Recommended Vaccine for Adult with Prior Herpes Zoster
You should advise the patient to receive the recombinant herpes zoster vaccine (Shingrix/RZV) in a 2-dose series, regardless of their previous herpes zoster episode. 1
Why Recombinant Zoster Vaccine (Shingrix) is the Answer
The recombinant zoster vaccine (RZV/Shingrix) is the preferred and recommended vaccine for all adults aged ≥50 years, including those with a history of herpes zoster. 2, 1 This is not the live-attenuated vaccine (Zostavax), varicella vaccine, or a generic "shingles vaccine"—the specific product is Shingrix. 1
Key Evidence Supporting This Recommendation
Prior herpes zoster does not preclude vaccination—guidelines explicitly state that adults should receive RZV regardless of whether they report a prior episode of herpes zoster. 2, 1
Superior efficacy: RZV demonstrates 97.2% efficacy in preventing herpes zoster in adults aged ≥50 years, with protection persisting for at least 8 years with minimal waning (maintaining >83.3% efficacy). 1, 3, 4
Recurrence risk justifies vaccination: Having shingles once does not provide reliable protection against future episodes, with a 10-year cumulative recurrence risk of 10.3%. 1 Natural immunity from a prior episode is insufficient. 1
Dosing Schedule
First dose: Administer immediately (assuming the acute episode resolved years ago). 1
Second dose: Give 2-6 months after the first dose, with a minimum interval of 4 weeks if needed. 1, 5
Route: Intramuscular injection. 1
Why NOT the Other Options
Live-attenuated vaccine (Zostavax): This vaccine shows poor long-term protection with efficacy declining to only 14.1% by year 10, and is no longer preferred. 1, 6 Even if the patient previously received Zostavax, they should still receive the full 2-dose Shingrix series. 1
Varicella vaccine: This is for prevention of chickenpox in VZV-seronegative individuals, not for herpes zoster prevention in adults who already had chickenpox or shingles. 1 The patient's prior shingles episode confirms VZV seropositivity. 1
Generic "Shingles Vaccine": While technically correct, the specific recommendation is for the recombinant formulation (Shingrix), not the live-attenuated version. 1, 3
Timing After Prior Episode
The patient had herpes zoster years ago, so they are well beyond the recommended 2-month waiting period after acute symptom resolution. 1
There is no maximum interval after a previous episode—do not delay vaccination. 1
Important Clinical Considerations
Safety profile: While RZV causes more injection-site reactions (pain, redness, swelling in 9.5% grade 3 reactions) and systemic symptoms (11.4% vs 2.4% placebo), these are transient and mild-to-moderate. 1, 4
No serious safety concerns: Large clinical trials show similar rates of serious adverse events between vaccine and placebo groups. 1
Safe for most patients: RZV can be administered to patients with chronic medical conditions and is the only herpes zoster vaccine safe for immunocompromised individuals (unlike the live vaccine). 1, 5
Common Pitfall to Avoid
Do not assume that having had shingles provides adequate protection—this is a critical misconception. The 10.3% recurrence risk over 10 years and the vaccine's 97.2% efficacy make vaccination essential even after a prior episode. 1