Is there any association between the shingles vaccines (Zostavax [live‑attenuated varicella‑zoster vaccine] or Shingrix [recombinant zoster vaccine]) and paronychia?

Association Between Shingles Vaccines and Paronychia

Direct Answer

There is no established association between shingles vaccines (Zostavax or Shingrix) and paronychia in any published guidelines, FDA labeling, or major clinical trials.

Evidence Review

Common Adverse Reactions of Shingrix

The most frequently reported adverse reactions with Shingrix are well-characterized and do not include paronychia:

• Injection-site reactions (pain, redness, swelling) occur in 9.5% of recipients as grade 3 reactions, compared to 0.4% with placebo 1
• Systemic symptoms including myalgia and fatigue were reported in 11.4% of vaccine recipients versus 2.4% in placebo recipients 1
• Most solicited adverse reactions are transient and mild to moderate in severity, resolving within 4 days 2

Safety Profile from Clinical Trials

Large-scale clinical trials have not identified paronychia as an adverse event:

• No serious safety concerns were identified in the pivotal ZOE-50 and ZOE-70 trials, with similar rates of serious adverse events between vaccine and placebo groups 1
• The recombinant zoster vaccine had a favorable safety and tolerability profile in extensive clinical testing 2, 3

Zostavax Safety Data

The live-attenuated vaccine (Zostavax) similarly does not list paronychia among its adverse events:

• The most commonly reported adverse events were non-severe injection-site reactions 4
• Zostavax had a favorable safety and tolerability profile with injection-site adverse events being the most common 5

Rare Adverse Event Consideration

While one case report documented prolonged neurological and musculoskeletal symptoms following Shingrix vaccination 6, this report did not mention paronychia and emphasized that severe adverse reactions are thought to be rare, with long-term side effects not well documented.

Clinical Implications

• If paronychia develops temporally after shingles vaccination, it should be evaluated as a separate clinical entity rather than assumed to be vaccine-related
• Consider alternative etiologies including bacterial or fungal infection, trauma, or underlying dermatologic conditions
• The temporal association alone does not establish causation, particularly for a common condition like paronychia that has well-established non-vaccine-related causes