Do individuals who have had herpes zoster (shingles) still require the varicella-zoster vaccine (Shingrix)?

Shingles Vaccination After Prior Herpes Zoster Infection

Yes, individuals who have had shingles absolutely require the Shingrix vaccine, as a prior episode does not provide reliable protection against future recurrences. 1

Vaccination Timing After Shingles Episode

Wait at least 2 months after the acute shingles episode has completely resolved before administering the first dose of Shingrix. 1, 2 This interval is based on documented evidence showing this is the minimum time between a herpes zoster episode and possible recurrence, allowing for complete resolution of the acute phase and recovery of the immune system to optimize vaccine response. 2

• The 2-month waiting period is recommended by the American College of Physicians and represents the standard in the United States, Germany, and Austria 2
• Some countries (Canada, Ireland, Australia) recommend waiting at least 1 year, but this longer interval increases the risk of recurrence unnecessarily 2

Why Vaccination Is Essential After Prior Shingles

Having had one episode of shingles does not provide reliable protection against future recurrences. 1, 2 The cumulative risk of herpes zoster recurrence is substantial:

• 2.5% at 2 years 2
• 6.6% at 6 years 2
• 10.3% at 10 years 1, 2

Vaccination Schedule

Administer the complete 2-dose Shingrix series for optimal protection:

• First dose: Give immediately after the 2-month waiting period following resolution of the acute episode 1, 2
• Second dose: Administer 2-6 months after the first dose for immunocompetent adults 1, 2
• Immunocompromised patients: A shorter schedule with the second dose given 1-2 months after the first dose is recommended 1, 2
• Minimum interval: 4 weeks between doses if earlier administration is necessary 1

Vaccine Efficacy and Protection

Shingrix demonstrates superior efficacy compared to prior infection alone:

• 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
• Two-dose vaccine effectiveness of 70.1% in real-world studies, with 76.0% effectiveness against postherpetic neuralgia 3

Special Populations

For immunocompromised patients (including those on biologics, JAK inhibitors, or other immunosuppressants):

• Shingrix is the preferred and safe option as it is a non-live recombinant vaccine 1, 2
• Consider deferring vaccination until after immunosuppressive medication has been suspended for an appropriate period before and 4 weeks after vaccination to ensure robust immune response 2
• For patients on JAK inhibitors, treatment should be temporarily discontinued until the episode resolves 2

For patients on low-dose glucocorticoids (prednisone equivalent <10 mg/day):

• The vaccine can be safely administered without adversely impacting vaccine response 1

Critical Pitfalls to Avoid

Never use Zostavax (live-attenuated vaccine) after a shingles episode, especially in immunocompromised patients—only Shingrix is appropriate. 1, 2

• Do not wait longer than 2 months after symptom resolution, as this increases the risk of recurrence unnecessarily 2
• Do not confuse the 2-month waiting period after herpes zoster with the 2-6 month interval between vaccine doses 2
• Do not assume prior shingles provides adequate protection—vaccination remains essential 1, 2

Patients Who Previously Received Zostavax

Adults who received Zostavax should still receive the complete 2-dose Shingrix series, regardless of prior herpes zoster history. 1 Zostavax efficacy wanes significantly over time, dropping to only 14.1% by year 10. 1 Administer Shingrix at least 2 months after the last Zostavax dose. 1