Are the Side Effects of the Second Shingrix Shot as Bad as the First?

Reviewed on 5/7/2021

There are two shingles vaccines (Shingrix and Zostavax) available for adults 50 years and older to reduce the chance of developing shingles. Shingrix, a two-dose shot, is preferred because it is more effective. People may have a worse reaction to the first or second dose of Shingrix, or may have side effects from both doses
There are two shingles vaccines (Shingrix and Zostavax) available for adults 50 years and older to reduce the chance of developing shingles. Shingrix, a two-dose shot, is preferred because it is more effective. People may have a worse reaction to the first or second dose of Shingrix, or may have side effects from both doses

Shingles is a painful belt-like patterned rash caused by varicella-zoster virus (the same virus that causes chickenpox). Shingles is more common in adults over age 50 and in people who are immunocompromised. 

The main way to prevent shingles is vaccination. There are two shingles vaccines available for adults 50 years and older to reduce the chance of developing shingles.

  • Shingrix 
    • Shingrix (recombinant zoster vaccine) requires two doses administered two to six months apart
    • The two-dose vaccine is preferred because it is more effective
    • Side effects of Shingrix include: 
      • A sore arm with mild or moderate pain 
      • Redness and swelling at the injection site
      • Tiredness
      • Muscle pain
      • Headache
      • Shivering
      • Fever
      • Stomach pain
      • Nausea
      • Side effects usually go away on their own in about 2 to 3 days
    • People may have a worse reaction to the first or second dose of Shingrix, or may have side effects from both doses
    • Two doses of Shingrix shingles vaccine are more than 90% effective at preventing shingles and postherpetic neuralgia
    • Protection from the Shingrix shingles vaccine stays above 85% for at least four years after vaccination
  • Zostavax 
    • Side effects of Zostavax include: 
      • Redness, soreness, swelling, or itching at the site of the injection 
      • Headache 
      • A chickenpox-like rash near the injection site
    • Zostavax (zoster vaccine live) shingles vaccine is available in a single dose
    • Protection from the Zostavax (zoster vaccine live) shingles vaccine lasts about 5 years
    • Zostavax reduces the risk of developing shingles by 51% and postherpetic neuralgia, a complication of shingles, by 67%

What Are Symptoms of Shingles?

Early symptoms of shingles include: 

  • Abnormal sensations such as tingling, itching, or burning on part of the skin on one side of the body
  • Headache
  • Fever
  • Feeling unwell (malaise)

After one to two days, symptoms of shingles include: 

  • A rash of blisters in a band-like pattern on one side of the body 
    • Commonly occurs on the trunk (chest, abdomen, and back) but can develop on almost any part of the body
    • After three to four days, blisters become open sores (ulcers)
    • After 7 to 10 days, the sores crust over and are no longer contagious (in people with healthy immune systems)
    • A rash near the eye that can permanently affect vision if not treated
  • Pain
    • Often starts days before the rash develops
    • May range from mild to severe
    • May have a stabbing, sharp, or burning feeling
    • Only affects the parts of the skin where the rash occurs, but it can be severe and interfere with daily activities and sleep
    • Is often worse in older adults than in younger people

Skin color changes and scarring may occur after shingles has gone away.

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What Causes Shingles?

Shingles is caused by the varicella-zoster virus, which is a type of herpesvirus and is the same virus that causes chickenpox

Once a person has had chickenpox, the varicella-zoster virus remains dormant in the body and may be reactivated later in life, causing shingles. 

Shingles itself is not transmitted from person-to-person, however, a person who never had chickenpox or the chickenpox vaccine can get chickenpox from a person who has shingles.


 

How Is Shingles Diagnosed?

Shingles is usually diagnosed with a physical examination and patient history. 

A polymerase chain reaction (PCR) test may be used to confirm a diagnosis.


 

What Is the Treatment for Shingles?

Treatment of shingles usually involves a combination of medications. 

  • Antiviral medications
  • Pain medications
  • Antibiotics, if the rash becomes infected
  • Home remedies to help relieve itching
    • Wet compresses
    • Calamine lotion
    • Colloidal oatmeal baths 

 

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Reviewed on 5/7/2021
References
https://www.uptodate.com/contents/shingles-beyond-the-basics?search=herpes%20zoster&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2

https://www.cdc.gov/shingles/index.html

https://www.cdc.gov/vaccines/vpd/shingles/public/zostavax/index.html

https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html