What are the next steps if I experience paresthesias (abnormal sensations) in my face after receiving the Shingrix (recombinant zoster vaccine)?

Management of Facial Paresthesias After Shingrix Vaccination

Facial paresthesias following Shingrix vaccination require prompt medical evaluation to rule out serious neurological complications and determine appropriate management.

Initial Assessment

When experiencing facial paresthesias after receiving the Shingrix vaccine, the following steps should be taken:

1. Seek medical attention promptly - Facial paresthesias could represent:

   • A transient vaccine reaction
   • A more serious neurological complication
   • Unrelated neurological condition coinciding with vaccination

2. Neurological evaluation to assess:

   • Distribution and pattern of paresthesias
   • Presence of facial weakness (to rule out Bell's palsy)
   • Other neurological symptoms (visual changes, speech difficulties)
   • Motor function

Diagnostic Approach

The healthcare provider should:

• Perform a detailed neurological examination focusing on cranial nerves
• Consider laboratory tests to rule out inflammatory processes
• Consider imaging studies if symptoms are severe, persistent, or accompanied by other neurological deficits
• Document the timing of symptom onset in relation to vaccination

Management Algorithm

For Mild to Moderate Symptoms (no motor weakness, isolated sensory symptoms)

1. Observation and monitoring

   • Most post-vaccination paresthesias are transient and resolve within days to weeks 1
   • Document symptoms and their progression

2. Symptomatic treatment

   • NSAIDs for associated discomfort
   • Avoid medications that may exacerbate paresthesias

3. Follow-up within 1-2 weeks to assess symptom progression

For Severe or Progressive Symptoms

1. Immediate medical evaluation

   • Rule out acute neurological conditions requiring intervention

2. Consider neurology consultation if:

   • Symptoms persist beyond 1-2 weeks
   • Motor involvement develops
   • Symptoms spread beyond initial distribution
   • Visual or speech disturbances develop 2

3. Consider reporting to Vaccine Adverse Event Reporting System (VAERS)

   • Important for post-marketing surveillance
   • Helps identify rare adverse events

Evidence and Considerations

• Post-vaccination paresthesias have been reported with various vaccines, including those with novel adjuvants like Shingrix 1
• A study of AS03-adjuvanted influenza vaccine found paresthesias affecting not only the vaccinated arm (58%) but also face (45%), with symptoms sometimes including weakness, motor impairment, and visual/speech effects 2
• While most reactions to Shingrix are mild to moderate and transient, there have been case reports of prolonged neurological symptoms 3
• The Advisory Committee on Immunization Practices (ACIP) notes that severe adverse reactions to vaccines are rare, and proper screening is key to preventing most serious adverse reactions 1

Special Considerations

• For the second dose decision:

  • If symptoms have completely resolved, proceeding with the second dose is generally acceptable
  • If symptoms are persistent or severe, discuss risks and benefits with healthcare provider
  • Consider that single-dose effectiveness is 56.9% compared to 70.1% for the two-dose regimen 4

• For immunocompromised patients:

  • More vigilant monitoring may be needed as immune responses may differ
  • Shingrix is still recommended as it is a non-live vaccine 5, 6

When to Seek Emergency Care

Advise immediate medical attention if:

• Facial weakness develops (possible Bell's palsy)
• Symptoms rapidly worsen or spread
• Speech, swallowing, or breathing difficulties occur
• Severe headache or altered consciousness develops

While paresthesias following vaccination can be concerning, most cases are self-limiting. Proper evaluation, monitoring, and symptomatic management are typically sufficient for most patients experiencing this side effect.