What is the recommended age to begin shingles vaccination?

Recommended Age to Begin Shingles Vaccination

The recommended age to begin shingles vaccination is 50 years and older for all adults, using the recombinant zoster vaccine (Shingrix) administered as a two-dose series 2-6 months apart. 1, 2

FDA-Approved Indications

• Shingrix is FDA-approved for adults aged ≥50 years for prevention of herpes zoster (shingles) 2
• The vaccine is also approved for adults aged ≥18 years who are or will be immunocompromised due to known disease or therapy 2

Current Guideline Recommendations

The landscape of shingles vaccination recommendations has evolved significantly, and there is important divergence between older and newer guidelines:

Historical Recommendation (Age 60)

• A 2013 guideline recommended starting vaccination at age 60 years with the older live-attenuated zoster vaccine (Zostavax) 3, 4
• This recommendation was based on the Advisory Committee on Immunization Practices (ACIP) choosing age 60 as the threshold for routine vaccination, despite FDA approval at age 50, primarily due to cost-effectiveness and resource allocation considerations 4

Current Recommendation (Age 50)

• More recent guidelines from 2025 recommend starting vaccination at age 50 years with Shingrix, superseding the older age 60 recommendation 1
• This change reflects the superior efficacy of Shingrix (97.2% efficacy) compared to Zostavax, with high effectiveness maintained across all age groups 50 and older 1
• Multiple international guidelines from the United States, Canada, United Kingdom, and Taiwan consistently recommend vaccination starting at age 50 1

Vaccination Schedule

• Two doses (0.5 mL each) administered intramuscularly 2
• Standard schedule: First dose at Month 0, second dose 2-6 months later 1, 2
• For immunocompromised patients: Shorter schedule with second dose 1-2 months after the first dose 1, 2
• Minimum interval between doses is 4 weeks, though this is not the preferred schedule 1

Special Population: Immunocompromised Adults

• Adults aged ≥18 years who are immunocompromised should receive Shingrix regardless of age 1, 2
• This includes patients with HIV, cancer, autoimmune diseases requiring immunosuppressive therapy, and solid organ or stem cell transplant recipients 1
• Shingrix is the only appropriate vaccine for immunocompromised patients, as the live-attenuated Zostavax is contraindicated in this population 1, 2

Key Clinical Considerations

Why Age 50 Is the Current Threshold

• Herpes zoster incidence increases substantially with age, with risk becoming clinically significant after age 50 1
• The pivotal ZOE-50 trial that established Shingrix's 97.2% efficacy enrolled adults aged ≥50 years 1
• Real-world effectiveness studies demonstrate 70.1% effectiveness for the two-dose series, significantly reducing disease burden 1, 5

Prior Shingles History Does Not Change Recommendations

• Vaccination is recommended regardless of prior herpes zoster history 3, 1
• Having had shingles once does not provide reliable protection against future episodes, with a 10-year cumulative recurrence risk of 10.3% 1
• Wait at least 2 months after acute symptoms resolve before vaccinating 1

Transitioning from Zostavax to Shingrix

• Adults who previously received Zostavax should receive the full 2-dose Shingrix series 1
• Minimum interval between Zostavax and Shingrix is 2 months 1
• This recommendation is critical because Zostavax efficacy declines dramatically to only 14.1% by year 10 1

Common Pitfalls to Avoid

• Do not confuse FDA approval age (50+) with older ACIP recommendation age (60+) - the current standard is age 50 1, 4
• Do not use live-attenuated Zostavax in immunocompromised patients - only Shingrix is appropriate 1, 2
• Do not confuse varicella (chickenpox) vaccination with herpes zoster vaccination - these are different vaccines for different purposes 1
• Do not delay the second dose beyond 6 months unless necessary - while effectiveness is maintained with delayed dosing, completing the series on schedule is preferred 1, 5

Expected Adverse Events

• Injection-site reactions are common: pain (78%), redness (38%), swelling (26%) 2
• Systemic symptoms occur frequently: myalgia (45%), fatigue (45%), headache (38%), shivering (27%), fever (21%) 2
• Most symptoms are mild to moderate intensity and resolve within 4 days 1
• Despite these side effects, the vaccine has an excellent safety profile with no increased risk of serious adverse events or death compared to placebo 1, 6