Can a patient with a history of shingles (Herpes Zoster) twice, receive the Shingrix (Recombinant Zoster Vaccine) vaccination?

Shingles Vaccination After Recurrent Herpes Zoster

Yes, this 24-year-old patient with two prior episodes of shingles should receive the Shingrix (recombinant zoster vaccine, RZV) vaccination, ideally waiting at least 2 months after the most recent episode has completely resolved. 1, 2

Age Consideration and Current Recommendations

While standard guidelines recommend Shingrix for adults aged ≥50 years, this patient's history of recurrent herpes zoster at unusually young ages (13 and 24 years old) represents a significant risk factor that warrants vaccination consideration. 1

• The recurrence risk after one episode of shingles is substantial: 2.5% at 2 years, 6.6% at 6 years, and 10.3% at 10 years, demonstrating that prior infection does not provide reliable protection against future episodes. 1, 2
• Prior history of herpes zoster is explicitly NOT a contraindication to vaccination—in fact, guidelines specifically recommend vaccination regardless of previous shingles history. 3, 1, 2

Optimal Timing After Most Recent Episode

Wait at least 2 months after the acute symptoms of the most recent shingles episode have completely resolved before administering the first dose. 1, 2

• This 2-month interval is based on documented evidence showing this is the minimum interval between herpes zoster episodes and potential recurrence. 2
• The waiting period allows for complete resolution of the acute phase, abatement of symptoms, and immune system recovery to optimize vaccine response. 2

Vaccination Schedule

Administer Shingrix as a 2-dose series with the second dose given 2-6 months after the first dose (minimum interval of 4 weeks). 1

• Complete vaccination with both doses is strongly recommended for optimal protection, as two-dose vaccine effectiveness is 70.1% compared to only 56.9% for a single dose. 1, 4
• If the second dose is administered beyond 6 months, effectiveness is not impaired—real-world data shows second doses given at ≥180 days maintain full effectiveness. 1, 4

Why Shingrix Over Zostavax

Only Shingrix (RZV) should be considered—never Zostavax (live attenuated vaccine). 1, 5

• Shingrix demonstrates 97.2% efficacy against herpes zoster compared to Zostavax's 51.3% efficacy. 5, 6
• Shingrix maintains efficacy above 83.3% for at least 8 years with minimal waning, while Zostavax efficacy declines markedly with age. 1, 5
• Shingrix is a non-live recombinant vaccine, making it safer for broader populations. 5, 7

Special Considerations for This Young Patient

This patient's recurrent shingles at young ages suggests possible underlying immune dysregulation or increased susceptibility to VZV reactivation.

• Consider evaluating for immunocompromising conditions, though this does not preclude vaccination—Shingrix is safe and effective even in immunocompromised individuals. 1, 7, 6
• If any immunosuppressive therapy is being considered, ideally complete the full 2-dose Shingrix series before starting such therapy to maximize immune response. 1

Common Pitfalls to Avoid

• Do not delay vaccination beyond the 2-month minimum waiting period—waiting too long increases the risk of another recurrence without providing additional benefit. 2
• Do not assume prior shingles episodes provide immunity—they do not, and this patient's two episodes prove the point. 1, 2
• Do not confuse the 2-month waiting period after shingles with the 2-6 month interval between vaccine doses—these are separate timing considerations. 2
• Do not skip the second dose—single-dose effectiveness is significantly lower than the complete 2-dose series. 1, 4

Expected Side Effects

Prepare the patient for common reactogenicity, which is more pronounced with Shingrix than with placebo. 1, 6

• Injection-site reactions (pain, redness, swelling) occur commonly, with 9.5% experiencing grade 3 injection site reactions. 1
• Systemic symptoms (myalgia, fatigue) were reported in 11.4% of vaccine recipients versus 2.4% in placebo recipients. 1, 6
• Most solicited adverse reactions are transient and mild to moderate in severity. 6
• No serious safety concerns have been identified in large clinical trials. 1