Should a 31-year-old female (F) previously diagnosed with herpes zoster (shingles) 1 year ago receive the Shingrix (zoster vaccine) early?

Shingles Vaccination in a 31-Year-Old Female with Prior Shingles

A 31-year-old female with a history of shingles one year ago should not receive the shingles vaccine at this time, as current guidelines only recommend vaccination for adults aged 50 years and older regardless of prior shingles history.

Current Recommendations for Shingles Vaccination

The most recent guidelines clearly specify age-based recommendations for shingles vaccination:

• The Advisory Committee on Immunization Practices (ACIP) recommends shingles vaccination for immunocompetent adults aged 50 years and older 1
• Taiwan's 2024 guidelines similarly recommend herpes zoster vaccination for immunocompetent adults aged 50 years and older (strong recommendation, moderate quality evidence) 1
• The recombinant zoster vaccine (Shingrix) is approved for prevention of herpes zoster in adults aged ≥50 years 2

Prior Shingles History and Vaccination

Having a prior episode of shingles does not change the age recommendation for vaccination:

• A single dose of zoster vaccine is recommended for adults aged 60 years and older regardless of whether they report a prior episode of herpes zoster 1, 3
• The zoster vaccine is not indicated to treat acute zoster, to prevent persons with acute zoster from developing postherpetic neuralgia (PHN), or to treat ongoing PHN 3

Rationale for Age-Based Recommendations

The age-based recommendations are based on several factors:

• Risk of shingles increases significantly with age, with the probability of having had shingles before age 45 being only 8.6% for males and 10.5% for females 4
• Vaccine efficacy studies primarily focused on adults aged ≥50 years 1, 2
• Cost-effectiveness analyses support vaccination at older ages 4

Vaccine Types and Considerations

Two types of shingles vaccines have been available:

1. Zostavax (ZVL): A live-attenuated vaccine with decreasing efficacy with increasing age (only 18% effective in those ≥80 years) 5

2. Shingrix (RZV): A non-live recombinant vaccine with higher efficacy across all age groups (91.3% in adults ≥70 years vs. 18% with Zostavax) 5, 2

Special Considerations for Immunocompromised Patients

While not applicable to this case, it's worth noting:

• Live zoster vaccine (ZVL) should not be administered to highly immunocompromised patients due to risk of disseminated viral infection 5
• Recombinant zoster vaccine (RZV) is not contraindicated in immunocompromised individuals 2

Conclusion for This Patient

For this 31-year-old female with a history of shingles one year ago:

• She should not receive the shingles vaccine at this time
• She should wait until age 50 to receive the shingles vaccine per current guidelines
• Having had a prior episode of shingles does not change this recommendation

Barriers to Vaccination When Age-Appropriate

When she does reach age 50, awareness of common barriers to vaccination may be helpful:

• Lack of physician recommendation is a significant barrier to shingles vaccination 6
• Cost concerns can limit access to the vaccine 7
• Racial and ethnic disparities exist in vaccination coverage 7