How long should an adult wait after having herpes zoster (shingles) before receiving the Shingrix (recombinant zoster vaccine) vaccine?

Timing of Shingles Vaccine After Herpes Zoster

You should administer the first dose of Shingrix at least 2 months after the acute herpes zoster episode has completely resolved, followed by the second dose 2-6 months later.

Rationale for the 2-Month Waiting Period

The 2-month interval is based on documented evidence showing this represents the minimum interval between an episode of herpes zoster and potential recurrence 1. This waiting period allows for:

• Complete resolution of the acute phase of herpes zoster 1
• Full abatement of symptoms 2
• Recovery of the immune system to optimize vaccine response 1, 2

The recommendation is consistent across major guidelines, with the American College of Physicians and other societies recommending vaccination once acute symptoms have resolved, typically waiting at least 2 months 3, 2.

Vaccination Schedule After Recovery

For immunocompetent adults:

• Administer the first dose immediately after the 2-month waiting period 2
• Give the second dose 2-6 months after the first dose 3, 1, 2
• The minimum interval between doses is 4 weeks, though this is not optimal 3

For immunocompromised adults:

• Consider a shortened schedule with the second dose given 1-2 months after the first dose 3, 1, 2
• If possible, defer vaccination until after holding immunosuppressive medication for an appropriate period before and 4 weeks after vaccination to ensure robust immune response 4, 1, 2

Why Vaccination After Herpes Zoster Is Critical

Having one episode of herpes zoster does not provide reliable protection against future recurrences 3, 1, 2. The cumulative recurrence risk is substantial:

• 2.5% at 2 years 1, 2
• 6.6% at 6 years 2
• 10.3% at 10 years 3, 1, 2

Shingrix demonstrates 70.1% effectiveness for the two-dose series in real-world studies, significantly reducing recurrence risk 3, 5.

Important Caveats and Common Pitfalls

Do not wait longer than necessary: Delaying vaccination beyond the minimum 2-month period unnecessarily increases the risk of recurrence 1, 2. Some countries recommend waiting 1 year (Canada, Ireland, Australia), but the US and Germany recommend the shorter 2-month interval 1, 2.

Do not confuse waiting periods: The 2-month waiting period after herpes zoster is distinct from the 2-6 month interval between vaccine doses 1, 2.

Only use Shingrix (RZV), never Zostavax: The recombinant zoster vaccine is the preferred option after a herpes zoster episode, particularly for immunocompromised patients where the live-attenuated vaccine is contraindicated 1, 2.

Second doses beyond 6 months remain effective: Real-world data shows that second doses administered at ≥180 days maintain full effectiveness, so do not restart the series if the patient misses the 6-month window 3, 5.

Special Population Considerations

For patients on immunosuppressive therapy (including JAK inhibitors):

• Temporarily discontinue treatment until the episode resolves 2
• Consider antiviral prophylaxis for those with recurrent herpes zoster 2
• Ideally complete the full 2-dose series before restarting immunosuppressive therapy 3

For hematopoietic stem cell transplant recipients:

• Allogeneic HSCT: Wait at least 6-12 months post-transplantation 1
• Autologous HSCT: Can begin vaccination 50-70 days post-transplantation 1