Recombinant Zoster Vaccine (Shingrix) is the Recommended Choice
For a patient who had herpes zoster 3 years ago, you should advise the recombinant herpes zoster vaccine (Shingrix/RZV) administered as a 2-dose series, regardless of their prior shingles history. 1, 2, 3
Why Recombinant Zoster Vaccine (Option A)
Prior shingles infection does not provide reliable protection against future episodes, with a 10-year cumulative recurrence risk of 10.3%, making vaccination essential even after a previous episode. 1, 2
The recombinant zoster vaccine (Shingrix) demonstrates 97.2% efficacy in preventing herpes zoster in adults aged 50 years and older, with protection persisting for at least 8 years with minimal waning (maintaining efficacy above 83.3%). 1, 4
Current guidelines from the CDC and American College of Physicians explicitly recommend RZV for all adults aged ≥50 years, regardless of previous herpes zoster history, making this the standard of care. 1, 2, 3
Dosing Schedule
Administer the first dose immediately, followed by the second dose 2-6 months later (minimum interval of 4 weeks between doses). 1, 2, 3
Wait at least 2 months after acute shingles symptoms have resolved before initiating vaccination, though since this patient's episode was 3 years ago, they can proceed immediately. 1, 2
Why NOT the Other Options
Option B (Active/Live-Attenuated Herpes Zoster Vaccine - Zostavax)
The live-attenuated vaccine (Zostavax) is no longer preferred due to significantly inferior efficacy (51-70% initially, declining to only 14.1% by year 10) compared to RZV's sustained 97.2% efficacy. 5, 1, 2
Adults who previously received Zostavax should still receive the full 2-dose Shingrix series due to inadequate long-term protection from the live vaccine. 1, 2
Option C (Varicella Vaccine)
Varicella vaccine is indicated for primary prevention of chickenpox in VZV-seronegative individuals, not for herpes zoster prevention. 2
This patient's prior shingles episode confirms VZV seropositivity, making varicella vaccination inappropriate and unnecessary. 2
Option D (Generic "Shingles Vaccine")
- This is too vague - while technically both Zostavax and Shingrix are "shingles vaccines," only the recombinant formulation (Shingrix/RZV) is currently recommended as the preferred vaccine. 1, 2, 3
Important Clinical Considerations
RZV is safe for immunocompromised patients (unlike the live-attenuated vaccine which is contraindicated), making it appropriate for patients on immunosuppressive therapy, with autoimmune diseases, or other immunodeficiency states. 5, 3, 6
Real-world effectiveness studies confirm 70.1% effectiveness for the 2-dose series, which is lower than clinical trial efficacy but still represents substantial protection. 7
Common side effects include injection-site reactions (pain, redness, swelling) and systemic symptoms (myalgia, fatigue), with 9.5% experiencing grade 3 injection site reactions, but most adverse events are transient and resolve within 4 days. 1, 2