Transient Increased Risk of Shingles Post-Shingrix Vaccination: Self-Controlled Case-Series Analysis

Area of Science:

• Immunology
• Vaccinology
• Epidemiology

Background:

• Reports of shingles presentations emerged following the rollout of the recombinant shingles vaccine (RZV) program for adults aged 65 and older in Australia.
• Investigated potential short-term increases in shingles risk immediately after RZV vaccination.

Purpose of the Study:

• To assess the immediate risk of shingles following RZV vaccination in adults.
• To evaluate the impact of RZV vaccination on shingles and postherpetic neuralgia (PHN) risk.

Main Methods:

• Self-controlled case series (SCCS) analyses were conducted on two independent datasets.
• The risk window for shingles was set at 21 days post-vaccination.
• Analyses included adults aged 18 years and older, stratified by age (<65 and ≥65 years) and sex.

Main Results:

• An 11-fold increase in shingles presentations was observed within 21 days post-dose 1 of RZV in adults aged ≥65 in one dataset.
• No increased shingles risk was detected in younger adults after dose 1.
• Shingles risk decreased after dose 2, with a 73% reduction in shingles following two doses; PHN risk was not elevated.

Conclusions:

• A transient increase in shingles presentations occurs shortly after the first RZV dose in older adults.
• These post-vaccination shingles cases are likely mild.
• Two doses of RZV demonstrate significant vaccine effectiveness against shingles and do not increase PHN risk.