Can You Get Shingles In-Between Doses Of Shingrix?

Although your risk may be lessened, is possible to get shingles in-between doses of Shingrix.

Question

I had shingles in October 2017. I had the first Shingrix shot in October 2018. In December 2018. I have been diagnosed once again with shingles lesions on my back! I am taking anti-viral meds for the week. Why do I have shingles again? Should I get the second Shingrix dose in March as planned? What are my chances of again getting shingles?

Asked by Marie On Dec 07, 2018

Answered by
Medical Content Reviewed By PharmacistAnswers Staff

On Dec 08, 2018
Outer Shingrix Package

Answer

Yes, it is possible to experience an episode of shingles (i.e. herpes zoster) in-between dose one and two of Shingrix, which are recommended to be given 2-6 months apart.

Although the Shingrix vaccine is effective, it doesn't completely eliminate the risk of a shingles infection, even after getting both doses. A study published in the New England Journal of Medicine reported the following efficacy data:

Overall vaccine [Shingrix] efficacy against herpes zoster was 97.2% (95% confidence interval [CI], 93.7 to 99.0; P<0.001). Vaccine efficacy was between 96.6% and 97.9% for all age groups.

As Shingrix isn't 100% effective, it stands to reason that there is a chance you could, unfortunately, experience an episode between dose one and dose two.

Your risk of shingles after your first dose of Shingrix is most likely lower than it would be without it. However, there isn't any data available to know just how common it is as studies for Shingrix only evaluated how effective it was in preventing confirmed cases of shingles after the second dose.

Clinical studies have not been conducted evaluating the efficacy of Shingrix when just one dose is received.

The Centers for Disease Control also states that it is unknown how effective one dose of Shingrix is. Additionally, they specify that individuals may be at higher risk of a shingles infection if the dosing schedule isn't followed:

The vaccine series need not be restarted if more than 6 months have elapsed since the first dose; however, the efficacy of alternative dosing regimens has not been evaluated, data regarding the safety of alternative regimens are limited, and individuals might remain at risk for herpes zoster during a longer than recommended interval between doses 1 and 2.

It is important to note that Shingrix is not a live vaccine and cannot 'give' you shingles. If you do experience an episode between dose one and two, it's likely just bad luck (or due to other precipitating factors).

Answer Summary

It is possible to experience an episode of shingles between dose one and two of the Shingrix vaccine. Although your risk is most likely decreased after your first shot, the incidence rate is unknown.

Immune Response After One Dose

Even though we don't have data on exactly what your risk of developing shingles is after one dose of Shingrix, small studies in specific populations do show an immune response greater than placebo after getting the first shot in the series.

One such study, done in individuals with hematologic malignancies (i.e. cancers that affect the blood and lymphatic system), showed the following results:

Immune Response Graph After One Shingrix Dose

Source: Poster Abstract Session: Herpes Zoster Vaccine


The above graph is certainly a bit difficult to completely dissect but illustrates a clear immune response after one dose of Shingrix.

  • The 'M1' label indicates 1 to 2 months after dose one of Shingrix.
  • The blue bar is for Shingrix while the orange bar is for placebo.

The chart also shows how much greater of an immune response there is after the second dose (M2).

Unfortunately, we don't know how much the immune response after dose one translates to effectiveness in preventing shingles.

Summary

Studies show a significant immune response after the first dose of Shingrix and an ever greater response after dose two. However, it is unknown how much only one dose reduces the risk of shingles.

Getting The Second Dose

If you have an episode of shingles in-between dose one and dose two, you are still recommended to get the second dose. However, you should wait until it has cleared. From the CDC:

If a patient is experiencing an episode of herpes zoster, vaccination should be delayed until the acute stage of the illness is over and symptoms abate. Studies of safety and immunogenicity of RZV in this population are ongoing.

If you had the first dose of Shingrix in October, you should still get your second scheduled dose (which per your question is in March) as long as your current episode of shingles has cleared.

Summary

The second dose of Shingrix is recommended even if you experience an episode of shingles in-between dose one and dose two. The current episode needs to be cleared first however.

References
  1. ^ Efficacy of an Adjuvanted Herpes Zoster Subunit Vaccine in Older Adults. NEJM
  2. ^ Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. CDC
  3. ^ 1344. Immunogenicity and Safety of an Adjuvanted Herpes Zoster Subunit Candidate Vaccine in Adults with Hematologic Malignancies: A Phase III, Randomized Clinical Trial. IDSA
  4. ^ Shingrix Prescribing Information. GSK

About the Pharmacist

Dr. Brian Staiger Pharm.D

Dr. Brian Staiger is a licensed pharmacist in New York State and the founder of PharmacistAnswers.com. He graduated from the University At Buffalo with a Doctor of Pharmacy degree in 2010. He has been featured in numerous publications including the Huffington Post as well as a variety of health and pharmacy-related blogs. Please feel free to reach out to him directly if you have any inquiries or want to connect! He's answered thousands of medication and pharmacy-related questions and he's ready to answer yours! Brian.Staiger@PharmacistAnswers.com Office: 716-389-3076

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