Safety of zoster vaccine in adults from a large managed-care cohort: a Vaccine Safety Datalink study

J Intern Med. 2012 May;271(5):510-20. doi: 10.1111/j.1365-2796.2011.02474.x. Epub 2011 Nov 22.


Objectives: The aim of this study was to examine a large cohort of adults who received the zoster vaccine for evidence of an increased risk of prespecified adverse events requiring medical attention.

Design: Two self-comparison approaches, including a case-centred approach and a self-controlled case series (SCCS) analysis were used.

Setting: Eight managed-care organizations participating in the Vaccine Safety Datalink project in the United States.

Subjects: A total of 193 083 adults aged 50 and older receiving a zoster vaccine from 1 January 2007 to 31 December 2008 were included.

Main outcome measures: Prespecified adverse events were identified by aggregated International Classification of Diseases, Ninth Revision (ICD-9) codes in automated health plan datasets.

Results: The risk of allergic reaction was significantly increased within 1-7 days of vaccination [relative risk = 2.13, 95% confidence interval (CI): 1.87-2.40 by case-centred method and relative rate = 2.32, 95% CI: 1.85-2.91 by SCCS]. No increased risk was found for the following adverse event groupings: cerebrovascular events; cardiovascular events; meningitis; encephalitis; and encephalopathy; and Ramsay-Hunt syndrome and Bell's palsy.

Conclusions: The results of this study support the findings from the prelicensure clinical trials, providing reassurance that the zoster vaccine is generally safe and well-tolerated with a small increased risk of allergic reactions in 1-7 days after vaccination.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adverse Drug Reaction Reporting Systems / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / immunology
  • Cohort Studies
  • Female
  • Herpes Zoster / epidemiology
  • Herpes Zoster / immunology
  • Herpes Zoster / prevention & control*
  • Herpes Zoster Vaccine* / administration & dosage
  • Herpes Zoster Vaccine* / adverse effects
  • Humans
  • Hypersensitivity / etiology
  • Hypersensitivity / immunology
  • Male
  • Middle Aged
  • Nervous System Diseases / etiology
  • Nervous System Diseases / immunology
  • Population Surveillance
  • Risk Assessment
  • Time Factors
  • United States / epidemiology


  • Herpes Zoster Vaccine