Should a partner of a patient with herpes zoster (shingles) receive the Shingrix (zoster vaccine)?

Shingles Vaccination for Partners of Patients with Shingles

Shingles vaccination is not specifically indicated for partners of patients with active shingles, as exposure to someone with shingles does not increase the risk of developing shingles. Rather, vaccination recommendations are based on age and individual risk factors.

Understanding Shingles Transmission and Risk

• Shingles (herpes zoster) is caused by reactivation of the varicella-zoster virus (VZV) that has remained dormant in a person's body after a previous chickenpox infection
• A person cannot "catch" shingles from someone else with shingles
• However, a person with active shingles can transmit the varicella virus to someone who has never had chickenpox, potentially causing chickenpox (not shingles)
• The risk of developing shingles is primarily related to:
  • Age (increasing risk after 50 years)
  • Immunocompromised status
  • Previous history of varicella infection

Vaccination Recommendations

For Adults 50 Years and Older:

• The recombinant zoster vaccine (Shingrix) is recommended for all adults 50 years and older regardless of exposure to someone with shingles 1
• Shingrix has demonstrated high efficacy:
  • 97.2% effectiveness in adults ≥50 years
  • 91.3% effectiveness in adults ≥70 years 1
• The vaccine requires a two-dose series administered 2-6 months apart

For Immunocompromised Individuals:

• Immunocompromised adults should receive Shingrix with a shortened dosing interval of 1-2 months between doses 1
• This includes patients with:
  • History of non-Hodgkin's lymphoma
  • Other conditions causing immune dysfunction
  • Those receiving immunosuppressive treatments

For Partners of Patients with Shingles:

• No specific recommendation exists for partners solely based on exposure to someone with shingles
• The Advisory Committee on Immunization Practices (ACIP) does not recommend vaccination specifically for contacts of persons with shingles 2
• Vaccination decisions should be based on the partner's age and risk factors, not on exposure

Common Pitfalls and Misconceptions

1. Confusing transmission risk: Many people incorrectly believe that exposure to someone with shingles increases their own risk of developing shingles. This is not true - shingles develops from reactivation of one's own dormant virus.

2. Thinking vaccination prevents transmission: The shingles vaccine is intended to prevent shingles in the vaccinated individual, not to prevent transmission to others.

3. Delaying vaccination: The American College of Rheumatology recommends that eligible individuals receive the herpes zoster vaccine before starting biologic therapy for conditions like rheumatoid arthritis 3, highlighting the importance of timely vaccination for at-risk individuals.

Practical Approach

• If the partner is ≥50 years old: Consider Shingrix vaccination based on age eligibility, not because of exposure to someone with shingles
• If the partner is immunocompromised: Prioritize vaccination according to their specific condition and treatment regimen
• If the partner has never had chickenpox or received varicella vaccine: They should avoid contact with the fluid from shingles blisters to prevent chickenpox infection

The shingles vaccine has shown excellent efficacy and an acceptable safety profile, with the most common side effects being injection site reactions and transient systemic symptoms 4, 1.