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

From the Guidelines

Yes, it is possible to develop shingles (herpes zoster) after receiving the Shingrix vaccination, although the risk is significantly reduced. Shingrix is highly effective but not 100% protective, with clinical trials showing it reduces the risk of developing shingles by more than 90% in people 50 and older 1. The vaccine works by boosting your immune system's response to the varicella-zoster virus, which remains dormant in your body after a chickenpox infection.

Key Points to Consider

• If you do develop shingles after vaccination, the symptoms are typically milder and the duration shorter than if you hadn't been vaccinated.
• Shingrix is a non-live recombinant vaccine given in two doses, 2-6 months apart, and is recommended for adults 50 and older, even if you've previously had shingles or received the older Zostavax vaccine 1.
• If you notice a painful, blistering rash despite vaccination, you should still seek medical attention promptly, as early treatment with antiviral medications can help reduce the severity and duration of shingles.

Additional Considerations

• The vaccine efficacy of Shingrix was maintained above 83.3% for up to 8 years, and decreased to 73% at 10 years 1.
• Safety data from the ZOE-50 and ZOE-70 trials showed that there was no difference between the vaccinated and placebo groups in the incidence of serious adverse events (SAEs) and deaths, however, the vaccinated group had a significantly higher incidence of grade 3 injection site reactions and systemic symptoms compared to the placebo group 1.

From the Research

Shingles Vaccination Efficacy

• The Shingrix (zoster vaccine live) vaccination has been shown to reduce the incidence of herpes zoster (HZ) and postherpetic neuralgia (PHN) in older adults 2.
• The vaccine was found to reduce the HZ burden of illness by 61.1% and the incidence of PHN by 66.5% in a randomized, double-blind, placebo-controlled trial 2.
• However, it is possible to develop shingles after receiving the vaccination, as the vaccine does not provide 100% protection against the disease.

Vaccine Safety and Side Effects

• The Shingrix vaccine is generally well tolerated, with injection site reactions being the most common side effect 2.
• There have been reports of rare side effects, such as unilateral ptosis, proptosis, and orbital myositis, which may be related to an autoimmune reaction to the vaccine 3.
• The vaccine has not been shown to cause or induce shingles, but it is possible for the virus to reactivate after vaccination, especially in immunocompromised individuals.

Duration of Protection

• The duration of protection provided by the Shingrix vaccine is still being studied, but it is estimated to last for at least 5 years after vaccination 4.
• The vaccine efficacy has been shown to decrease over time, with a decline in efficacy after year 1 and a further decline thereafter 4.
• It is unclear whether the vaccine provides long-term protection against shingles, and further research is needed to determine the optimal vaccination schedule.

Special Considerations

• Immunocompromised individuals, such as those with autoimmune diseases or taking immunosuppressive medications, may be at higher risk of developing shingles after vaccination 5, 6.
• Children who receive the varicella vaccine may be at risk of developing shingles, especially if they have a weakened immune system or other underlying health conditions 5.