Timing of Shingles Vaccination After Shingles Infection
The shingles vaccine should be administered at least 2 months after a person has recovered from shingles, once all symptoms have resolved and the acute phase has ended. 1
Rationale and Recommendations
- The 2-month waiting period is based on evidence showing this is the minimum interval between an episode of herpes zoster and potential recurrence, allowing for complete resolution of symptoms and optimal immune response to vaccination 1
- Different countries have varying recommendations for the timing after a shingles episode:
Vaccine Options After Shingles
- Recombinant zoster vaccine (RZV, Shingrix) is the preferred option due to higher efficacy and stronger immune response 1, 2
- Complete the full two-dose series for optimal protection, with doses given 2-6 months apart 1, 3
- For immunocompromised adults aged ≥18 years, the second dose can be given 1-2 months after the first if a shorter vaccination schedule would be beneficial 1
- The live zoster vaccine (ZVL, Zostavax) is contraindicated in immunocompromised patients 4, 1
Effectiveness and Importance of Vaccination
- Even after experiencing shingles, individuals remain at risk for recurrence, with cumulative recurrence rates of 2.5% at 2 years, 6.6% at 6 years, and 10.3% at 10 years 1
- Real-world effectiveness studies show that the recombinant zoster vaccine (Shingrix) provides approximately 70.1% effectiveness with two doses and 56.9% with one dose 5
- The vaccine is effective even in adults over 80 years of age and those with certain autoimmune conditions 5
- Effectiveness against postherpetic neuralgia (a painful complication of shingles) is approximately 76% 5
Clinical Considerations
- Waiting too long beyond the 2-month minimum period can increase the risk of recurrence 1
- Don't miss the opportunity to vaccinate older adults who have had shingles, as they remain at risk for recurrence 1, 6
- For optimal protection, ensure patients complete the two-dose series - studies show approximately 80% of patients complete the series within 12 months 3
- The Advisory Committee on Immunization Practices (ACIP) recommends a single dose of zoster vaccine for adults aged 60 years or older regardless of whether they report a prior episode of herpes zoster 4
Special Populations
- Persons with chronic medical conditions may be vaccinated unless their condition constitutes a contraindication, such as pregnancy or severe immunodeficiency 4
- For immunocompromised individuals, follow specific guidelines regarding timing and vaccine type, as live vaccines are contraindicated in this population 4, 1