Shingles (Herpes Zoster) Vaccines
Shingles Disease and How to Protect Against It
Shingles, or herpes zoster, is a painful skin rash that develops on one side of the face or body. It is caused by the varicella-zoster virus (VZV), the same virus that causes chickenpox. Anyone who has had chickenpox in the past can get shingles because VZV remains in the body after a person recovers from chickenpox. VZV can reactivate many years later, causing shingles.
Shingles is more common in older adults, people who have medical conditions that weaken the immune system, and people who take medications that suppress their immune systems. Getting vaccinated is the best way to prevent shingles.
There are currently two shingles vaccines licensed and available for use in the United States — Shingrix® (recombinant zoster vaccine) and Zostavax® (zoster vaccine live). While both shingles vaccines are safe and effective, they are different in their composition, effectiveness, and potential side effects.
CDC recommends Shingrix as the preferred vaccine, over Zostavax, to prevent shingles and the complications from the disease. Shingrix provides stronger protection against shingles compared to Zostavax.
- Shingrix pdf icon[PDF – 1 MB]external icon The Food and Drug Administration (FDA) licensed Shingrix in 2017 to prevent shingles. CDC recommends that adults age 50 years and older receive two doses of Shingrix. Shingrix is the preferred vaccine to prevent shingles. See the Recommendations of the Advisory Committee on Immunization Practices (ACIP) for Shingrix (2018).
- Zostavax pdf icon[PDF – 169 KB]external icon: The FDA licensed Zostavax in 2006 to prevent shingles. CDC recommends one dose of Zostavax for adults age 60 years and older. This vaccine may be used in certain cases, such as when a person prefers Zostavax or is allergic to Shingrix. See the Recommendations of the ACIP for Zostavax (2008).
Vaccines, like any medicine, can have side effects. Because the two herpes zoster vaccines are different in composition, their potential side effects may differ.
Common side effects:
- Pain, redness, and swelling at the injection site
- Muscle pain
- Upset stomach
Most side effects are mild to moderate – lasting 2-3 days – and may affect normal daily activities. Side effects are more common in younger people.
Who Should Not Get Shingrix
People with a history of severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine or after a previous dose of Shingrix.
People who currently have shingles, and women who are pregnant or breastfeeding, should wait to get Shingrix.
Common side effects:
- Redness, pain, swelling, warmth or itching at the injection site
Most side effects are mild to moderate, and last 1-3 days.
Who Should Not Get Zostavax
Pregnant women, some people who have medical conditions or are taking medications that could weaken the immune system (ask your doctor if you have concerns), and people with a history of severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine.
CDC and FDA continuously monitor the safety of vaccines after they are approved. If a problem is found with a vaccine, CDC and FDA will inform health officials, health care providers, and the public.
CDC uses three systems to monitor vaccine safety:
- The Vaccine Adverse Event Reporting System (VAERS): an early warning system that helps CDC and FDA monitor problems following vaccination. Anyone can report possible vaccine side effects to VAERS.
- The Vaccine Safety Datalink (VSD): a collaboration between CDC and eight integrated health care organizations which allows ongoing monitoring and research.
- The Clinical Immunization Safety Assessment (CISA) Project: a partnership between CDC and seven medical research centers that conducts clinical research on vaccine-associated health risks.
A Closer Look at the Safety Data
Both Shingrix and Zostovax shingles vaccines have been shown to be safe and well tolerated. Common side effects, such as soreness and redness at the injection site, are usually mild to moderate in intensity and resolve quickly on their own.
In 8 clinical trials of more than 10,000 participants:
- Grade 3 reactions (vaccination-related reactions severe enough to prevent normal activities) were common (17%) after patients received Shingrix.
- About 1 out of 10 adults who received Shingrix reported grade 3 injection-site symptoms such as pain, redness, and swelling.
- About 1 out of 10 reported grade 3 systemic reactions such as myalgia (muscle pain), fatigue (feeling tired), headache, shivering, fever, and gastrointestinal illness.
- Most people (78%) who got Shingrix reported at least some pain at the injection site.
- A 2013 study showed that patients with a history of a previous shingles rash had the same side effects after Zostavax as those with no history of shingles. See Safety of zoster vaccine in elderly adults following documented herpes zosterexternal icon.
