What are the recommendations for the Herpes Zoster (Shingles) vaccine?

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Last updated: April 11, 2025View editorial policy

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From the Guidelines

The Shingrix vaccine is recommended for adults aged 50 years and older, due to its high efficacy in preventing shingles and postherpetic neuralgia, as demonstrated in the ZOE-50 and ZOE-70 trials 1. The vaccine efficacy of Shingrix was 97.2% in the ZOE-50 trial, which enrolled individuals aged 50 years, and 89.8% in the ZOE-70 trial, which included individuals aged 70 years 1. Key benefits of the Shingrix vaccine include:

  • High efficacy in preventing shingles and postherpetic neuralgia, with a vaccine efficacy of 91.3% against HZ and 88.8% against PHN in individuals aged 70 years or older 1
  • Persistence of protection for up to 8 years, with a decrease to 73% at 10 years 1
  • A favorable safety profile, with no significant difference in serious adverse events or deaths compared to the placebo group, although it was associated with a higher incidence of grade 3 injection site reactions and systemic symptoms 1 The Shingrix vaccine is given as a two-dose series, with the second dose administered 2-6 months after the first. Individuals with weakened immune systems aged 19 and older should also receive Shingrix, as it can help boost their immune system's ability to protect against the varicella-zoster virus 1. Common side effects of the vaccine are generally mild to moderate and may include pain at the injection site, muscle pain, fatigue, headache, shivering, fever, and upset stomach, typically lasting 2-3 days. Medicare Part D and most private insurance plans cover the vaccine, though copayments may vary. Even if you've had shingles previously, vaccination is important as recurrences can occur.

From the FDA Drug Label

SHINGRIX is a vaccine indicated for prevention of herpes zoster (HZ) (shingles): • in adults aged 50 years and older. • in adults aged 18 years and older who are or will be at increased risk of HZ due to immunodeficiency or immunosuppression caused by known disease or therapy The recommended vaccine for shingles prevention is SHINGRIX (Zoster Vaccine Recombinant, Adjuvanted), which is indicated for:

  • Adults aged 50 years and older
  • Adults aged 18 years and older who are or will be at increased risk of HZ due to immunodeficiency or immunosuppression caused by known disease or therapy 2

From the Research

Shingles Vaccine Recommendation

The Shingles vaccine is recommended for adults aged 50 years and older to prevent herpes zoster and postherpetic neuralgia.

  • The recombinant zoster vaccine (Shingrix) has been shown to be effective in preventing herpes zoster, with a vaccine effectiveness of 70.1% for two doses and 56.9% for one dose 3.
  • The live, attenuated shingles vaccine (Zostavax) has also been shown to be effective in preventing herpes zoster and postherpetic neuralgia, with a reduction in the incidence of herpes zoster and postherpetic neuralgia in adults aged 50 years and older 4, 5, 6, 7.

Vaccine Effectiveness

The effectiveness of the Shingles vaccine has been demonstrated in several studies, including:

  • A cohort study of Medicare Part D beneficiaries aged 65 years and older, which found a vaccine effectiveness of 70.1% for two doses of Shingrix 3.
  • The Shingles Prevention Study, which found that Zostavax reduced the burden of illness associated with herpes zoster by 61% and reduced the incidence of herpes zoster by 51% 6, 7.
  • The ZEST trial, which found that Zostavax protected against herpes zoster in adults aged 50-59 years 4, 5.

Vaccine Safety and Tolerability

The Shingles vaccine has been shown to be safe and well-tolerated, with the most commonly reported adverse events being non-severe injection-site reactions 4, 5, 7.

  • A review of the safety and tolerability of Zostavax found that it had a favorable safety profile, with no significant increase in serious adverse events 5.
  • A study of the safety and tolerability of Shingrix found that it was well-tolerated, with the most commonly reported adverse events being injection-site pain and fatigue 3.

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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