PriMera Scientific Medicine and Public Health (ISSN: 2833-5627)

Review Article

Volume 7 Issue 6

Investigating the Association Between Shingrix®, Skin adverse effects and Shoulder Injury Related to Vaccine Administration (SIRVA): A Review

Ciccullo C, Ciccullo A, Farah S, Bevilacqua C, Grassi M, Farinelli L, Molinelli E, Simonetti O, Aspriello S* and Gigante AP

December 07, 2025

View PDF

Abstract

Herpes zoster, commonly known as shingles, is caused by the reactivation of varicella zoster virus (VZV), the same virus responsible for chickenpox. It is estimated that one in three individuals will develop shingles during their lifetime, with the risk increasing to one in two among adults over 85 years old. Shingrix® (GlaxoSmithKline) is a recombinant zoster vaccine that has demonstrated high efficacy in preventing herpes zoster, especially in older and immunocompromised populations. However, concerns about shoulder injury related to vaccine administration (SIRVA), a rare adverse event also observed following COVID-19 vaccination, have prompted investigations into its potential association with other vaccines, including Shingrix. This scoping review explores the incidence of skin manifestations and SIRVA in the context of Shingrix vaccination by analyzing available evidence from MEDLINE, Embase, PsycINFO, the Cochrane Library, and Google Scholar databases. All forms of original research, including prospective and retrospective studies, cross-sectional analyses, and randomized controlled trials, were considered. For what concern cutaneous adverse effect the cases of VZV reactivation were lower with respect the general population. Other cases of non-HZ vesicular and bullous cutaneous eruptions were attributed to the vaccine's reactogenicity. Our findings reveal no significant evidence indicating a higher incidence of SIRVA following Shingrix administration compared to other vaccines. Nonetheless, isolated cases highlight the importance of proper vaccine administration techniques, including anatomical precision during injection, to minimize potential risks. While current data do not establish a strong causal link, further studies are warranted to explore subtle associations. This review underscores the necessity of rigorous vaccination protocols to ensure safety and maintain public confidence in immunization programs.

Keywords: Shingrix; recombinant zoster vaccine; rotator cuff desease; SIRVA; Shoulder desease

References

  1. Patil A, Goldust M and Wollina U. “Herpes zoster: A Review of Clinical Manifestations and Management”. Viruses 14 (2022): 192.
  2. Nair PA and Patel BC. “Herpes Zoster”. European Handbook of Dermatological Treatment (2023): 409-416.
  3. Mirinaviciute G., et al. “The burden of herpes zoster disease in Norway”. Vaccine 38 (2020): 3501-3507.
  4. Oleszko M., et al. “Herpes Zoster: Risk Factors for Occurrence, Complications, and Recurrence with a Focus on Immunocompromised Patients”. Diseases 13 (2025).
  5. Weinberger B. “Vaccination of older adults: Influenza, pneumococcal disease, herpes zoster, COVID-19 and beyond”. Immun Ageing 18 (2021).
  6. WHO’s work on the UN Decade of Healthy Ageing (2021-2030). https://www.who.int/initiatives/decade-of-healthy-ageing
  7. Life expectancy at birth, total (years) - European Union | Data. https://data.worldbank.org/indicator/SP.DYN.LE00.IN?locations=EU
  8. Curran D., et al. “Meta-Regression of Herpes Zoster Incidence Worldwide”. Infect Dis Ther 11 (2022): 389-403.
  9. Shingles (Herpes Zoster) | Shingles (Herpes Zoster) | CDC. https://www.cdc.gov/shingles/
  10. Cohen JI. “Clinical practice: Herpes zoster”. N Engl J Med 369 (2013): 255-63.
  11. Dai YX., et al. “Cigarette smoking and risk of herpes zoster: a population-based cohort study in Taiwan”. Clin Exp Dermatol 46 (2021): 1293-1298.
  12. Giannelos N., et al. “The Incidence of Herpes Zoster Complications: A Systematic Literature Review”. Infect Dis Ther 13 (2024): 1461.
  13. de Gomensoro E, Del Giudice G and Doherty TM. “Challenges in adult vaccination”. Ann Med 50 (2018): 181-192.
  14. Doherty TM, Del Giudice G and Maggi S. “Adult vaccination as part of a healthy lifestyle: moving from medical intervention to health promotion”. Ann Med 51 (2019): 128-140.
  15. Grabar S., et al. “Incidence of herpes zoster in HIV-infected adults in the combined antiretroviral therapy era: results from the FHDH-ANRS CO4 cohort”. Clin Infect Dis 60 (2015): 1269-1277.
  16. Parikh R., et al. “Herpes Zoster Recurrence: A Narrative Review of the Literature”. Dermatol Ther (Heidelb) 14 (2024): 569-592.
  17. Dooling KL., et al. “Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines”. MMWR Morb Mortal Wkly Rep 67 (2018): 103-108.
  18. Shingrix® (zoster vaccine recombinant, adjuvanted) prescribing information. Research Triangle Park, North Carolina: GlaxoSmithKline; 2018. - Cerca con Google. 
  19. James SF., et al. “Shingrix: The New Adjuvanted Recombinant Herpes Zoster Vaccine”. Ann Pharmacother 52 (2018): 673-680.
  20. Boutry C., et al. “The Adjuvanted Recombinant Zoster Vaccine Confers Long-Term Protection Against Herpes Zoster: Interim Results of an Extension Study of the Pivotal Phase 3 Clinical Trials ZOE-50 and ZOE-70”. Clin Infect Dis 74 (2022): 1459-1467.
  21. Cunningham AL., et al. “Immune Responses to a Recombinant Glycoprotein E Herpes Zoster Vaccine in Adults Aged 50 Years or Older”. J Infect Dis 217 (2018): 1750-1760.
  22. Parikh R, Widenmaier R and Lecrenier N. “A practitioner’s guide to the recombinant zoster vaccine: review of national vaccination recommendations”. Expert Rev Vaccines 20 (2021): 1065-1075.
  23. Janssen ERC., et al. “The prevalence and clinical course of shoulder injury related to vaccine administration (SIRVA) after COVID-19 vaccines in Dutch hospital workers”. Vaccine 41 (2023): 6042-6047.
  24. Cook IF. “Best vaccination practice and medically attended injection site events following deltoid intramuscular injection”. Hum Vaccin Immunother 11 (2015): 1184-1191.
  25. Gao W., et al. “Bibliometric analysis and visualization mapping of herpes zoster vaccine publications from 1999 to 2024”. Front Med (Lausanne) 12 (2025).
  26. Orru S., et al. “Skin manifestations after immunisation with an adjuvanted recombinant zoster vaccine, Germany, 2020”. Euro Surveill 28 (2023).
  27. Aquino MR., et al. “Delayed allergic skin reactions to vaccines”. Allergy Asthma Proc 43 (2022): 20-29.
  28. Shingrix | European Medicines Agency (EMA). https://www.ema.europa.eu/en/medicines/human/EPAR/shingrix
  29. Thompson H, Nichols L and Santiago TG. “Bullous fixed drug eruption following administration of the recombinant adjuvant Shingrix vaccine”. BMJ Case Rep 14 (2021).
  30. Assmann G, Schmidt M and Sester M. “Scattered pustular lesions 10 days after Shingrix vaccination in systemic sclerosis patient after successful autologous non-myeloablative haemopoietic stem-cell transplantation”. BMJ Case Rep 17 (2024).