- A 2012 study found a small risk for allergic reactions 1 to 7 days after Zostavax. See Safety of zoster vaccine in adults from a large managed-care cohort: a Vaccine Safety Datalink studyexternal icon.
- In rare cases, people who got vaccinated with Zostavax experienced a blister-like rash; some were found to have been caused by the vaccine.
Related Scientific Articles
English D. Willis, Meredith Woodward, Elizabeth Brown, Zoran Popmihajlov, Patricia Saddier, Paula W. Annunziato, Neal A. Halsey, Anne A. Gershon, Herpes zoster vaccine live: A 10 year review of post-marketing safety experienceexternal icon. Vaccine. 2017 Dec 19:35(52):7231-7239.
Cunningham AL, Lal H, Kovac M, Chlibek R, Hwang SJ, Diez-Domingo J, et al. Efficacy of the herpes zoster subunit vaccine in adults 70 years of age or older.external icon NEJM. 2016:375(11), 1019-32.
Lal H, Cunningham AL, Godeaux O, Chlibek R, Diez-Domingo J, Hwang SJ, Levin MJ, McElhaney JE, Poder A, Puig-Barberà J, Vesikari T. Efficacy of an adjuvanted herpes zoster subunit vaccine in older adultsexternal icon. NEJM. 2015:372(22):2087-96.
Cohen J. A New Vaccine to Prevent Herpes Zosterexternal icon, NEJM. 2015:372:2149-2150 [Link: ]
Baxter R, Tran TN, Hansen J, Emery M, Fireman B, et al. Safety of Zostavax™-A cohort study in a managed care organization.external icon Vaccine. 2012 Oct 19;30(47):6636-41.
Gagliardi AM, Gomes Silva BN, Torloni MR, Soares BG. Vaccines for preventing herpes zoster in older adultsexternal icon. Cochrane Database Syst Rev. 2012 Oct 17;10:CD008858.
Hales CM, Harpaz R, Ortega-Sanchez I, Bialek SR. Update on Recommendation for Use of Herpes Zoster Vaccine . MMWR. 2014 Aug 22; 63(33):729-731.
Harpaz R, Ortega-Sanchez IR, Seward JF. Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). Prevention of herpes zoster: Recommendations of the Advisory Committee on Immunization Practices (ACIP).external icon MMWR Recomm Rep. 2008 Jun 6;57(RR-5):1-30.
Mills R, Tyring SK, Levin MJ, Parrino J, Li X, et al. Safety, tolerability, and immunogenicity of zoster vaccine in subjects with a history of herpes zoster.external icon Vaccine. 2010 Jun 7;28(25):4204-9.
Morrison VA, Oxman MN, Levin MJ, Schmader KE, Betts RF, et al. Safety of Zoster Vaccine in Elderly Adults Following Documented Herpes Zosterexternal icon. J Infect Dis. 2013;208(4):559-563.
Murray AV, Reisinger KS, Kerzner B, Stek JE, Sausser TA, et al. Safety and tolerability of zoster vaccine in adults ≥60 years old.external icon Hum Vaccin. 2011 Nov;7(11):1130-6.
Schmader KE, Levin MJ, Gnann JW Jr, McNeil SA, Vesikari T, et al. Efficacy, safety, and tolerability of herpes zoster vaccine in persons aged 50-59 years.external icon Clin Infect Dis. 2012 Apr;54(7):922-8.
Simberkoff MS, Arbeit RD, Johnson GR, Oxman MN, Boardman KD, et al. Safety of herpes zoster vaccine in the shingles prevention study: A randomized trial.external icon Ann Intern Med. 2010 May 4;152(9):545-54.
Tseng HF, Liu A, Sy L, Marcy SM, Fireman B, et al. Safety of zoster vaccine in adults from a large managed-care cohort: A Vaccine Safety Datalink study.external icon J Intern Med. 2012 May;271(5):510-20.
Vermeulen JN, Lange JM, Tyring SK, Peters PH, Nunez M, et al. Safety, tolerability, and immunogenicity after 1 and 2 doses of zoster vaccine in healthy adults ≥60 years of age.external icon Vaccine. 2012 Jan 20;30(5):904-10.