Can a patient get the Shingrix (herpes zoster) vaccine if they are exposed to shingles?

Shingrix Vaccination After Shingles Exposure

Yes, a patient can and should receive Shingrix vaccine after exposure to shingles—there is no contraindication to vaccination following exposure, and the recombinant vaccine poses no risk of causing disease even in recently exposed individuals. 1, 2

Key Distinction: Shingrix vs. Live Vaccines

The critical factor here is that Shingrix is a non-live recombinant vaccine, not a live-attenuated vaccine like the older Zostavax or varicella vaccine. 3, 4 This fundamental difference means:

• Shingrix cannot cause varicella-zoster virus infection under any circumstances, including after exposure to active shingles 3
• The vaccine contains only a single viral protein (glycoprotein E) with an adjuvant, not replication-competent virus 3
• There is no theoretical or documented risk of vaccine-strain disease transmission or reactivation 4

Post-Exposure Vaccination Guidance

Proceed with vaccination on the planned schedule without delay. 1, 2 The evidence shows:

• No guidelines recommend deferring Shingrix vaccination after shingles exposure 1, 2
• The vaccine will not worsen or complicate potential incubating infection from the exposure 3
• Even if the patient develops shingles from the exposure, completing the vaccine series afterward (waiting at least 2 months after symptom resolution) remains indicated 1

Contrast with Live Varicella Vaccine Guidance

This differs markedly from live varicella vaccine recommendations, where post-exposure prophylaxis with varicella-zoster immune globulin (VZIG) is recommended for susceptible individuals within 96 hours of exposure 5. However:

• VZIG is for preventing primary varicella (chickenpox) in non-immune individuals 5
• Shingrix is for preventing herpes zoster reactivation, a completely different clinical scenario 1
• The live varicella vaccine can be given 3-5 days post-exposure to modify disease, but this applies only to susceptible individuals without immunity 5

Clinical Algorithm for Exposed Patients

For patients scheduled to receive Shingrix who are exposed to shingles:

1. Confirm the patient is ≥50 years old (or ≥18 years if immunocompromised) 1, 6
2. Administer Shingrix as planned without delay or modification 1, 2
3. Monitor for development of shingles from the exposure over the next 10-21 days (standard incubation period)
4. If shingles develops from the exposure, treat appropriately and complete the vaccine series at least 2 months after acute symptoms resolve 1

Important Caveats

• Do not confuse this with varicella (chickenpox) exposure in non-immune individuals, where different post-exposure prophylaxis applies 5
• Healthcare personnel exposed to shingles should follow workplace exposure protocols regarding work restrictions, but vaccination status does not change based on exposure 5
• The vaccine does not treat active shingles and is not indicated for post-exposure prophylaxis to prevent disease from the current exposure 7

Safety in Immunocompromised Patients

Even for immunocompromised patients exposed to shingles, Shingrix remains safe to administer because it is non-live. 6, 2 This represents a major advantage over Zostavax, which is absolutely contraindicated in immunocompromised individuals. 6