Herpes Zoster Vaccination for COPD Patients with Prior Infection
Give him the recombinant zoster vaccine (RZV/Shingrix) now—a history of previous herpes zoster infection is actually an indication for vaccination, not a contraindication. 1
Why Vaccinate After Prior Infection
Prior herpes zoster does not provide reliable protection against recurrence. The cumulative recurrence risk reaches 10.3% at 10 years, making vaccination essential even after a previous episode. 1
The recombinant zoster vaccine (RZV) is specifically recommended for adults aged ≥50 years regardless of whether they report a prior episode of herpes zoster. 2
Vaccination should ideally be administered once acute symptoms have resolved, typically waiting at least 2 months after the episode. Since this patient had the infection "a few years ago," they are well beyond this minimum interval. 1
Specific Recommendations for This Patient
The patient should receive the complete 2-dose RZV series:
- First dose administered now
- Second dose given 2-6 months after the first dose 2, 1
- The minimum interval between doses is 4 weeks, though 2-6 months is preferred 2
Why RZV is Superior
RZV demonstrates significantly higher efficacy compared to the older live-attenuated vaccine (ZVL):
- Vaccine efficacy of 97.2% in adults aged 50 years and older 1
- Protection persists for at least 8 years with minimal waning, maintaining efficacy above 83.3% during this period 1
- In comparison, ZVL efficacy was only 51% in adults ≥60 years and dropped to 37% in those ≥70 years 3
COPD-Specific Considerations
COPD patients are at increased risk for herpes zoster complications:
- Chronic lung disease increases susceptibility to severe infections
- RZV is a non-live recombinant vaccine, making it safe even if the patient is on corticosteroids or other immunosuppressive therapy commonly used in COPD management 1
- Concomitant low-dose glucocorticoids (prednisone equivalent <10 mg/day) do not adversely impact vaccine response 1
Common Pitfalls to Avoid
Do not delay vaccination based on:
- Previous herpes zoster infection—this is NOT a contraindication 2, 1
- Current use of inhaled or low-dose systemic corticosteroids 1
- The misconception that "natural immunity" from prior infection is sufficient 1
Expected side effects that should not deter vaccination:
- Injection-site reactions occur in 9.5% (grade 3) compared to 0.4% with placebo 1
- Systemic symptoms reported in 11.4% versus 2.4% in placebo recipients 1
- No serious safety concerns have been identified in large clinical trials 1
Clinical Bottom Line
Answer: A. Give him the vaccine
The patient's fear of recurrence is medically justified given the 10.3% cumulative recurrence risk, and vaccination is the most effective prevention strategy. There is no need to wait additional years (eliminating option C), and "no need for vaccine" (option B) contradicts all current guidelines for adults ≥50 years with or without prior herpes zoster history. 2, 1