Do women need the shingles (herpes zoster) vaccine earlier than men?

Do Women Need Shingles Vaccine Earlier Than Men?

No, women do not need the shingles vaccine earlier than men—current guidelines recommend the same vaccination age (50 years and older) for both sexes, regardless of the higher lifetime risk women face. 1, 2

Current Vaccination Recommendations Apply Equally to Both Sexes

• The Advisory Committee on Immunization Practices (ACIP) recommends Shingrix (recombinant zoster vaccine) for all adults aged 50 years and older, with no sex-specific age modifications 1, 2
• The two-dose series should be administered with the second dose given 2-6 months after the first dose, regardless of patient sex 2
• While the FDA licensed the vaccine for use starting at age 50, and ACIP initially recommended starting at age 60 for the older Zostavax vaccine, current guidance supports vaccination beginning at age 50 for both men and women 1, 3

Evidence of Sex Differences in Herpes Zoster Risk

• Women have a significantly higher lifetime risk of developing shingles compared to men—32% versus 22% by age 45 in one population study 4
• The probability of having had shingles before age 45 is 10.5% for females compared to 8.6% for males 4
• Despite this documented higher risk in women, no major guideline organization has translated this epidemiologic difference into sex-specific vaccination timing recommendations 1, 2, 5

Why Guidelines Don't Differentiate by Sex

• Shingrix demonstrates consistently high efficacy (>90%) across all age groups 50 and older, regardless of sex, making age-based rather than sex-based recommendations more practical 2, 5
• The vaccine maintains efficacy above 83.3% for at least 8 years with minimal waning, providing robust protection when initiated at age 50 for both sexes 2
• Cost-effectiveness analyses that informed guideline development evaluated vaccination strategies by age (50,60,65 years) but did not stratify recommendations by sex, despite known epidemiologic differences 5, 4

Practical Clinical Approach

• Vaccinate all patients—both men and women—starting at age 50 years with the two-dose Shingrix series 2, 5
• Do not delay vaccination in women based on their higher risk; the standard age 50 recommendation already captures the period when risk begins to accelerate for both sexes 4
• For patients who previously received Zostavax, administer Shingrix regardless of sex, waiting at least 2 months after the last Zostavax dose 2, 5

Important Caveats

• The higher lifetime risk in women (32% vs 22%) represents a meaningful epidemiologic difference, but current evidence does not support earlier vaccination in women as a strategy to improve outcomes 4
• Vaccination at age 50 (rather than waiting until 60 or 65) already provides earlier protection for the higher-risk female population, even though guidelines don't explicitly frame it this way 2, 5
• Immunocompromised patients of either sex may benefit from vaccination starting at age 18, with a shortened interval (1-2 months) between doses 2