Can you develop shingles (herpes zoster) after receiving the Shingrix (recombinant zoster vaccine) vaccination?

From the Guidelines

Yes, it is possible to develop shingles after receiving the Shingrix vaccination, though the risk is significantly reduced. According to the most recent and highest quality study 1, Shingrix is approximately 90% effective at preventing shingles, which means a small percentage of vaccinated individuals may still develop the condition. The vaccine works by boosting your immune system's ability to recognize and fight the varicella-zoster virus, which causes both chickenpox and shingles.

Key Points to Consider

• The vaccine efficacy of Shingrix was 97.2% in individuals aged 50 years, and 89.8% in those aged 70 years, as demonstrated in the ZOE-50 and ZOE-70 trials 1.
• The persistence of protection conferred by Shingrix was maintained above 83.3% for up to 8 years, and decreased to 73% at 10 years 1.
• If you do develop shingles after vaccination, the episode is typically less severe and shorter in duration than it would be without vaccination.
• The recommended Shingrix regimen consists of two doses given 2-6 months apart for adults 50 years and older, regardless of previous shingles history or prior Zostavax vaccination.
• Even if you've already had shingles, getting vaccinated is still recommended to prevent future occurrences, with a minimal 2-month interval between an episode of shingles and zoster vaccination 1.

Implications for Clinical Practice

• The high rates of shingles recurrence after a prior episode of shingles highlight the importance of vaccination with zoster vaccine, either ZVL or RZV, after a prior episode of shingles 1.
• The vaccine stimulates the production of memory T-cells that help your immune system recognize and combat the virus if it reactivates from its dormant state in your nerve tissues, which is why it provides such strong protection even though breakthrough cases can occasionally occur.

From the Research

Shingles after Shingrix Vaccination

• The Shingrix vaccine has been shown to be effective in preventing herpes zoster (shingles) and postherpetic neuralgia (PHN) in older adults 2, 3, 4, 5.
• Studies have demonstrated that the vaccine can reduce the incidence of shingles by 51.3% to 70.1% and the incidence of PHN by 66.5% to 76.0% 2, 3, 5.
• While the vaccine is highly effective, it is not 100% effective, and some individuals may still develop shingles after receiving the vaccine 3, 6.
• In rare cases, individuals may experience dermatomal rash after Shingrix vaccination, but this is considered a rare possibility and the benefit of receiving the vaccination outweighs the risk 6.

Vaccine Effectiveness

• The effectiveness of the Shingrix vaccine has been evaluated in several studies, including a large real-world observational study that found a vaccine effectiveness of 70.1% against confirmed herpes zoster 3.
• The vaccine has been shown to be effective in preventing shingles and PHN in individuals with autoimmune or immunosuppressive conditions, as well as in those who receive a delayed second dose 3.
• The duration of protection following vaccination is still being studied, but available data suggest that the vaccine provides long-term protection against shingles and PHN 4.

Safety and Adverse Events

• The Shingrix vaccine has been shown to be well-tolerated, with injection site reactions being the most common adverse event 2, 3, 5.
• Serious adverse events are rare, and the vaccine has not been associated with an increased risk of shingles or PHN 2, 3, 5.