Common Side Effects of Shingrix Vaccination
Shingrix is a highly reactogenic vaccine with frequent injection-site reactions and systemic symptoms, but these are typically transient and mild-to-moderate in severity, with no serious safety concerns identified in large clinical trials. 1, 2
Local (Injection-Site) Reactions
The most common local adverse effects occur at the injection site and include: 3
- Pain (most frequent local reaction) 3
- Redness 3
- Swelling 3
- Grade 3 injection-site reactions occur in 9.5% of vaccine recipients compared to only 0.4% with placebo 1
These injection-site reactions are typically transient and resolve within a few days. 2
Systemic Reactions
The most common systemic adverse effects include: 2, 3
- Myalgia (muscle pain) 2, 3
- Fatigue 2, 3
- Headache 3
- Overall systemic symptoms were reported in 11.4% of vaccine recipients versus 2.4% in placebo recipients 1
Most solicited adverse reactions were mild to moderate in severity and transient in nature. 2
Important Safety Considerations
No serious safety concerns have been identified in large clinical trials, with similar rates of serious adverse events between vaccine and placebo groups. 1
Common Pitfalls to Avoid
- Patient counseling is critical: Patients must understand that Shingrix contains noninfectious killed virus components and cannot cause shingles or influenza-like illness, though coincidental respiratory illness unrelated to the vaccine can occur after vaccination. 4
- Tolerability concerns significantly impact vaccine uptake: Studies show that concerns about side effects are associated with 1.22 times higher likelihood of not receiving any dose and 1.83 times higher likelihood of receiving only one dose instead of completing the two-dose series. 5
- Preemptive counseling about expected reactogenicity can improve series completion rates, as tolerability concerns are the leading reason for both non-initiation and non-completion of the vaccine series. 5
Special Population Considerations
Patients on Immunosuppressive Therapy
- Mild disease flares (4-17%) have been reported in patients with autoimmune conditions taking glucocorticoids after Shingrix vaccination, but no serious adverse events occurred. 1
- Large database studies found no statistically significant increase in disease flares following vaccination, alleviating concerns that the AS01B adjuvant might trigger inflammatory disease exacerbations. 1
Comparative Reactogenicity
Shingrix is significantly more reactogenic than placebo and more reactogenic than the older live-attenuated Zostavax vaccine, but this increased reactogenicity is the trade-off for its superior efficacy (>90% vs. 51.3% for Zostavax). 2, 3