Is the herpes zoster (shingles) vaccine necessary after the age of 90?

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From the Guidelines

The shingles vaccine is recommended for adults aged 50 and older, including those over 90, as it can prevent shingles and reduce the severity of symptoms, with the preferred vaccine being Shingrix, a two-dose vaccine given 2-6 months apart. According to the most recent study 1, the recombinant zoster vaccine, Shingrix (RZV), has been shown to be highly effective in preventing herpes zoster (HZ) and postherpetic neuralgia (PHN), with a vaccine efficacy of 91.3% against HZ and 88.8% against PHN in individuals aged 70 years or older. The study also found that the persistence of protection conferred by RZV was maintained above 83.3% for up to 8 years, and decreased to 73% at 10 years.

The benefits of vaccination outweigh the risks, as the risk of developing shingles increases with age, and older adults tend to experience more severe symptoms and complications like postherpetic neuralgia (persistent nerve pain) 1. While advanced age might slightly reduce vaccine effectiveness, the potential benefits of preventing this painful condition typically outweigh any risks. The most common side effects include temporary pain at the injection site, fatigue, and muscle aches.

Key points to consider:

  • The CDC recommends Shingrix as the preferred shingles vaccine for all eligible adults 1
  • The vaccine is effective in preventing shingles in about 90% of recipients and reduces the severity of symptoms if shingles does occur 1
  • Before getting vaccinated, individuals should discuss their specific health conditions and medications with their healthcare provider to ensure there are no contraindications
  • The vaccine can be given to adults aged 50 and older, including those over 90, with a two-dose series given 2-6 months apart 1

From the Research

Shingles Vaccine After Age 90

  • The available studies do not specifically address the need for a shingles vaccine after age 90 2, 3, 4, 5, 6.
  • However, the studies suggest that the risk of herpes zoster (HZ) increases with age, and the vaccines are licensed for the prevention of HZ and postherpetic neuralgia (PHN) in healthy older adults 2, 3, 4, 5, 6.
  • The recombinant zoster vaccine (RZV) is more effective for prevention of HZ than the live-attenuated varicella-zoster virus (VZV) vaccine (ZVL) 2, 5, 6.
  • The safety and efficacy of both vaccines have been demonstrated in clinical trials in immunocompetent adults, but there is limited information on their use in adults over 90 years old 2, 3, 4, 5, 6.
  • Some studies suggest that the vaccine efficacy may decline over time, but the need for a booster dose is still unknown 4, 5.
  • The Advisory Committee on Immunization Practices (ACIP) recommends the routine use of the recombinant zoster vaccine (RZV) as the preferred vaccine for the prevention of herpes zoster in immunocompetent adults 50 years of age and older 5.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Herpes Zoster Vaccines.

The Journal of infectious diseases, 2021

Research

Shingles vaccine.

Expert opinion on biological therapy, 2010

Research

Shingles (Herpes Zoster) Vaccine (Zostavax(®)): A Review in the Prevention of Herpes Zoster and Postherpetic Neuralgia.

BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy, 2016

Research

Shingrix: The New Adjuvanted Recombinant Herpes Zoster Vaccine.

The Annals of pharmacotherapy, 2018

Research

Shingrix for Herpes Zoster: A Review.

Skin therapy letter, 2019

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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