Timing of Shingrix Vaccination After Shingles
You should wait at least 2 months after a shingles episode before receiving the Shingrix (recombinant zoster vaccine) vaccination. 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 the acute phase of herpes zoster, abatement of symptoms, and recovery of the immune system to optimize vaccine response 1
- Vaccination after a shingles outbreak is particularly important as having one episode of shingles does not provide reliable protection against future recurrences 2
Country-Specific Recommendations
- Different countries have varying recommendations for the time frame between a shingles episode and vaccination: 1
- USA recommends waiting until the acute stage has resolved and symptoms have abated (minimum 2 months)
- Austria recommends waiting at least 2 months
- Canada, Ireland, and Australia recommend waiting at least 1 year
Risk of Recurrence Without Vaccination
- A recent US study with 5.6 years of follow-up showed a cumulative incidence of shingles recurrence of: 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
Vaccination Schedule After Shingles
Shingrix is administered as a two-dose series: 2
- For immunocompetent adults: 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
Studies show that 70% of patients complete the two-dose series within six months and 80% within 12 months post initial dose 3
Clinical Considerations and Pitfalls
- Do not wait too long after the 2-month minimum period as this can increase the risk of recurrence 1
- Do not confuse the waiting period after shingles with the interval between vaccine doses 1
- Shingrix (RZV) is preferred over the older live-attenuated Zostavax (ZVL) vaccine due to higher efficacy and stronger immune response 1, 4
- Shingrix can be safely administered to most immunocompromised patients, unlike the live Zostavax vaccine which is contraindicated in immunocompromised individuals 2
- Stop biologic therapy for at least 6 months before giving live vaccines, and for 12 months in the case of shingles (herpes zoster) vaccine 5
Remember that vaccination after a shingles episode is important since having one episode does not provide reliable protection against future occurrences, with a 10.3% cumulative risk of recurrence at 10 years 2.