How long after developing shingles (Herpes Zoster) should you wait to receive the shingles vaccine?

Timing of Shingles Vaccine After Acute Shingles Episode

You should wait at least 2 months after developing shingles before receiving the shingles vaccine, specifically the recombinant zoster vaccine (Shingrix/RZV). 1, 2, 3

Rationale for the 2-Month Waiting Period

• The 2-month interval is based on documented evidence showing this is the minimum time between an episode of herpes zoster and potential recurrence. 1, 4
• This waiting period allows for complete resolution of the acute phase, abatement of symptoms, and recovery of the immune system to optimize vaccine response. 3, 4
• The recommendation balances the need for immune system recovery against the risk of recurrent shingles, which can occur as early as 2 months after the initial episode. 1

International Variation in Recommendations

While the 2-month minimum is the most practical recommendation, different countries have varying guidelines: 1, 3, 4

• USA and Germany: Wait until acute stage has resolved and symptoms have abated (minimum 2 months)
• Austria: At least 2 months
• Canada, Ireland, and Australia: At least 1 year

The 2-month recommendation represents the most evidence-based approach, as longer waiting periods unnecessarily delay protection without clear benefit. 1

Why Vaccination After Shingles Is Critical

• Having one episode of shingles does not provide reliable protection against future recurrences. 2, 3
• The cumulative risk of shingles recurrence is substantial: 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. 1, 3, 4
• Vaccination significantly reduces this recurrence risk. 1

Vaccine Choice and Dosing Schedule

Shingrix (RZV) is strongly preferred over the older Zostavax (ZVL) vaccine due to superior efficacy (97.2% vs. declining to 14.1% by year 10 for Zostavax). 1, 2, 3

For Immunocompetent Adults:

• Administer the two-dose series with the second dose given 2-6 months after the first dose. 2, 4
• Complete both doses for optimal protection, as two doses provide significantly stronger immunogenicity than one. 1

For Immunocompromised Adults (≥18 years):

• Use a shorter schedule with the second dose given 1-2 months after the first dose. 2, 3, 4
• Shingrix is safe for immunocompromised patients, unlike the live Zostavax which is contraindicated. 3, 4

Common Clinical Pitfalls to Avoid

• Do not wait longer than necessary: While 2 months is the minimum, delaying vaccination beyond this increases recurrence risk without benefit. 4
• Do not confuse the waiting period after shingles (2 months) with the interval between vaccine doses (2-6 months). 4
• Do not use live zoster vaccine (Zostavax) in immunocompromised patients—only Shingrix is appropriate. 4
• Do not miss vaccination opportunities in older adults who have had shingles, as they remain at high risk for recurrence. 4

Special Considerations

• If the patient previously received Zostavax, Shingrix should be administered at least 2 months after the Zostavax dose. 2
• For patients on low-dose glucocorticoids (<10 mg/day prednisone equivalent), Shingrix maintains effectiveness and can be safely administered. 2
• No screening for varicella history or serology testing is needed before vaccination in immunocompetent adults ≥50 years. 1