Timing of Shingrix Vaccination After a Shingles Outbreak
Wait at least 2 months after a shingles outbreak before receiving the Shingrix (recombinant zoster vaccine). 1
Rationale for the 2-Month Waiting Period
- The 2-month interval recommendation is based on documented evidence showing this is the minimum interval between an episode of herpes zoster and potential recurrence 1
- This waiting period allows for complete resolution of acute symptoms and recovery of the immune system to optimize vaccine response 1
- Vaccination should occur once the acute symptoms have resolved, typically waiting at least 2 months after the episode 2
Vaccination Schedule After Shingles
- For immunocompetent adults, Shingrix is administered as a two-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 is recommended 3, 2
- The minimum interval between doses is 4 weeks; if administered earlier than this minimum interval, the dose should be repeated 2
Importance of Vaccination After Shingles
- Having one episode of shingles does not provide reliable protection against future recurrences 2
- A recent US study showed a cumulative incidence of shingles recurrence of 2.5% at 2 years, increasing to 10.3% at 10 years 1
- Vaccination after a shingles outbreak is particularly important due to this significant risk of recurrence 2
Vaccine Efficacy
- Shingrix demonstrates high efficacy in preventing herpes zoster with vaccine efficacy of 97.2% in adults aged 50 years and older 2
- Protection persists for at least 8 years with minimal waning, maintaining efficacy above 83.3% during this period 2
- Real-world effectiveness studies show approximately 70.1% effectiveness for 2 doses and 56.9% for 1 dose 4
Special Considerations
- For patients who have previously received the live-attenuated herpes zoster vaccine (Zostavax), Shingrix should be given at least 2 months after the last Zostavax dose 3, 2
- For recipients of autologous hematopoietic stem cell transplant (HSCT), Shingrix should be given 50-70 days post-transplantation 2
- 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 2, 5
Country-Specific Variations
- Different countries have varying recommendations for the time frame between a shingles episode and vaccination: USA and Germany recommend waiting until the acute stage has resolved, Austria recommends waiting at least 2 months, while Canada, Ireland, and Australia recommend waiting at least 1 year 1
Common Pitfalls to Avoid
- Waiting too long after the 2-month minimum period can increase the risk of recurrence 1
- Confusing the waiting period after shingles with the interval between vaccine doses 1
- Missing the opportunity for vaccination in older adults who have had shingles, as they remain at risk for recurrence 1
- Assuming that starting antiviral therapy immediately makes the patient non-contagious - viral shedding continues until lesions are fully crusted 6