From the Guidelines
The shingles vaccine, such as Shingrix (recombinant zoster vaccine (RZV)), can be administered after recovery from herpes zoster, with a recommended minimal interval of 2 months between the episode of shingles and vaccination. This recommendation is based on the high rates of shingles recurrence after a prior episode, as documented in a recent study 1. The study found that the cumulative incidence of recurrence at 2,4,6,8, and 10 years was 2.5%, 4.8%, 6.6%, 8.0%, and 10.3%, respectively.
Key points to consider:
- The vaccine significantly reduces the risk of future shingles episodes by boosting the immune response to the varicella-zoster virus.
- Shingrix is given as a two-dose series, with the second dose administered 2-6 months after the first dose.
- The vaccine is highly effective, reducing the risk of shingles by more than 90% in adults 50 and older, as noted in previous guidelines 1.
- Even though patients have already experienced shingles, vaccination is still important because subsequent episodes can be equally painful and may lead to complications like postherpetic neuralgia, which becomes more common with age.
It is essential to wait until the acute phase of shingles has resolved and the patient is no longer experiencing active symptoms before administering the vaccine. The exact timing may vary, but a 2-month interval is recommended as a minimum based on the documented minimal interval between an episode of shingles and recurrence of 2 months 1.
From the Research
Shingles Vaccine Administration After Recovery
- The shingles vaccine, such as Shingrix (recombinant zoster vaccine (RZV)), can be administered after recovery from herpes zoster (shingles) 2, 3.
- There is no contraindication for administering the RZV vaccine after recovery from shingles, and it is preferred over a live attenuated HZ vaccine in immunocompetent individuals, according to the US and Canadian guidelines 3.
- The safety and efficacy of the RZV vaccine have been demonstrated in clinical trials in immunocompetent adults and in selected immunocompromised persons and persons with immune-mediated diseases 2, 4.
- Real-world effectiveness studies have confirmed the safety and effectiveness of the RZV vaccine, with a vaccine effectiveness of 70.1% (95% confidence interval [CI], 68.6-71.5) for 2 doses 5.
- The RZV vaccine is nonreplicating and is thus safe in immunocompromised persons, and its use is recommended for the prevention of herpes zoster and postherpetic neuralgia in adults aged ≥50 years 3, 6.
Key Considerations
- The RZV vaccine is more effective for prevention of HZ than the live zoster vaccine, with efficacy rates of 90 to 97% compared to 50 to 70% for the live vaccine 2, 6.
- The vaccine is well tolerated, with mostly local injection-site reactions and mild systemic reactions seen, although in larger proportions with the recombinant vaccine 3, 6.
- Rare adverse events, occurring less than 1% of the time, have been seen with both vaccine types and include disseminated herpes zoster with the live zoster vaccine and Guillain-Barré syndrome with the recombinant vaccine 6.