Shingles (herpes zoster) is a common condition that causes a painful, itchy rash and blisters, usually on one side of the body or face. About a third of people in the U.S. will develop shingles at some point during their lifetime, including about 1 million people every year.
Shingles is caused by a reactivation of the same virus that causes chickenpox—varicella-zoster virus (VZV). Older adults are particularly at risk of developing shingles complications, such as a condition called postherpetic neuralgia (PHN)—long-lasting, severe nerve pain—and vision loss and pneumonia.
Learn more about the shingles vaccine, including why it is administered in two doses, side effects from the second dose, and what to expect.
Why Is Shingrix Administered in Two Doses?
Shingrix is typically given in two doses, usually as a shot to the upper arm.
The CDC recommends that all adults ages 50 and up and immunocompromised adults ages 19 and over get two doses of Shingrix. This includes people who don’t know whether they had chickenpox and people who previously received Zostavax (an older shingles vaccine) or the chickenpox vaccine.
A 2021 study found that adults over 65 were significantly less likely to develop either shingles or PHN after getting two doses of Shingrix than they were after one dose. Two doses of Shingrix also offered better protection against shingles complications to adults over 80 and immunocompromised adults.
Previously, Zostavax (the live zoster vaccine) was offered to older and immunocompromised adults to prevent shingles, PHN, and other shingles-related health problems. Zostavax is a live vaccine, which means it contains a weakened version of the herpes zoster virus. Shingrix is a recombinant vaccine, meaning that it uses only a small piece of the virus.
In 2017, the Food and Drug Administration (FDA) approved Shingrix for the prevention of shingles and related complications. Zostavax is no longer available in the U.S. People who have gotten Zostavax in the past should now get Shingrix.
Studies have shown that Zostavax—a one-dose vaccine—is generally less effective than two doses of Shingrix in preventing shingles complications among older and immunocompromised adults. Shingrix currently offers the best chance of protection against shingles, PHN, and shingles-related hospitalization.
When Should I Get the Second Dose?
The CDC recommends that adults ages 50 and older get a second dose of Shingrix two to six months after their first dose. If you’ve waited longer than six months since your first dose of Shingrix, it’s safe to get a second dose right away. Most people don’t need to repeat the first dose.
Two doses of Shingrix offer effective protection against shingles and related complications for at least seven years. Among healthy adults ages 50-69, Shingrix is more than 90% effective in preventing PHN when two doses are administered. Among adults ages 70 and older, it is 89% effective.
Some immunocompromised adults may need a second dose within one to two months. If you have a disease or are taking medication that affects your immune system, talk to your healthcare provider about the best timeline for your two doses of the shingles vaccine.
Shingrix Side Effects
Shingrix is generally safe and effective for most people. Most side effects from Shingrix are mild and go away on their own.
Side effects are slightly more common after the second dose of Shingrix. However, you may experience side effects from the first dose and have no symptoms after the second.
The most common side effects of the shingles vaccine are redness, pain, and/or swelling at the site of injection. Other Shingrix side effects include headache, itchiness, muscle pain, joint pain, chills, fatigue, headache, dizziness, and gastrointestinal upset.
About 17% of people report that they experience Shingrix side effects that are serious enough to limit their daily activities.
In very rare cases, Shingrix may increase the risk of Guillain-Barré syndrome (GBS). GBS is an uncommon neurological condition that causes symptoms like muscle weakness and paralysis.
Redness
Clinical trials have found that about 38% of people experience redness at the injection site after receiving at least one dose of Shingrix.
Swelling
Over a quarter of people who get the shingles vaccine experience mild swelling at the site of injection.
Pain
Pain is the most common side effect of Shingrix. About 78% of people who get the shingles vaccine report that they experience pain at the injection site.
Itchiness
Some people experience mild itchiness and/or warmth in the area where they received their second dose of Shingrix.
Fever
About a fifth of people experience fever shortly after getting the shingles vaccine.
Muscle Pain
Myalgia (muscle pain) is one of the most common side effects of Shingrix, with nearly 45% of people experiencing muscle pain after getting the shingles vaccine.
Joint Pain
Arthralgia (joint pain) affects about 1% of people who get the shingles vaccine. Like other Shingrix side effects, this symptom should go away on its own in a few days.
Chills
Many people experience chills after getting one to two doses of the shingles vaccine. Studies suggest that nearly 27% of people experience shivering as a side effect of Shingrix.
Fatigue
Many people report fatigue as a side effect of the shingles vaccine. Almost 46% of people feel tired after two doses of Shingrix.
Headache
A mild to moderate headache is a common Shingrix side effect, affecting approximately 37.7% of people who get the shingles vaccine.
Dizziness
If you feel dizzy shortly after getting the shingles vaccine, seek medical help immediately. Dizziness could be a sign of anaphylaxis (a severe allergic reaction).
Gastrointestinal Upset
Some people experience gastrointestinal problems after getting two doses of Shingrix. Research indicates that about 17.3% of people who get the shingles vaccine experience nausea or other stomach issues.
Who Should Not Get the Vaccine?
It is safe for most people to get two doses of Shingrix. However, you should talk to your healthcare provider before getting the shingles vaccine if:
You are pregnantYou currently have shinglesYou have severe allergies to any of the Shingrix ingredientsYou have ever experienced a severe allergic reaction to Shingrix
If you have a mild sickness, such as a cold, it’s usually safe to get the shingles vaccine. If you are moderately or severely ill, you should wait until you feel better to get your next dose of Shingrix.
You should still get the shingles vaccine if you don’t remember having the chickenpox virus in the past and if you’ve had shingles previously. Shingrix can protect you against developing shingles again in the future.
When to See a Healthcare Provider
For most people, the effects of Shingrix are mild and short-term. In very rare cases, Shingrix can cause more serious side effects.
Seek urgent medical care if you experience signs of a severe allergic reaction a few minutes or hours after your second dose of Shingrix, such as:
Rapid heartbeat Lightheadedness Muscle weakness Hives (raised welts) Breathing difficulties Facial swelling Swelling in the throat or mouth
You should also let your healthcare provider know if your Shingrix side effects are severe or aren’t going away on their own.
Summary
Shingles (herpes zoster) is a condition that causes a painful, itchy rash and blisters. Adults ages 50 and up are especially likely to get shingles and related complications, such as postherpetic neuralgia.
The FDA approved the shingles vaccine Shingrix to prevent shingles and possible health complications. The CDC recommends adults ages 50 and older and immunocompromised adults ages 19 and over get two doses of Shingrix.
Shingrix is administered in two doses, usually two to six months apart. Shingrix is safe and effective for most people. Side effects from the second dose of Shingrix are somewhat more common than the first dose, although that’s not always the case. Most side effects of Shingrix are mild and resolve on their own.
The most common side effects from the shingles vaccine include redness/pain/swelling at the site of injection, headache, itchiness, muscle pain, joint pain, chills, fatigue, headache, dizziness, and upset stomach. Very rarely, serious side effects, such as a severe allergic reaction, may occur.
A Word From Verywell
Shingrix has been shown to be safe and effective in preventing shingles and related complications for most people. If you have questions or concerns about the second dose of the shingles vaccine or possible side effects, talk to your healthcare provider.
The side effects from both doses of Shingrix are typically mild for most people.
