From the Guidelines
A patient who has already had varicella zoster should not receive the vaccine immediately, but rather wait until the acute episode has resolved and consider vaccination after recovery to prevent future recurrences. The primary goal in managing a patient with varicella zoster is to reduce the risk of complications and improve quality of life. According to the most recent guidelines, such as those outlined in the study published in the Journal of Microbiology, Immunology and Infection in 2024 1, the focus is on preventing herpes zoster in adults. For individuals who have had varicella zoster, the approach is slightly different, as they have already developed natural immunity. However, this immunity may wane over time, leaving them at risk for future episodes.
Key considerations in this scenario include:
- The patient's age and immune status, as these factors influence the risk of complications and the potential benefit of vaccination.
- The type of vaccine to be used, with recombinant vaccines like Shingrix generally preferred over live attenuated vaccines like Zostavax due to higher efficacy and safety profiles.
- The timing of vaccination, which should be after the acute episode has resolved, typically at least 6-12 months after recovery, to minimize potential adverse reactions and maximize the vaccine's effectiveness.
Given the weak recommendation and low quality of evidence for vaccinating adults 50 years old without a history of varicella or with an unclear history 1, the decision to vaccinate a patient who has already had varicella zoster should be made on a case-by-case basis, considering the individual's risk factors and the potential benefits and risks of vaccination. Vaccination after recovery can help reduce the risk of future recurrences and is recommended for adults 50 years and older, with a preferred interval of 2-6 months between doses for recombinant vaccines.
From the Research
Varicella Zoster Vaccine
- The patient has already contracted varicella zoster, so the primary concern is managing the symptoms and preventing further complications.
- According to 2, prevention of herpes zoster is now possible with the HZ vaccine, which is preferable to treatment.
- However, since the patient has already developed varicella zoster, the focus should be on treating the symptoms and preventing postherpetic neuralgia (PHN).
Treatment Options
- Studies 3, 4, 5 suggest that antiviral medications such as valacyclovir, famciclovir, and brivudine can be effective in managing pain and reducing the severity of herpes zoster.
- 5 found that valacyclovir was more efficacious than famciclovir in resolving zoster-associated pain.
- 3 found that brivudine may be the first choice in severe HZ cases as it controls pain earlier and is easier to use.
Vaccine Administration
- There is no direct evidence to suggest that the patient should receive the vaccine after contracting varicella zoster.
- However, 2 mentions that prevention is preferable to treatment, implying that vaccination may be beneficial in preventing future episodes of herpes zoster.
- The decision to administer the vaccine should be made on a case-by-case basis, taking into account the patient's individual circumstances and medical history.