Shingles Vaccination Age Recommendation
Adults aged 50 years and older should receive the recombinant zoster vaccine (Shingrix) as a two-dose series, with the second dose administered 2-6 months after the first dose. 1
Standard Age Recommendation
The recommended age for routine shingles vaccination is 50 years and older, as established by current guidelines from the Centers for Disease Control and Prevention and the American College of Physicians. 1, 2
While older guidelines from 2009 recommended vaccination starting at age 60 years for the live-attenuated vaccine (Zostavax), this recommendation has been superseded by newer evidence supporting vaccination at age 50 with the superior recombinant vaccine. 3
The Advisory Committee on Immunization Practices expanded the recommendation to include adults aged 50-59 years based on demonstrated high efficacy (>90%) across all age groups 50 and older. 4, 5
Vaccine Selection by Age
Shingrix (RZV) is the preferred vaccine for all adults aged 50 years and older, demonstrating 97.2% efficacy in preventing herpes zoster in this age group. 1, 2
The vaccine maintains efficacy of 89.8% even in adults aged 70 years and older, with protection sustained above 83.3% for at least 8 years. 1, 2
Real-world effectiveness studies confirm 70.1% effectiveness for the two-dose series, with no significant decline in effectiveness for beneficiaries aged 80 years and older. 6
Special Population: Younger Than 50 Years
Adults aged 18-49 years should receive Shingrix only if they are or will become immunocompromised due to disease or therapy, including those on chronic high-dose glucocorticoids (≥20 mg/day prednisone equivalent). 2
For immunocompromised adults under age 50, a shortened vaccination schedule is recommended with the second dose given 1-2 months after the first dose (rather than the standard 2-6 months). 1, 2
Common indications for early vaccination include immunodeficiency disease, immunosuppressive therapy, solid organ malignancies, hematologic malignancies, HIV/AIDS, and hematopoietic stem cell transplant recipients. 2
Dosing Schedule
The standard two-dose series consists of doses given 2-6 months apart, with a minimum acceptable interval of 4 weeks between doses. 1
If the second dose is administered beyond 6 months, effectiveness is not impaired—real-world data show second doses given at ≥180 days maintain full effectiveness. 6
For immunocompromised adults, the shortened schedule (1-2 months between doses) optimizes protection in this higher-risk population. 1, 2
Important Clinical Caveats
Prior history of shingles is not a contraindication to vaccination—adults should receive Shingrix regardless of previous herpes zoster episodes, waiting at least 2 months after acute symptoms resolve. 1, 2
Adults who previously received Zostavax should receive Shingrix, as the older live-attenuated vaccine demonstrates poor long-term protection (efficacy declining to only 14.1% by year 10). 3, 1
The minimum interval between Zostavax and Shingrix is 2 months, though this timing requirement is easily satisfied for most patients who received Zostavax years ago. 1
Shingrix is not indicated for prevention of primary varicella (chickenpox)—patients without prior varicella immunity should receive varicella vaccine first if not contraindicated. 2
Efficacy Against Complications
Shingrix demonstrates 88.8% efficacy against postherpetic neuralgia in adults aged 70 years and older, and 76.0% real-world effectiveness against this debilitating complication. 2, 6
The vaccine's high efficacy across all age groups 50 and older, including the oldest adults, represents a major advantage over the previous live-attenuated vaccine which showed only 18% efficacy in those aged 80 years and older. 1