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There are no published data in the United States on Shingrix-associated VZV rash, unlike the Zostavax live vaccine, which has had serious side effects in the immunocompromised. 6 Similarly, in immunocompromised patients, Shingrix vaccination resulted in improved antibody response with significant disease reduction, further establishing its efficacy and safety. 5 A review of multiple trials suggested strong immune response and significant efficacy with minimal serious adverse events to prevent herpes zoster in immunocompetent adults. 4 Glycoprotein E elicits anti-VZV immunity while the adjuvant system stimulates VZV-specific antibody and a CD4 T-cell response. Shingrix is an adjuvanted subunit vaccine made up of a single recombinant VZV antigen, glycoprotein E, and the AS01B adjuvant system. Her rash completely resolved over the next few days with no sequela of pain ( Figure 1c). Since the vesicular lesions had resolved, no samples could be sent for Tzank smear. Upon returning from the Philippines, she contacted the internal medicine clinic. She had chickenpox as a child and had received the Zostavax vaccine about 10 years earlier with no complications. She received the flu vaccine at the same time as Shingrix. ![]() The day after rash onset, she flew to the Philippines and returned 7 days later. She described the rash as tingly, itchy, and tender with no discharge from vesicular lesions. It started with vesicular lesions on the right side of her abdominal wall, which over the next few days progressed to her back in the 元–L4 dermatome ( Figure 1a, 1b). ![]() A 73-year-old woman with known hypertension, hypothyroidism, and stage IIA infiltrating ductal breast cancer status post bilateral mastectomy on letrozole for 3 years reported mild, itchy rash 3 days after receiving the first dose of the Shingrix vaccine.
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