicity and safety of an adjuvanted herpes zoster subunit vaccine coadministered with seasonal influenza vaccine in adults aged 50 years or older. J Infect Dis. 2017;16(11):1352-61.
3. Marechal C, Lal H, Ferguson M, Enweonye I, et al. Immunogenecity and safety of the adjuvanted recombinant zoster vaccine coadministered with the 23-valen pneumococcal polysaccharide vaccine in adults ≥0 yeas of age: A randomized trial. Vaccine. 2018;36(29):4278-86.