Patients who have had a first outbreak of shingles should still receive the herpes zoster vaccine, a clinician advises in a paper published in the Journal of the American Academy of Dermatology.1
Herpes zoster can lead to complications that vary depending on the site of involvement and include postherpetic neuralgia; Ramsay-Hunt syndrome; ophthalmic complications such as keratitis, uveitis, and optic nerve palsies; and neurologic sequelae, including cranial neuropathies, polyneuritis, myelitis, aseptic meningitis, or partial facial paralysis. Immunocompromised patients have an increased risk for herpes zoster and recurrent disease.
In a recent study, Qian et al assessed herpes zoster recurrence in a population-based cohort.2 Among 17,413 patients who had a first zoster episode (9.43 per 1000 person-years), 675 (0.4%) had a recurrence. The mean time between first and recurrent zoster was 2 years for patients aged 45 to 54 years and 3 years for those who were aged 55 years or older.
In patients who had a first episode of herpes zoster, the incidence of recurrence was 11.05 per 1000 person-years. A higher recurrence incidence was observed in women vs men, in younger patients vs older patients, and in immunosuppressed individuals vs nonimmunosuppressed individuals.
The recurrence appeared to be lower for 1 year after zoster onset and then was consistent at about 12.00 per 1000 person-years in the following 8 years. The increased risk for recurrence in younger patients also occurred in immunocompetent patients. The study authors support vaccination of patients who have already had an episode of herpes zoster, as it may be beneficial if administered within 12 months of the first episode.
In 2017, the FDA approved Shingrix, a subunit (nonlive) recombinant vaccine with adjuvant, for those aged 50 years and older. The intramuscular 2-dose vaccine should be administered 2 to 6 months apart and may be given to patients who have already received the Zostavax vaccine (live) if the vaccines are at least 2 months apart.
The vaccines should not be administered during an acute outbreak of herpes zoster or when a patient is taking antiviral medications for any indication. In addition, both vaccines are well tolerated in patients who have had herpes zoster.
“How will I advise my patients who have already had an episode of herpes zoster if they should receive the (recombinant) vaccine? Unless there are specific contraindications, my answer is ‘absolutely’ for the immunocompromised and ‘yes’ for everyone else,” concluded the study author.
1. Heymann WR. Diminishing the risk of herpes zoster recurrence. J Am Acad Dermatol. Published online July 1, 2021. doi:10.1016/j.jaad.2021.06.870
2. Qian J, Macartney K, Heywood AE, et al. Risk of recurrent herpes zoster in a population-based cohort study of older adults. J Am Acad Dermatol. Published online July 2, 2021. doi: 10.1016/j.jaad.2020.06.1013