Can the shingles vaccine cause a chronic cough?

Can the Shingles Vaccine Cause Chronic Cough?

Based on the available evidence, there is no established link between shingles vaccines and chronic cough as a side effect. The evidence does not support shingles vaccination as a cause of chronic cough.

Understanding Chronic Cough and Its Causes

Chronic cough is defined as a cough persisting for more than 8 weeks in adults. The most common causes include:

• Post-viral or post-infectious cough following upper respiratory tract infections 1
• Pertussis and pertussis-like infections 1
• Mycoplasma and other respiratory infections 1
• Asthma and non-asthmatic eosinophilic bronchitis 1
• Medication side effects, particularly ACE inhibitors 1

Medication-Related Cough

When considering medication-induced chronic cough:

• ACE inhibitors are well-documented to cause chronic cough as a side effect 1
• Inhaled asthma medications can cause immediate post-inhalation cough 1
• The shingles vaccine is not listed among medications known to cause chronic cough in any of the guidelines 1

Shingles Vaccines and Reported Side Effects

Current shingles vaccines include:

• Recombinant zoster vaccine (Shingrix) - non-live adjuvanted vaccine 2, 3
• Live attenuated zoster vaccine (Zostavax) - older live virus vaccine 3

Common documented side effects include:

• Local injection site reactions (pain, redness, swelling) 2, 3
• Systemic reactions (fever, fatigue, myalgia) 2, 3
• Chronic cough is not listed as a known or common side effect in any of the evidence 4, 2, 3

Special Considerations: Herpes Zoster and Respiratory Symptoms

While chronic cough is not established as a vaccine side effect, there are rare cases where:

• Laryngeal herpes zoster (shingles affecting the vagus nerve) can cause chronic cough 5
• This is due to the virus itself, not the vaccine 5
• Such cases involve direct viral damage to nerves controlling cough reflexes 5

Diagnostic Approach for Chronic Cough

If a patient develops chronic cough after receiving a shingles vaccine, clinicians should:

• Consider the timing - post-infectious cough typically resolves within 1-3 weeks but can persist up to 8 weeks 1
• Evaluate for more common causes of chronic cough including:
  • Post-viral cough from recent respiratory infections 1
  • Pertussis infection (even in vaccinated individuals) 1
  • Asthma and non-asthmatic eosinophilic bronchitis 1
  • Medication side effects, particularly from ACE inhibitors 1

Conclusion on Shingles Vaccine and Chronic Cough

The evidence does not support a causal relationship between shingles vaccines and chronic cough. If chronic cough develops after vaccination, clinicians should investigate other more common etiologies rather than attributing it to the vaccine.