How long should you wait to get a flu shot after having shingles

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Diseases & Conditions

September 16, 2019

• By Urmila Parlikar, Associate Director, Digital Health Products at Harvard Health Publishing

No one who has experienced the burning, stabbing, painful misery of shingles wants to think about it again. But they should. Why? Because shingles can strike twice, or rarely, even a third time. A shingles vaccine can reduce the chances of a recurrence.

There’s some disagreement about how often recurrence occurs. In one study, researchers examined medical records of nearly 1,700 patients who had a documented case of shingles between 1996 and 2001. They found that more than 5% of these patients were treated for a second episode within an average of eight years. That’s about as likely as getting shingles in the first place if you’re age 60 or older. Other studies have shown the recurrence rate to be much lower.

But the bottom line is the same: having shingles once doesn’t protect you from ever having it again.

Shingles virus can sleep, reactivate

Shingles is caused by the same virus — the varicella zoster virus — that causes chickenpox. Once you have had chickenpox, the virus that caused it remains inside your nerves. It is inactive, but it can be reactivated later in life. This causes shingles.

When the virus reactivates, the infected nerves, and the skin the nerves go to, become inflamed, causing a burning or stabbing pain. A few days later, when the virus reaches the skin, a rash of blisters appear along the affected nerve. The skin may be very sensitive, unable to tolerate even the lightest touch.

About 1 in 10 adults who get shingles experience long-term pain, even after the rash has healed completely. This condition is called post-herpetic neuralgia (PHN). It may last for months, or even years. And it can be debilitating.

After causing shingles, the virus again goes "back to sleep" inside your nerves. But it can still flare up again.

Vaccinate to decrease your shingles risk

Your chances of getting shingles increase as you get older. The U.S. Centers for Disease Control and Prevention (CDC) recommends that adults age 50 and older get vaccinated against shingles.

Two vaccines, recombinant zoster vaccine (RZV, Shingrix) and zoster vaccine live (ZVL, Zostavax) are available in the United States to prevent shingles. Shingrix is the preferred vaccine.

The CDC recommends Shingrix for adults 50 years and older, whether or not they have already had shingles or previously received the Zostavaxvaccine, which has been used since 2006. You should get two doses of Shingrix, two to six months apart. Two doses of Shingrix are more than 90% effective at preventing shingles. Shingrix is also 90% effective in helping to prevent PHN in those who get shingles despite being vaccinated.

While Zostavax is still available, studies show it is less effective than Shingrix.Zostavax may be used in some healthy adults 60 years and older, for example, in those who are allergic to Shingrix.

There is no specific time that you must wait after having shingles before receiving the shingles vaccine. But it’s probably best to hold off until the shingles rash has disappeared before getting vaccinated.

About the Author

Urmila Parlikar, Associate Director, Digital Health Products at Harvard Health Publishing

Urmila Parlikar is Associate Director, Digital Health Products at Harvard Health Publishing. She first joined Harvard as a staff writer in 1998. She wrote articles for the Harvard Health newsletters, revised and updated Special Health Reports … See Full Bio

View all posts by Urmila Parlikar

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People who got the zoster (shingles) vaccine the same day as their annual influenza shot were more likely to skip their flu shot the following year than people who got the two shots on separate days, according to results from a new study.

Evidence suggests that people mistakenly think adverse effects commonly related to the zoster vaccine — including chills, fever, pain, and nausea — are caused by the flu vaccine, researchers write in an original investigation published in JAMA Network Open.

Benjamin Rome

The work by Benjamin Rome, MD, MPH, a primary care physician from the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital in Boston, and colleagues was published online November 19.

The study involved 89,237 people with an average age of 72 years. Researchers used Optum's deidentified Clinformatics Data Mart Database, a national, commercial health insurance claims database that contains information on 17 million patients with commercial insurance and Medicare Advantage plans in all 50 states.

The cohort consisted of people at least 50 years of age who received the influenza vaccine between August 1, 2018 and March 31, 2019, and received the shingles vaccine on the same day or separately in the previous 6 months.

