What vaccine should be given to a patient with a history of shingles and chronic obstructive pulmonary disease (COPD) to prevent future episodes?

Shingles Vaccination for COPD Patient with Prior Herpes Zoster

Give the recombinant zoster vaccine (Shingrix) now—a history of prior shingles is not a contraindication and this patient needs protection against recurrence. 1, 2

Vaccine Selection

• The recombinant zoster vaccine (RZV/Shingrix) is the appropriate choice for this patient with COPD, regardless of her prior shingles episode. 1, 2

• The live attenuated vaccine (Zostavax) is no longer the preferred option and has been largely replaced by the recombinant vaccine due to superior efficacy. 3, 4

• COPD patients are at increased risk for herpes zoster-related complications, making vaccination particularly important in this population. 2

Timing of Vaccination

• Prior history of shingles is NOT a contraindication to vaccination—in fact, the recombinant zoster vaccine is specifically recommended for adults aged 50 years and older regardless of prior episodes of herpes zoster. 5, 3

• There is no required waiting period after a previous shingles episode before administering the vaccine. 5

• The vaccine should be offered at the patient's first clinical encounter rather than postponing for an arbitrary time period like 5 years. 3

Administration Details

• The recombinant vaccine requires two doses administered 2-6 months apart for complete protection. 1, 6

• Approximately 70% of patients complete the two-dose series within 6 months, and 80% within 12 months. 6

• The vaccine remains effective for at least 8 years after administration, though effectiveness gradually wanes over time. 1

Why Not the Other Options?

• Option B (live attenuated vaccine) is inferior to the recombinant vaccine in terms of efficacy and is not the current standard of care. 4

• Option C (postponing 5 years) is incorrect—there is no evidence-based rationale for delaying vaccination, and this leaves the patient vulnerable to recurrence during the waiting period. 3

• Option D (reassurance without vaccination) is inappropriate—approximately one in three persons will develop zoster during their lifetime, and prior infection does not prevent recurrence. 3

Clinical Rationale

• The recombinant vaccine is remarkably effective in restoring protective T cell-mediated immunity required to prevent herpes zoster, with clinical efficacy much greater than other vaccines for older individuals. 4

• Patients with chronic lung diseases such as COPD are at increased risk of herpes zoster-related complications, making prevention through vaccination especially important. 2

• The vaccine offers robust protection against both herpes zoster and its complications, including postherpetic neuralgia (PHN), which can be debilitating. 2, 4