Shingles Vaccine After an Outbreak
The recombinant zoster vaccine (RZV) is recommended after a shingles outbreak, with vaccination ideally administered once the acute symptoms have resolved, typically waiting at least 2 months after the episode. 1
Vaccination Recommendations After Shingles
- RZV (Shingrix) is the preferred vaccine for adults who have experienced a shingles outbreak, as it provides superior efficacy compared to the older live-attenuated vaccine 1, 2
- Vaccination is recommended regardless of prior shingles history due to the significant risk of recurrence (10.3% cumulative recurrence risk at 10 years) 1
- The minimum recommended interval between a shingles episode and vaccination is 2 months, based on documented minimal interval between episodes of herpes zoster and recurrence 1
Dosing Schedule
- RZV is administered as a two-dose series 2
- For immunocompetent adults, the second dose should be given 2-6 months after the first dose 1, 2
- For immunocompromised adults aged ≥18 years, a shorter schedule with the second dose given 1-2 months after the first dose is recommended 1, 2
- The minimum interval between doses is 4 weeks; if administered earlier, the dose should be repeated 2
Efficacy and Benefits
- RZV demonstrates high efficacy in preventing herpes zoster with 97.2% vaccine efficacy in adults aged 50 years and older 2, 3
- Protection persists for at least 8 years with minimal waning, maintaining efficacy above 83.3% during this period 1, 2
- RZV significantly reduces the risk of postherpetic neuralgia (PHN), a common and debilitating complication of shingles 3, 4
- Second-dose completion rates are approximately 70% within 6 months and 80% within 12 months of the first dose 5
Special Populations
- For immunocompromised patients, including those with solid cancers or hematologic malignancies, RZV is the preferred vaccine as it is non-live and considered safe 1, 6
- For recipients of autologous hematopoietic stem cell transplant (HSCT), RZV should be given 50-70 days post-transplantation 1
- For kidney transplant recipients, vaccination is recommended at least 4 months post-transplantation 6
- For patients who previously received the live-attenuated zoster vaccine (ZVL), RZV should be given at least 2 months after the ZVL dose 1, 2
Side Effects and Safety
- RZV produces more injection-site reactions (pain, redness, swelling) compared to placebo, with 9.5% experiencing grade 3 injection site reactions 2, 3
- Systemic symptoms (fatigue, myalgia, headache) were reported in 11.4% of vaccine recipients versus 2.4% in placebo recipients 2, 3
- Despite higher reactogenicity, no serious safety concerns have been identified, with similar rates of serious adverse events between vaccine and placebo groups 3, 4
- Most adverse reactions are transient and mild to moderate in severity 4
Important Clinical Considerations
- Vaccination after a shingles outbreak is particularly important as having one episode of shingles does not provide reliable protection against future recurrences 1
- RZV is not indicated to treat acute zoster or to prevent persons with acute zoster from developing PHN 7
- Complete the full two-dose series to ensure optimal protection, as a single dose may not provide adequate long-term immunity 5
- Patients do not need to be tested for prior varicella (chickenpox) exposure before receiving RZV 7