From the Guidelines
Yes, a patient who has had shingles should still receive the shingles vaccine, as the CDC recommends that adults 50 years and older get two doses of Shingrix (recombinant zoster vaccine), even if they've previously had shingles. The vaccine should be administered 2-6 months after the shingles rash has resolved, and the two doses of Shingrix should be given 2-6 months apart 1. Having shingles once doesn't provide lifetime immunity against future outbreaks, as the varicella-zoster virus remains dormant in nerve tissue and can reactivate.
The Shingrix vaccine is over 90% effective at preventing shingles and postherpetic neuralgia (a painful complication of shingles) and this protection remains high for at least 7 years after vaccination 1. The most common side effects include pain, redness, and swelling at the injection site, along with muscle pain, fatigue, and headache, which typically resolve within 2-3 days.
Some key points to consider:
- The recombinant zoster vaccine, Shingrix, is preferred over the live zoster vaccine, Zostavax, due to its higher efficacy and longer duration of protection 1.
- The CDC recommends that adults 50 years and older receive two doses of Shingrix, even if they've previously had shingles or received Zostavax 1.
- The vaccine should be administered 2-6 months after the shingles rash has resolved, and the two doses of Shingrix should be given 2-6 months apart 1.
Overall, the benefits of receiving the shingles vaccine outweigh the risks, and it is an important step in preventing future outbreaks of shingles and related complications 1.
From the FDA Drug Label
SHINGRIX is a vaccine indicated for prevention of herpes zoster (HZ) (shingles): • in adults aged 50 years and older. • in adults aged 18 years and older who are or will be at increased risk of HZ due to immunodeficiency or immunosuppression caused by known disease or therapy.
The patient has already had shingles, and the vaccine is indicated for prevention of herpes zoster (shingles).
- The vaccine is not indicated for treatment of existing shingles.
- There is no information in the label that suggests the vaccine should be given to patients who have already had shingles. The FDA drug label does not answer the question.
From the Research
Shingles Vaccine and Previous Infection
- If a patient has had shingles, the need for the shingles vaccine depends on several factors, including the patient's age and immune status 2.
- The recombinant adjuvanted zoster vaccine (RZV, trade name Shingrix) is recommended for immunocompetent adults aged 50 years and older, regardless of their history of shingles 2.
- Studies have shown that the vaccine can reduce the risk of herpes zoster and postherpetic neuralgia in older adults, even if they have had shingles before 3, 4.
Vaccine Effectiveness
- The effectiveness of the shingles vaccine in preventing herpes zoster and postherpetic neuralgia has been demonstrated in several studies 5, 3, 4.
- A study published in 2021 found that the vaccine effectiveness was 70.1% for two doses and 56.9% for one dose 5.
- Another study published in 2008 found that the vaccine reduced the burden of illness due to herpes zoster by 61.1% and the incidence of postherpetic neuralgia by 66.5% 3.
Special Considerations
- Patients with autoimmune or immunosuppressive conditions may still benefit from the vaccine, although the effectiveness may be lower 5.
- The vaccine is well tolerated, with minor local injection site reactions being the most common adverse event 3, 4.
- Patients who have had shingles should consult with their healthcare provider to determine if the vaccine is recommended for them, based on their individual circumstances 2.