When can the Shingrix (herpes zoster vaccine) be administered after a shingles episode?

Shingrix Vaccination After Shingles Episode

Shingrix (recombinant zoster vaccine) should be administered at least 2 months after a shingles episode has resolved and symptoms have abated. 1

Timing of Vaccination After Shingles

The timing of Shingrix administration following a shingles episode is based on the following considerations:

• According to the Journal of Microbiology, Immunology and Infection (2024), recommendations regarding the timeframe for vaccination following an episode of herpes zoster vary between countries 1:

  • In Germany and USA: Wait until the acute stage of herpes zoster has resolved and symptoms have abated
  • In Austria: Wait at least 2 months
  • In Canada, Ireland, and Australia: Wait at least 1 year

• The minimum recommended interval is 2 months after resolution of the shingles episode 1

Rationale for Vaccination After Shingles

Vaccination after a shingles episode is strongly recommended due to:

1. High recurrence risk: The cumulative incidence of herpes zoster recurrence (defined as having HZ at 6 months after the most recent diagnosis) increases over time 1:

   • 2.5% at 2 years
   • 4.8% at 4 years
   • 6.6% at 6 years
   • 8.0% at 8 years
   • 10.3% at 10 years

2. Superior vaccine efficacy: Shingrix (RZV) is the preferred vaccine with significantly higher efficacy compared to the older live zoster vaccine (ZVL) 2:

   • RZV efficacy: 97.2% for adults 50+ years and 91.3% for adults 70+ years
   • Two-dose effectiveness in real-world studies: 70.1% (compared to 56.9% for a single dose)

Vaccination Schedule

For optimal protection after a shingles episode:

• Standard schedule: Two doses (0.5 mL each) administered 2-6 months apart for immunocompetent adults aged 50 years and older 2
• Immunocompromised adults: Shortened dosing interval of 1-2 months apart for adults ≥18 years who are immunocompromised 2
• Complete the series: Completing the full two-dose series is crucial for maximum effectiveness 2

Important Considerations

1. Prior vaccination status: If previously vaccinated with the older live zoster vaccine (ZVL), RZV is still recommended after an interval of more than 5 years (strong recommendation) or even within 5 years (weak recommendation) 1

2. Immunocompromised patients: Shingrix is recommended for adults aged 18 years and older who are or will be at increased risk of herpes zoster due to immunodeficiency or immunosuppression 2

3. Potential adverse effects: Be aware that common adverse reactions include 2:

   • Local reactions: Pain, redness, swelling at injection site
   • Systemic reactions: Myalgia, fatigue, headache

Clinical Pitfalls to Avoid

1. Delaying vaccination unnecessarily: While some countries recommend waiting up to a year after a shingles episode, evidence supports vaccination once the acute phase has resolved (minimum 2 months) to prevent recurrence 1

2. Using Shingrix to treat active shingles: Shingrix is not indicated to treat acute zoster, to prevent persons with acute zoster from developing postherpetic neuralgia, or to treat ongoing postherpetic neuralgia 3

3. Incomplete vaccination: Failing to administer the second dose significantly reduces vaccine effectiveness (70.1% with two doses vs. 56.9% with one dose) 2

4. Overlooking high-risk patients: Individuals with certain conditions (rheumatoid arthritis, lupus, cancer, HIV/AIDS, diabetes) have 1.5-2 times higher risk of herpes zoster and should be prioritized for vaccination 2