Timing of Shingles Vaccination After a Shingles Episode
The minimum recommended interval between a shingles episode and vaccination is 2 months, based on documented evidence showing this is the minimum interval between an episode of herpes zoster and potential recurrence. 1
Rationale for the 2-Month Waiting Period
- The 2-month waiting period allows for complete resolution of the acute phase of herpes zoster and abatement of symptoms 2
- This interval optimizes immune system recovery to ensure better vaccine response 1
- The 2-month minimum is based on documented evidence showing this is the shortest interval between an episode of herpes zoster and potential recurrence 2
Country-Specific Recommendations
- Different countries have varying recommendations for the time frame between a shingles episode and vaccination: 2
- USA and Germany: Wait until acute stage has resolved and symptoms have abated
- Austria: Wait at least 2 months
- Canada, Ireland, and Australia: Wait at least 1 year
Risk of Recurrence Without Vaccination
- A recent US study with 5.6 years of follow-up showed significant cumulative incidence of shingles recurrence: 2, 1
- 2.5% at 2 years
- 4.8% at 4 years
- 6.6% at 6 years
- 8.0% at 8 years
- 10.3% at 10 years
Vaccine Options After Shingles
- Both available vaccines can be administered after a shingles episode: 2, 1
- Recombinant zoster vaccine (RZV, Shingrix)
- Live zoster vaccine (ZVL, Zostavax)
- RZV is the preferred option due to higher efficacy and stronger immune response 1, 3
- Complete vaccination with 2 doses of RZV is strongly recommended for optimal protection 2
Vaccination Schedule
- For RZV (Shingrix): 3
- Standard schedule: 2 doses with the second dose given 2-6 months after the first dose
- For immunocompromised adults: A shorter schedule with the second dose given 1-2 months after the first dose may be considered
- For ZVL (Zostavax): Single dose 4
Special Considerations
- Patients who previously received ZVL can receive RZV to further lower the incidence of herpes zoster 2
- A meta-analysis showed that the pooled vaccine effectiveness against HZ was 75.5% in adults aged 50 years who received ZVL within 5 years before RZV 2
- For immunocompromised patients, RZV is preferred as it is non-live and considered safer 3
Clinical Pitfalls to Avoid
- Waiting too long after the 2-month minimum period increases the risk of recurrence 1
- Don't confuse the waiting period after shingles with the interval between vaccine doses 1
- Live zoster vaccine (ZVL) should not be administered to immunocompromised patients 1
- Don't miss the opportunity to vaccinate older adults who have had shingles, as they remain at risk for recurrence 1, 5
Conclusion
The evidence clearly supports waiting at least 2 months after a shingles episode before receiving the shingles vaccine. This timeframe balances the need for complete resolution of the acute infection while not delaying protection against recurrence unnecessarily.