About 1 in 6 people who receive the recombinant shingles vaccine experience fatigue, headache, or fever, which can interfere with their normal daily activities the next day.
Mechanism
Synthesis from 5 studies
The vaccine has a special ingredient that strongly wakes up the body’s first responders. These cells release chemicals that travel through the blood and tell the brain to cause fever, tiredness, and headaches — just like when you’re getting sick from a virus. This is why so many people feel unwell the next day.
Most probable mechanism
The vaccine contains a substance that strongly wakes up the body’s first-line defense system. This causes immune cells to release chemicals that travel through the blood and make the brain signal fatigue, headache, and fever — like when you’re fighting off an infection.
The recombinant vaccine contains the adjuvant AS01B, which activates Toll-like receptor 4 and other pattern recognition receptors on innate immune cells.
Activated innate immune cells release pro-inflammatory cytokines including interleukin-6, tumor necrosis factor-alpha, and interferon-gamma into the bloodstream.
Circulating cytokines signal the hypothalamus in the brain to elevate the body’s thermoregulatory set point and induce sickness behavior.
Neuroendocrine responses to cytokine signaling result in systemic symptoms: fever, fatigue, and headache due to altered neural activity and vascular tone.
Less supported by current evidence, but not ruled out
The vaccine’s viral protein triggers a strong response from T-cells, which gather at the injection site and release chemicals that sometimes leak into the blood, causing mild whole-body symptoms.
Recombinant glycoprotein antigen is presented by dendritic cells, activating antigen-specific CD4+ T-helper 1 cells.
Activated T-cells migrate to lymph nodes and injection site, releasing interferon-gamma and other mediators.
Local cytokine concentrations rise sufficiently to enter systemic circulation in a subset of individuals.
Systemic cytokine levels reach thresholds that induce mild sickness behavior in susceptible individuals.
Evidence from Studies
Supporting (3)
Community contributions welcome
Immune response and safety of the adjuvanted recombinant zoster vaccine in adults 50 years of age and older in India: A randomized phase 3 trial.
Efficacy, effectiveness, and safety of herpes zoster vaccines in adults aged 50 and older: systematic review and network meta-analysis
Contradicting (2)
Community contributions welcome
Gold Standard Evidence Needed
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