What is the most appropriate timing for administering the herpes zoster (shingles) vaccine to a 60-year-old woman with a history of mild shingles, who recently received her annual influenza (flu) vaccine and is currently experiencing mild cold symptoms?

From the Guidelines

The most appropriate herpes zoster vaccine recommendation for this patient is option C - she should receive the vaccine now. The patient is a 60-year-old woman who has previously had shingles and is concerned about recurrence. The recombinant zoster vaccine (Shingrix) is recommended for adults 50 years and older, regardless of previous shingles episodes, as it can help prevent recurrence 1. Having mild cold symptoms is not a contraindication for receiving the zoster vaccine. Additionally, there is no need to separate the zoster vaccine from the recently received influenza vaccine, as they can be administered during the same time period. Some key points to consider in this decision include:

• The presence of young grandchildren, including an 8-month-old, is not a contraindication either, as the recombinant zoster vaccine does not contain live virus and cannot cause varicella infection in contacts.
• Previous shingles infection does not provide complete immunity against recurrence, so vaccination is still indicated for this patient to reduce her risk of developing shingles again and potentially experiencing post-herpetic neuralgia, which her mother suffered from.
• The recombinant zoster vaccine (Shingrix) has been shown to be highly effective in preventing herpes zoster and post-herpetic neuralgia, with a vaccine efficacy of 91.3% against herpes zoster and 88.8% against post-herpetic neuralgia in adults 70 years of age or older 1.
• The vaccine is well-tolerated, with the most common adverse events being injection-site reactions and systemic symptoms such as fatigue and headache 1.

From the Research

Herpes Zoster Vaccine Recommendation

The patient is a 60-year-old woman who has had a mild case of shingles in the past and is requesting the shingles vaccine. Considering her age and medical history, the following points are relevant:

• The recombinant zoster vaccine (Shingrix) is recommended for adults aged 50 years and older, regardless of their history of shingles 2, 3.
• The vaccine is effective in preventing herpes zoster and postherpetic neuralgia, with a vaccine effectiveness of 70.1% for 2 doses 4.
• The patient's history of shingles does not preclude her from receiving the vaccine, as it is recommended for all immunocompetent adults aged 50 years and older, regardless of their history of shingles 5, 3.
• The patient's recent influenza vaccination and current cold symptoms do not need to delay vaccination, as there is no recommendation to wait after receiving other vaccines or having mild illnesses 2, 6.
• The patient's role as a caregiver for her grandchildren, including an 8-month-old, does not affect the recommendation for the herpes zoster vaccine, as the vaccine is not live and cannot be transmitted to others 5.

Appropriate Course of Action

Based on the evidence, the most appropriate recommendation for this patient is to receive the herpes zoster vaccine as soon as possible, without delay due to her recent influenza vaccination or current cold symptoms. The correct answer is:

• C. she should receive the vaccine now