What are the side effects of the Herpes Zoster (shingles) vaccine?

From the Guidelines

The shingles vaccine, specifically Shingrix, commonly causes temporary side effects that typically last 2-3 days, including pain, redness, and swelling at the injection site, as well as systemic side effects like muscle pain, fatigue, headache, shivering, fever, and upset stomach, as reported in the most recent study 1. These reactions are normal signs that your body is building protection against shingles and are more common after the second dose.

• The side effects are generally mild and temporary, with the most common being:
  • Injection site reactions, such as pain, redness, and swelling
  • Systemic symptoms, such as muscle pain, fatigue, headache, shivering, fever, and upset stomach
• Severe allergic reactions are rare but require immediate medical attention if symptoms like hives, swelling of the face/throat, difficulty breathing, or dizziness occur.
• Taking over-the-counter pain medications like acetaminophen or ibuprofen after vaccination can help manage these side effects, as suggested by the evidence 1.
• It's essential to complete both doses of Shingrix (given 2-6 months apart) for maximum protection, even if you experience side effects after the first dose, as the benefits of vaccination in preventing shingles and its complications outweigh the temporary discomfort from side effects, as supported by the study 1. The temporary discomfort from these side effects is generally considered worth the long-term protection against shingles, which can cause severe pain and complications.
• The evidence from the study 1 also highlights that the recombinant zoster vaccine, Shingrix, has a higher efficacy and longer duration of protection compared to the live, attenuated vaccine, Zostavax.
• Therefore, based on the most recent and highest quality evidence, it is recommended to use Shingrix as the preferred vaccine for preventing shingles and its complications, despite the potential for temporary side effects, as it provides the best protection against this debilitating disease, as reported in the study 1.

From the FDA Drug Label

The percentages of subjects aged 18 years and older reporting each solicited local and general adverse reaction following administration of each dose of SHINGRIX or placebo in the auHSCT study (NCT01610414) are presented in Table 3.

Adverse Reactions Aged 18-49 Years Aged ≥50 Years SHINGRIX Placebo SHINGRIX Placebo Dose 1 Dose 2 Dose 1 Dose 2 Dose 1 Dose 2 Dose 1 Dose 2 Local Adverse Reactions n = 223 % n = 205 % n = 217 % n = 207 % n = 673 % n = 635 % n = 673 % n = 627 % Pain 81 82 8 6 75 74 6 5 Pain, Grade 3c 11 11 1 0 5 7 0 3 0 Redness 20 25 0 0 21 28 1 1 Redness, >100 mm 1 2 0 0 1 3 0 0 Swelling 14 17 0 0 10 15 1 1 Swelling, >100 mm 0 2 0 0 0 1 1 0 0 General Adverse Reactions n = 222 % n = 203 % n = 218 % n = 207 % n = 674 % n = 633 % n = 674 % n = 628 % Myalgia 41 51 22 21 37 43 18 17 Myalgia, Grade 3d 4 8 2 2 2 4 1 1 Fatigue 49 51 34 25 37 46 31 26 Fatigue, Grade 3d 6 10 1 2 3 4 2 3 Headache 23 38 17 17 15 25 13 8 Headache, Grade 3d 1 5 0 2 0 2 0 1 Shivering 20 26 12 6 11 21 7 7 Shivering, Grade 3d 1 6 0 0 0 3 1 0 2 Fever, ≥37 5 9 28 4 2 6 15 3 4 Fever, Grade 3 0 1 0 0 0 1 0 2 0 2 GIe 14 13 13 12 18 18 16 12 GI, Grade 3d 1 1 0 1 1 2 1 2

The side effects of the Herpes Zoster (shingles) vaccine include:

• Local adverse reactions:
  • Pain (75-82% of subjects)
  • Redness (20-28% of subjects)
  • Swelling (10-17% of subjects)
• General adverse reactions:
  • Myalgia (37-51% of subjects)
  • Fatigue (37-51% of subjects)
  • Headache (15-38% of subjects)
  • Shivering (11-26% of subjects)
  • Fever (6-15% of subjects)
  • Gastrointestinal symptoms (14-18% of subjects) These side effects are based on data from the auHSCT study (NCT01610414) and other studies, as reported in the drug label 2 and 2.

From the Research

Side Effects of the Herpes Zoster (Shingles) Vaccine

The side effects of the Herpes Zoster (shingles) vaccine are primarily mild to moderate in severity. Some of the common side effects include:

• Injection-site reactions 3, 4
• Myalgia (muscle pain) 3
• Fatigue 3
• Systemic reactions such as fever, headache, and nausea 4
• Local reactions such as redness, swelling, and pain at the injection site 4

Comparison of Side Effects between Vaccine Types

The live, attenuated zoster vaccine (LZV) and the recombinant zoster vaccine (RZV) have different side effect profiles.

• LZV is associated with a higher cumulative incidence of one or more adverse events, including injection site adverse events 4
• RZV is associated with a higher cumulative incidence of adverse events, including systemic symptoms and local symptoms 4

Special Considerations

In immunocompromised individuals, the recombinant zoster vaccine (RZV) is preferred over the live, attenuated zoster vaccine (LZV) due to its safer profile 5, 6 The spacing between injections of RZV may be reduced to 1-2 months in immunocompromised individuals 5 It is recommended to administer the first dose of RZV at least 14 days before the onset of immunosuppressive treatment 5