Adverse events of herpes zoster vaccination among adults in Saudi Arabia: A cross-sectional study

BACKGROUND: The varicella-zoster virus, which causes herpes zoster upon reactivation, remains a public health concern, particularly among older adults. Although Zostavax and Shingrix are effective vaccines, monitoring adverse events remains important. Limited vaccine uptake and low public awareness in Saudi Arabia further highlight this need. This study seeks to assess the adverse events linked to herpes zoster immunization throughout the Saudi Arabian population. METHODS: This cross-sectional study used a Google Form questionnaire administered from 16 September 2024-15 August 2025. RESULTS: A total of 382 participants completed the survey. The largest age subgroup was 18-25 years (22.3%). For the first dose, 185 participants (48.4%) did not know the vaccine type, whereas 144 (37.7%) received Zostavax and 53 (13.9%) received Shingrix. Among second-dose recipients (n = 152), 85 participants (55.9%) received Zostavax, 41 (27.0%) received Shingrix, and 26 (17.1%) were uncertain of the vaccine type. The most frequently reported adverse effects after the first dose were fatigue/headache, injection-site pain, and dizziness, whereas chills, injection-site pain, and dizziness were most frequent after the second dose. No adverse effects were reported by 112 participants (29.3%) after the first dose and 28 (18.4%) after the second dose. Participants who received Zostavax reported significantly higher self-reported severity scores than those who received Shingrix after both the first dose (p = 0.003) and the second dose (p < 0.001). CONCLUSION: Self-reported symptom severity was higher among participants with chronic disease and varied significantly by age after the first dose. The most commonly reported symptom duration was 1-2 days. No significant gender differences were observed. In unadjusted analyses, participants who reported receiving Zostavax had higher self-reported severity scores than those reporting Shingrix.