What is the ideal timing to delay the Shingrix (zoster vaccine recombinant) vaccination after a herpes zoster (shingles) infection?

From the Guidelines

The ideal timing to delay the Shingrix vaccine after a shingles infection is to wait at least 2 months after the acute stage of the infection has resolved and symptoms have abated, as recommended by recent guidelines 1. This recommendation is based on the documented minimal interval between an episode of herpes zoster (HZ) and recurrence of 2 months. The Shingrix vaccine (recombinant zoster vaccine) is a two-dose series, with the second dose administered 2-6 months after the first dose. When you do get vaccinated, you should complete the full two-dose series for optimal protection. Some key points to consider when deciding on the timing of the Shingrix vaccine after a shingles infection include:

• The risk of HZ recurrence, which can be as high as 10.3% at 10 years after the initial diagnosis 1
• The importance of allowing the body to fully recover from the infection and develop its natural immune response before introducing the vaccine
• The potential for antiviral medications to interfere with the vaccine's effectiveness, although this is not directly addressed in the provided evidence
• The fact that natural infection does not guarantee lifelong protection against future outbreaks, making vaccination still recommended even after having shingles. It's worth noting that different countries have varying recommendations for the timing of zoster vaccination after an episode of HZ, ranging from at least 2 months in Austria to at least 1 year later in Canada, Ireland, and Australia 1. However, based on the most recent and highest-quality evidence, waiting at least 2 months after the acute stage of the infection has resolved is the recommended approach.

From the Research

Ideal Timing to Delay Shingrix Vaccine After Shingles Infection

• The ideal timing to delay the Shingrix vaccine after a shingles infection is not explicitly stated in the provided studies, but some studies offer insights into the immunogenicity and safety of zoster vaccination after shingles.
• A prospective study 2 compared the immunogenicity and safety of administering live zoster vaccine at 6-12 months and 1-5 years after zoster illness, and found that the immunogenicity of zoster vaccine may be similar whether administered 6-12 months or >1 year after zoster illness.
• Another study 3 found that the 2-dose vaccine effectiveness of Shingrix was not significantly lower for beneficiaries who received the second dose at ≥180 days, suggesting that delaying the second dose may not impair effectiveness.
• However, the studies do not provide a clear recommendation for the ideal timing to delay the Shingrix vaccine after a shingles infection, and more research may be needed to determine the optimal timing.

Factors to Consider

• The immunogenicity and safety of zoster vaccination after shingles may depend on various factors, including the individual's immune status, age, and health conditions.
• The studies suggest that the Shingrix vaccine is effective in preventing herpes zoster disease, but the optimal timing for vaccination after a shingles infection is not well established.
• Healthcare providers may need to consider individual factors and consult with patients to determine the best approach for delaying the Shingrix vaccine after a shingles infection.

Available Vaccines

• The studies mention two types of zoster vaccines: live zoster vaccine (LZV) and recombinant zoster vaccine (RZV, also known as Shingrix).
• The RZV vaccine has been shown to be effective in preventing herpes zoster disease, with an overall vaccine efficacy of 97.2% among participants 50 years of age or older 4.
• The LZV vaccine has also been shown to be effective, but with a lower vaccine efficacy compared to RZV 5, 6.