Can someone with Guillain-Barré syndrome get the shingles vaccine?

Shingles Vaccination in Guillain-Barré Syndrome

Yes, individuals with a history of Guillain-Barré syndrome (GBS) can receive the shingles vaccine, particularly the recombinant zoster vaccine (Shingrix), which is strongly preferred over the live-attenuated vaccine. 1, 2

Vaccine Selection

• Recombinant zoster vaccine (RZV/Shingrix) is the vaccine of choice for patients with GBS history, as it is a non-live, subunit vaccine that poses no risk of vaccine-strain infection 3, 4, 2
• The live-attenuated vaccine (Zostavax) should be avoided in patients who may be immunocompromised or have underlying neurological conditions 5, 6
• RZV is administered as 2 doses (0.5 mL each) given 2-6 months apart for adults aged ≥50 years 5, 2

Risk-Benefit Assessment for GBS Patients

The established benefits of preventing herpes zoster and its complications outweigh the theoretical risks in most patients with prior GBS, especially those at high risk for severe influenza or zoster complications. 5, 1, 7

Key Considerations:

• History of GBS within 6 weeks of previous vaccination is a precaution, not an absolute contraindication 5, 7
• For patients with prior GBS who are NOT at high risk for severe complications, avoiding vaccination may be prudent 7
• For high-risk patients (including those with chronic conditions or immunosuppression), vaccination benefits clearly outweigh risks 5, 1, 7
• The incidence of GBS in the general population is low (approximately 1 additional case per 1,000 persons vaccinated with influenza vaccine), and no clear association has been established with herpes zoster vaccines 5

Safety Profile of Recombinant Zoster Vaccine

• RZV has demonstrated high efficacy (>90%) in preventing herpes zoster with an acceptable safety profile 3, 4, 2
• Most common adverse reactions are injection-site reactions, myalgia, and fatigue—these are transient and mild to moderate in severity 3
• RZV is non-replicating and safe in immunocompromised persons, making it particularly appropriate for patients with underlying conditions 4, 2
• No evidence suggests RZV increases the risk of GBS recurrence 3, 2

Clinical Implementation

• Administer RZV when the patient's condition is stable 1
• If patients are on high-dose or long-term corticosteroids, consider delaying vaccination until 4-6 weeks after treatment if clinically feasible 1
• Vaccines should be administered in settings where personnel and equipment for managing acute hypersensitivity reactions are available 7
• The majority of persons with a history of GBS who are at high risk for severe complications from herpes zoster should receive yearly vaccination 5, 1

Important Caveats

• A history of GBS is NOT listed as a contraindication to RZV by the FDA or ACIP 2
• The only absolute contraindication to zoster vaccination is anaphylactic or serious allergic reaction to any vaccine component 7
• Patients do not need serologic testing before RZV administration 6
• Consider antiviral chemoprophylaxis as an alternative only for patients who decline vaccination and are at very high risk 5