VACCINE RESOURCE COMMITTEE

of the Edmonton Zone Medical Staff Association

View Full List of Vaccine Questions Here

Herpes zoster (shingles) Vaccine Question #2:

What are the adverse events from this vaccine?

Very common adverse events occur in 10% or more of vaccines. Common adverse events occur in 1% to less than 10% of vaccines.

Injection site reactions 

Injection site reactions are very commonly reported by recipients of Live attenuated Zoster Vaccine (LZV) (Zostervax) and Recombinant Zoster Vaccine (RZV) (Shingrex). Approximately 80% report injection-site pain and approximately 30% report redness at the site of injection. For all ages, the majority (> 95%) of these events were rated mild or moderate in intensity and lasted less than 2 days.

Due to the adjuvant in RZV, which induces a high cellular immune response and helps address the natural age-related decline in immunity, RZV is more reactogenic than LZV. The adjuvant in RZV is new, so long-term data are not yet available.

Systemic adverse events

Systemic adverse events, primarily fatigue and myalgia, are very common in RZV recipients (reported by up to half of clinical trial vaccine recipients). Headache was reported by up to 40% of clinical trial vaccine recipients.

Local and systemic reactions that were severe enough to interfere with normal activities have been more frequently reported following the receipt of RZV than LZV. However, these reactions have been temporary (lasting 2-3 days). Patient education on the short-term reactogenicity of the RZV is recommended prior to vaccine administration to promote adherence to the second dose.

In adults 50 years of age and older, fever and shivering were more commonly reported when Pneu-P-23 was administered concurrently with RZV (16% and 21%, respectively) compared to when RZV was administered alone (7% for both adverse reactions).

Uncommon, rare and very rare adverse events

Uncommon adverse events occur in 0.1% to less than 1% of vaccinees. Rare and very rare adverse events occur, respectively, in 0.01% to less than 0.1% and less than 0.01% of vaccinees.

RZV is safe with serious adverse events reported very rarely in immunocompetent individuals. At this time, there is insufficient evidence to assess the risk related to herpes zoster ophthalmicus (HZO) recurrence following RZV recipients.

Contraindications

RZV is contraindicated in persons with a history of anaphylaxis after previous administration of the vaccine and in persons with proven immediate or anaphylactic hypersensitivity to any component of the vaccine or its container.

Precautions

In situations of suspected hypersensitivity or non-anaphylactic allergy to RZV components, investigation is indicated which may lead to immunization in a controlled setting. Consultation with an allergist is advised.

RZV should be considered for immunocompromised adults ≥ 50 years of age. RZV should be administered at least 14 days prior to the initiation of immunosuppressive drugs.

A number of clinical trials are still ongoing in the use of RZV in immunocompromised populations.

Precaution should be used if considering use of RZV in pregnancy or breastfeeding given the absence of data on its safety for these groups. 

Administration of RZV should be postponed in persons suffering from severe acute illness.

Sources:

Government of Canada: Herpes zoster (shingles) vaccine: Canadian Immunization Guide