Can You Still Get Shingles After the Shingles Vaccine?
Yes, you can still get shingles after receiving the shingles vaccine, but your risk is dramatically reduced—the recombinant zoster vaccine (Shingrix/RZV) reduces your risk by approximately 92%, while the older live vaccine (Zostavax/LZV) reduces risk by about 49-51%. 1, 2
Vaccine Effectiveness Against Shingles
Recombinant Zoster Vaccine (Shingrix/RZV)
- RZV demonstrates 92% effectiveness in preventing herpes zoster at 3.2 years of follow-up, meaning approximately 8 out of 100 vaccinated people might still develop shingles compared to the unvaccinated population 3, 1
- Protection remains robust for at least 8 years with minimal waning, maintaining efficacy above 83.3% throughout this period 4
- Real-world effectiveness studies corroborate clinical trial data, showing approximately 85% effectiveness in preventing shingles 5
Live Attenuated Zoster Vaccine (Zostavax/LZV)
- LZV shows 51% effectiveness (range 46-70%) in preventing herpes zoster, meaning roughly half of vaccinated individuals retain their baseline risk 1, 2
- Effectiveness wanes significantly over time: drops from 67.5% in the first year to 47.2% in the second year, then gradually declines to only 31.8% by year 8 2
- By year 10, vaccine efficacy against herpes zoster drops to only 14.1% 3
Why Breakthrough Cases Occur
No Vaccine Provides 100% Protection
- Even the highly effective RZV cannot prevent all cases because vaccine-induced immunity varies between individuals based on baseline immune function, age, and concurrent immunosuppressive conditions 3
- Cell-mediated immune responses correlate most strongly with protection, and these responses may be inadequate in some vaccinated individuals despite proper vaccination 3
Immunosuppression Reduces Vaccine Response
- Patients on disease-modifying antirheumatic drugs (DMARDs) may have reduced vaccine responses—for example, TNF-inhibitor treated patients develop only about 50% of the immune response seen in healthy subjects 3
- Immunocompromised individuals remain at higher baseline risk for herpes zoster even after vaccination, though vaccination still provides meaningful protection 3
Clinical Implications
Breakthrough Infections Are Typically Milder
- While breakthrough cases can occur, vaccinated individuals who develop shingles generally experience less severe disease and lower rates of post-herpetic neuralgia compared to unvaccinated individuals 3, 1
Vaccination Remains Strongly Recommended
- The substantial risk reduction (92% for RZV, 51% for LZV) far outweighs the residual breakthrough risk 1, 2
- RZV is strongly recommended for all adults ≥50 years regardless of prior shingles history or previous LZV vaccination 3, 4
Prior Vaccination with LZV Does Not Eliminate Need for RZV
- Adults who received Zostavax should still receive the full 2-dose Shingrix series because LZV provides inadequate long-term protection 3, 6
- RZV should be administered at least 2 months after LZV, though intervals beyond 5 years are preferred for optimal effectiveness 3
Important Caveats
Distinguish Vaccine-Strain from Wild-Type Reactivation
- With the live attenuated vaccine (LZV), rare cases of vaccine-strain herpes zoster can occur, particularly in immunocompromised individuals who should not have received this vaccine 3, 7
- RZV cannot cause herpes zoster under any circumstances because it contains only a viral glycoprotein fragment, not live virus 3, 8