How long should I wait after having herpes zoster (shingles) to get the shingles vaccine?

Timing of Shingles Vaccination After a Shingles Outbreak

A minimum of 2 months should be waited after having shingles before receiving the shingles vaccine. 1

Recommended Waiting Period

• The 2-month interval recommendation is based on documented evidence showing this is the minimum interval between an episode of herpes zoster and potential recurrence 1
• This waiting period allows for complete resolution of the acute phase of herpes zoster, abatement of symptoms, and recovery of the immune system to optimize vaccine response 1
• Different countries have varying recommendations for the time frame between a shingles episode and vaccination:
  • USA and Germany: Wait until the acute stage has resolved and symptoms have abated 1
  • Austria: Wait at least 2 months 1
  • Canada, Ireland, and Australia: Wait at least 1 year 1

Rationale for Vaccination After Shingles

• Having had shingles does not provide lifelong immunity against recurrence, with a US study showing cumulative recurrence rates of 2.5% at 2 years, 4.8% at 4 years, and up to 10.3% at 10 years 1, 2
• Based on these high rates of HZ recurrence after a prior episode, vaccination with zoster vaccine is recommended after a prior episode of HZ 2
• Vaccination helps prevent future recurrences and their associated complications, including postherpetic neuralgia 1

Vaccine Options After Shingles

• Both available vaccines can be administered after a shingles episode:
  • Recombinant zoster vaccine (RZV, Shingrix) - preferred option due to higher efficacy 1
  • Live zoster vaccine (ZVL, Zostavax) 1
• Complete vaccination with 2 doses of RZV is strongly recommended for optimal protection 2
• For RZV, the second dose should be given 2-6 months after the first dose for optimal protection 1

Important Considerations

• Do not wait too long after the 2-month minimum period as this increases the risk of recurrence 1
• The shingles vaccine is not indicated to treat acute zoster, to prevent persons with acute zoster from developing PHN, or to treat ongoing PHN 3
• For immunocompromised patients, the live zoster vaccine (Zostavax) is contraindicated, but the recombinant vaccine (Shingrix) can be used 1
• Before administration of zoster vaccine, patients do not need to be asked about their history of varicella (chickenpox) or to have serologic testing conducted to determine varicella immunity 3

Special Populations

• For immunocompromised adults aged ≥18 years, the second dose of RZV can be given 1-2 months after the first dose if they would benefit from a shorter vaccination schedule 1
• For patients previously vaccinated with ZVL (Zostavax), RZV (Shingrix) can be administered after an interval of more than 5 years (strong recommendation) or within 5 years (weak recommendation) 2