Timing of Shingrix After Influenza Illness
You do not need to wait after having the flu to receive Shingrix—you can get vaccinated as soon as your acute flu symptoms have resolved.
Evidence-Based Timing Recommendations
The most recent ACIP guidelines explicitly state that Shingrix can be administered simultaneously or sequentially with inactivated influenza vaccines, with no required waiting period between them. 1 This guidance applies whether you're receiving both vaccines at the same time or have recently had influenza illness.
Key Guideline Principles
Inactivated vaccines like Shingrix can be given at any time relative to other inactivated vaccines or after viral illnesses, without mandatory spacing intervals. 1
The 2024-25 ACIP recommendations confirm that recombinant zoster vaccine (Shingrix) containing the AS01B adjuvant can be coadministered with influenza vaccines without evidence of decreased immunogenicity or safety concerns. 1
When vaccines are given concomitantly, they should be administered at separate anatomic sites (different limbs if possible), but no time interval is required between administrations. 1
Practical Clinical Algorithm
For patients recovering from influenza illness:
Wait until acute flu symptoms (fever, severe malaise, myalgias) have resolved—this is a general principle for any vaccination, not a specific contraindication. 1
Once you feel well enough to tolerate potential vaccine side effects (which can include injection-site pain, fatigue, and myalgia), proceed with Shingrix vaccination immediately. 2
There is no specific waiting period (such as 2 weeks or 4 weeks) required after influenza illness before receiving Shingrix. 1
Important Distinction: Live vs. Non-Live Vaccines
This guidance differs fundamentally from live vaccine spacing requirements:
Live vaccines require a 4-week interval if not given simultaneously with other live vaccines. 1
Shingrix is a recombinant (non-live) vaccine, so these live vaccine spacing rules do not apply. 1, 2
The older live-attenuated zoster vaccine (Zostavax) would require different timing considerations, but Zostavax is no longer preferentially recommended. 2
Adjuvant Considerations
While Shingrix contains the AS01B adjuvant system, and theoretical concerns exist about administering multiple adjuvanted vaccines simultaneously, the evidence shows no safety concerns when Shingrix is coadministered with adjuvanted influenza vaccines. 1 A CISA randomized controlled trial found that simultaneous administration of Shingrix with adjuvanted influenza vaccine did not increase severe reactions compared to high-dose influenza vaccine. 1
Common Pitfalls to Avoid
Do not confuse the 4-week waiting period for live vaccines with requirements for Shingrix—no such waiting period exists for this recombinant vaccine after flu illness. 1, 3
Do not delay Shingrix vaccination unnecessarily—the vaccine should not be postponed if you are otherwise feeling well after flu illness. 1
Do not wait for a specific "optimal" time after flu—there is no evidence that waiting improves vaccine response or reduces side effects. 1
Side Effect Management
Most Shingrix side effects (injection-site reactions, myalgia, fatigue) resolve within 4 days. 1, 2
If you recently had flu symptoms, be aware that Shingrix can cause similar systemic symptoms (fatigue, myalgia), but these are vaccine-related and transient, not a flu recurrence. 2
Grade 3 injection-site reactions occur in 9.5% of recipients, and systemic symptoms in 11.4%, but these are generally mild to moderate and self-limited. 2
Special Population Considerations
For immunocompromised patients (including those on immunosuppressive therapy for inflammatory bowel disease, rheumatic diseases, or other conditions):
The same timing principles apply—no waiting period is required after flu illness. 1
These patients should receive Shingrix on the standard 2-dose schedule (second dose 2-6 months after first, or 1-2 months for high-risk immunocompromised patients). 2
Annual influenza vaccination is strongly recommended for immunocompromised patients, and Shingrix should not be delayed due to recent flu vaccination or illness. 1