Can a patient with herpes zoster (shingles) receive the varicella-zoster vaccine?

Can a Patient with Shingles Get the Vaccine?

Yes, patients who have had shingles should receive the recombinant zoster vaccine (Shingrix), but they must wait until the acute episode has completely resolved—ideally at least 2 months after symptom resolution. 1

Timing After Acute Shingles Episode

The critical consideration is when to vaccinate, not whether to vaccinate:

• Wait a minimum of 2 months after the acute shingles episode before administering the vaccine 1
• This waiting period allows for complete resolution of acute symptoms, recovery of the immune system, and optimization of vaccine response 1
• Different countries have varying recommendations: the USA and Germany recommend waiting until symptoms have abated, Austria recommends at least 2 months, while Canada, Ireland, and Australia recommend waiting at least 1 year 1
• The 2-month interval is based on documented evidence showing this is the minimum interval between an episode of herpes zoster and potential recurrence 1

Why Vaccination After Shingles Is Important

Having one episode of shingles does not provide reliable protection against future recurrences:

• The cumulative incidence 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
• Vaccination is recommended regardless of prior shingles history due to this significant recurrence risk 1
• Patients who have experienced shingles remain at risk and should not be missed as vaccination opportunities 1

Vaccine Selection and Dosing

Recombinant zoster vaccine (RZV, Shingrix) is the preferred option:

• Both RZV (Shingrix) and the older live-attenuated vaccine (ZVL, Zostavax) can technically be administered after a shingles episode, but RZV is strongly preferred due to higher efficacy and stronger immune response 1
• Complete the full 2-dose series: second dose given 2-6 months after the first dose for immunocompetent adults 1, 2
• For immunocompromised adults aged ≥18 years, a shorter schedule with the second dose at 1-2 months may be appropriate 1, 2
• RZV demonstrates 97.2% efficacy in preventing herpes zoster in adults aged 50 years and older, with protection persisting for at least 8 years (maintaining efficacy above 83.3%) 2

Special Populations and Contraindications

Immunocompromised patients require special consideration:

• RZV (Shingrix) is safe for immunocompromised patients because it is a non-live recombinant vaccine 1, 2
• Live zoster vaccine (Zostavax) is absolutely contraindicated in immunocompromised patients, including those with HIV, autoimmune diseases on immunosuppressive therapy, or cancer patients 3, 1
• For patients on immunosuppressive therapy, consider deferring vaccination until after holding immunosuppressive medication for an appropriate period before and 4 weeks after vaccination to ensure robust immune response 1

Common Pitfalls to Avoid

• Do not wait too long after the 2-month minimum period, as this increases the risk of recurrence 1
• Do not confuse the waiting period after shingles (2 months) with the interval between vaccine doses (2-6 months) 1
• Never administer live zoster vaccine (Zostavax) to immunocompromised patients—only Shingrix is appropriate 1
• Do not assume that having had shingles provides adequate protection—vaccination is still strongly indicated 1

Practical Algorithm

For immunocompetent patients:

1. Confirm acute shingles episode has completely resolved (all lesions crusted, pain improving)
2. Wait minimum 2 months from symptom resolution
3. Administer first dose of Shingrix
4. Administer second dose 2-6 months later 1, 2

For immunocompromised patients:

1. Confirm acute episode resolved and wait minimum 2 months
2. Assess degree of immunosuppression and consider timing relative to immunosuppressive therapy
3. Administer first dose of Shingrix (never Zostavax)
4. Administer second dose 1-2 months later for optimal protection 1, 2