When can the first dose of the shingles vaccine (Shingrix, recombivax) be given after a patient has had shingles?

Timing of Shingles Vaccination After Shingles Infection

The first dose of shingles vaccine (Shingrix) should be administered at least 2 months after resolution of acute herpes zoster (shingles) symptoms. 1

Rationale for Waiting Period

• The 2-month interval recommendation is based on evidence showing this is the minimum interval between an episode of herpes zoster and potential recurrence, allowing for complete resolution of acute symptoms and recovery of the immune system to optimize vaccine response 1
• This waiting period ensures that the patient's immune system can mount an appropriate response to the vaccine after recovering from the acute infection 1

Vaccine Recommendations

• Recombinant zoster vaccine (RZV, Shingrix) is the preferred vaccine option due to its higher efficacy and stronger immune response compared to the live zoster vaccine (ZVL, Zostavax) 1
• Shingrix is administered as a 2-dose series, with doses given 2-6 months apart for adults aged ≥50 years 2, 1
• Complete vaccination with both doses of Shingrix is strongly recommended for optimal protection, with effectiveness of 70.1% for two doses compared to 56.9% for a single dose 3

Clinical Considerations

• Different countries have varying recommendations for the time frame between a shingles episode and vaccination:
  • USA recommends waiting until the acute stage has resolved and symptoms have abated 1
  • Austria recommends waiting at least 2 months 1
  • Canada, Ireland, and Australia recommend waiting at least 1 year 1
• Patients remain at risk for recurrence after having shingles, with a cumulative incidence of recurrence of 2.5% at 2 years, 4.8% at 4 years, and up to 10.3% at 10 years without vaccination 1
• Vaccine effectiveness remains high even when the second dose is administered beyond the recommended 6-month interval 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
• The live zoster vaccine (Zostavax) is contraindicated in immunocompromised patients 1
• Shingrix has shown effectiveness in individuals with autoimmune conditions and those with immunosuppressive conditions 3

Potential Pitfalls to Avoid

• Waiting too long after the 2-month minimum period can increase the risk of recurrence 1
• Do not confuse the waiting period after shingles with the interval between vaccine doses 1
• Missing the opportunity to vaccinate older adults who have had shingles puts them at continued risk for recurrence 1
• Be aware that while minor side effects are common with Shingrix, severe adverse reactions are rare 4