Timing of Shingrix Vaccination After Shingles
Individuals who have had shingles should wait at least 2 months after the acute episode has resolved before receiving the Shingrix vaccine. 1
Recommended Waiting Period
- The 2-month minimum interval recommendation is based on documented evidence showing this is the minimum time 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:
Importance of Vaccination After Shingles
- Having one episode of shingles does not provide reliable protection against future recurrences 2
- A US study with 5.6 years of follow-up showed significant cumulative incidence of shingles recurrence: 2.5% at 2 years, 4.8% at 4 years, 6.6% at 6 years, 8.0% at 8 years, and 10.3% at 10 years 3, 1
- Vaccination after a shingles outbreak is particularly important due to this high risk of recurrence 2
Vaccine Administration After Shingles
- Shingrix (recombinant zoster vaccine, RZV) is the preferred vaccine for adults who have experienced a shingles outbreak due to its superior efficacy 1, 2
- The vaccine should be administered as a 2-dose series with the second dose given 2-6 months after the first dose 2
- For immunocompromised adults aged ≥18 years, a shorter schedule with the second dose given 1-2 months after the first dose may be considered 2
- Shingrix maintains high efficacy across all age groups, with vaccine effectiveness of 97.2% in adults aged 50 years and older 2, 4
- Real-world effectiveness studies show 70.1% effectiveness for 2 doses and 56.9% for 1 dose, highlighting the importance of completing the series 5
Special Considerations
- Individuals who previously received the live zoster vaccine (Zostavax) can receive Shingrix at least 2 months after Zostavax 2, 6
- For immunocompromised patients, Shingrix (which is a non-live vaccine) is the preferred option as it is considered safe, unlike the live Zostavax vaccine which is contraindicated in this population 2, 4
- Vaccination rates show good uptake with approximately 70% of individuals completing the two-dose series within six months and 80% within 12 months of the initial dose 7
Clinical Pitfalls to Avoid
- Waiting too long after the 2-month minimum period increases the risk of recurrence 1
- Do not confuse the waiting period after shingles (minimum 2 months) with the interval between vaccine doses (2-6 months) 1, 2
- Shingrix vaccination is not indicated to treat acute shingles or to prevent persons with acute shingles from developing postherpetic neuralgia 8
- Do not miss the opportunity to vaccinate older adults who have had shingles, as they remain at significant risk for recurrence 1, 2