Question explored with the scientific record
What is the autoimmune risk of taking the shingles vaccine
The shingles vaccine carries a real, measurable risk of triggering autoimmune flares, especially in people who already have an autoimmune condition.
A 2025 study of the Vaccine Adverse Event Reporting System (VAERS) found that among 920 people with autoimmune diseases who got the recombinant zoster vaccine (Shingrix), about 8.5% reported a disease flare afterward [3]. The risk was highest for people with lupus (SLE), with a reporting odds ratio of 7.5, meaning the signal was 7.5 times stronger than expected compared to other vaccines in the database [3]. Most flares happened within 3 days of vaccination [3]. A separate real-world study in Italy tracked 675 high-risk patients and found 16 disease flares (about 2.4%) after vaccination, mostly rheumatological [4].
The evidence is mixed on whether the vaccine itself causes new autoimmune disease. The large ZOE trials that showed 97% efficacy against shingles excluded people with unstable autoimmune conditions, so they cannot answer this question [5]. A 2011 observational study of people with autoimmune diseases found no clear short-term safety signal, but only 551 out of 44,115 patients were vaccinated, making the data too thin to draw conclusions [1]. A 2025 Kaiser Permanente study of people with inflammatory bowel disease found no increased flare risk after vaccination, but that was a single disease group [2].
| Population | Flare risk found | Source |
|---|---|---|
| Mixed autoimmune (VAERS) | 8.5% reported flares | [3] |
| Lupus (SLE) | Highest signal (ROR 7.5) | [3] |
| High-risk mixed (Italy) | 2.4% flares | [4] |
| IBD (Kaiser) | No increase | [2] |
The mechanism is plausible: the vaccine's AS01B adjuvant is a strong immune stimulant designed to provoke a powerful response. In someone whose immune system is already dysregulated, that same stimulation can overshoot and hit self-tissue. The spike protein itself is not the issue here; the adjuvant is.
My call: if you have an autoimmune condition, the shingles vaccine carries a real but poorly quantified risk of triggering a flare, with the strongest signal in lupus. The benefit (preventing shingles) is high, but the decision depends on your disease stability and your tolerance for a possible flare. Confidence: moderate.
Sources used 5
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The use, safety, and effectiveness of herpes zoster vaccination in individuals with inflammatory and autoimmune diseases: a longitudinal observational study
Zoster vaccination was underused among older adults with autoimmune diseases, and while there was no clear short-term safety signal or reduction in herpes zoster incidence among the vaccinated, conclusions are limited by the small number of vaccine recipients.
DOI: 10.1186/ar3497 -
Effectiveness and safety of the recombinant zoster vaccine in adults aged ≥50 years with inflammatory bowel disease
In a real-world Kaiser Permanente Southern California cohort of adults aged ≥50 with inflammatory bowel disease (IBD), two doses of recombinant zoster vaccine (RZV) significantly reduced herpes zoster incidence by about 65% without increasing short-term IBD flare risk, supportin…
DOI: 10.1080/21645515.2025.2576981 -
Risk of autoimmune disease flares after recombinant zoster vaccine: A vaccine safety analysis based on the Vaccine Adverse Event Reporting System database
This VAERS-based study quantified the risk of autoimmune-disease flares after recombinant zoster vaccination across five diseases (RA, MS, IBD, psoriasis, SLE), finding a positive safety signal with higher risk in SLE and most flares occurring within 3 days, highlighting the nee…
DOI: 10.1080/21645515.2025.2590257 -
Safety profile and medium- to long-term protection of the Recombinant Zoster Vaccine (RZV) in a cohort of high-risk patients: real-world data from a General Hospital in Southern Italy, 2021–2025
A prospective real-world study in a Southern Italian hospital evaluated the safety, disease-flare potential, and medium-to-long-term protection against herpes zoster after Recombinant Zoster Vaccine (RZV) in a medically diverse, vulnerable adult population, finding acceptable sa…
DOI: 10.1080/14760584.2025.2589216 -
Evaluating the Immunogenicity, Efficacy, and Effectiveness of Recombinant Zoster Vaccine for Global Public Health Policy
RZV is highly effective against herpes zoster and its complications, with protection lasting at least 10 years across age groups and in immunocompromised populations, but policy decisions require additional considerations such as cost-effectiveness and disease burden data.
DOI: 10.3390/vaccines13030250