Those who had both shots the same day (n = 27,161) were significantly less likely than those who got them on different days (n = 62,076) to get their annual flu shot the next (2019/20) flu season (87.3% vs 91.3%; adjusted odds ratio, 0.74; 95% CI, 0.71 - 0.78; P < .001). Results were similar across subgroups.

L.J. Tan

Although the difference between the two groups in the percentage of people getting the influenza shot the subsequent year was only 4 percentage points, when applied to the entire population getting shots concurrently, the number potentially affected is large, L.J. Tan, MS, PhD, chief strategy officer with the Immunization Action Coalition in St. Paul, Minnesota, told Medscape Medical News.

Addressing the issue could make a difference; however, asking people to get the shingles and influenza shots on different days might result in lack of adherence, he said. "Most adults will not come back."

A better way to address the potential problem is to educate people about the adverse effects of the shingles shot so they don't mistakenly think the flu shot made them feel ill when they get both together, said Tan.

He noted that the Centers for Disease Control and Prevention endorses giving vaccines — including the COVID-19 vaccine — concurrently to get patients caught up and has deemed them safe and effective when coadministered.

"We also know that the reactogenicity does not amplify because you got two vaccines together," Tan said.

Rome agreed that education is key. "Our study doesn't suggest that you shouldn't get the shingles and flu vaccine together. It really just suggests that we ought to be much more careful about advising patients about side effects of vaccines," he told Medscape Medical News.

Even if a small percentage of people are vaccine hesitant because they misunderstand adverse effects, he said, "that's important for us to know, from a public health standpoint."

Rome said he would like to repeat the study results using the COVID-19 vaccine and the flu shot to see if COVID-19 adverse effects also get incorrectly assigned to coadministered flu shots.

Shingles Vaccine Has Well-Known Adverse Effects

The recombinant zoster vaccine, approved in 2017, has replaced the live attenuated zoster vaccine. The previous vaccine caused fewer adverse effects but was far less effective in preventing shingles in older adults.

The recombinant vaccine is now recommended for most adults at least 50 years of age as a one-time, two-dose series.

It is critical to discern the reasons people are not getting their flu shots because fewer than half of American adults get an annual flu shot. Of those, 30% cite potential adverse effects as the reason for hesitation.

However, only injection-site symptoms, such as pain, redness, and swelling, are known to be caused by the influenza vaccine.

Researchers adjusted for factors that could differ between the two study groups, including demographic, clinical, and healthcare use variables.

They also adjusted for insurance type, month, and location (office vs pharmacy) of the 2018/19 influenza vaccination, and concurrent administration of any additional vaccines besides the zoster vaccine.

"We also adjusted for several comorbidities known to increase the risk of complications from influenza, including hypertension, diabetes, cardiovascular disease, chronic obstructive pulmonary disease or asthma, chronic kidney disease, or liver disease, and immunocompromising conditions," the authors write.

They also took into account whether people in the study had had the flu vaccine in the year prior to the study.

"Somebody who has received the flu vaccine 2 years in a row is far more likely to get it a third time, as opposed to someone who just gets it intermittently," Rome noted.

To further test their results, the researchers looked at whether people engaged in other preventive measures, such as cancer screenings or tetanus vaccines, in the subsequent year. They found no significant differences between the groups.

That suggests that that the two groups seemed equally likely to get preventive services, he said. "Something about the flu vaccine seems to stand out."

Rome reports receiving grants from the Anthem Public Policy Institute and personal fees from Blue Cross Blue Shield of Massachusetts and Alosa Health outside the submitted work. Coauthors report receiving personal fees from Alosa Health, Aetion, and Blue Cross Blue Shield of Massachusetts outside the submitted work, and grants from Bayer, Novartis, and Vertex outside the submitted work. Tan has disclosed no relevant financial relationships .

JAMA Network Open. 2021;4(11):e2135362. Full text

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick

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