Which Shingles Vaccine Should I Get? – Shingrix vs. Zostavax

Let’s talk about it.

Shingles is common, affecting one in three adults. It causes painful blisters, and in 20% of folks who get them, an even worse complication known as “postherpetic neuralgia” that consists of chronic shooting nerve pain can occur.

With any new vaccine, there are always questions and concerns: cost, side effects, and when or if you should get it. Given this year’s Shingrix shortage, there are also questions about whether Zostavax is good enough.

Is Shingrix THAT much better than Zostavax?

Yes. Shingrix is 97% effective at preventing herpes zoster (shingles) in folks over 50 whereas the Zostavax shot is 50-64% effective in preventing shingles in those 50-70 and even lower for those over 70. Shingrix also stays effective for longer.

When should I get the shingles vaccine?

The CDC (Centers for Disease Control and Prevention) recommends that people 50 years of age and older receive Shingrix in a series of two vaccines. Zostavax can be given to those 50 years of age and over with a medical condition or anyone 60 years of age and older.

What if I’m not sure if I’ve had chickenpox?

First, know that almost everyone born before 1980 tests positive for exposure to Varicella zoster, the virus that causes chickenpox and reactivates later to cause shingles. All published recommendations suggest that whether you remember having chickenpox or not, you should receive the Shingles vaccine, either Zostavax or Shingrix. 

Are side effects of Shingrix and Zostavax different?

There is where the issue arises. Yes, the side effects are quite a bit different, and I’ve been seeing this in my patients who get Shingrix.

These are adverse reactions of Zostavax (given as a single vaccine):

  • Pain at injection site (≤ 34% to 54% of patients)
  • Redness at injection site (36% to 48% of patients)
  • Swelling at injection site (26% to 40% of patients), localized tenderness (≤ 34% of patients), itching at injection site (7% to 11% of patients)
  • Other uncommon side effects (< 1% of patients)

These are adverse reactions of Shingrix (given a series of two vaccines):

  • Fatigue (37% to 57% of patients)
  • Headache (29% to 51% of patients)
  • Shivering (20% to 36% of patients)
  • Gastrointestinal adverse effects (14% to 24% of patients)
  • Pain at injection site (69% to 88% of patients)
  • Swelling at injection site (23% to 31% of patients)
  • Muscle aches/Myalgia (35% to 57% of patients)
  • Fever (14% to 28% of patients)
  • Other uncommon side effects (< 1% of patients)

To sum it up, Shingrix is a much better vaccine than Zostavax, but with a twist. That twist? Shingrix has many more adverse reactions. This means we need to keep an eye on this vaccine because it is still new. If you get Shingrix, stay alert to any adverse effects you may feel; a 500 mg acetaminophen (Tylenol) after the shot has helped for some of my patients.

Dr. O

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