At what age is the shingles vaccine, specifically Shingrix (herpes zoster vaccine), recommended for healthy adults?

Shingles Vaccine Age Recommendation

Shingrix is recommended for all healthy adults starting at age 50 years, administered as a two-dose series 2-6 months apart. 1

FDA-Approved Indications

The FDA has approved Shingrix for two distinct populations:

• Adults aged 50 years and older (standard indication) 1
• Adults aged 18 years and older who are or will be immunocompromised due to known disease or therapy 1

Current Guideline Recommendations

The most recent guidelines (2026) from multiple medical societies consistently recommend vaccination starting at age 50 years. 2 This represents the current standard of care and supersedes older recommendations that suggested waiting until age 60. 2

Key Points on Age 50 Recommendation:

• The Advisory Committee on Immunization Practices now recommends vaccination at age 50 with the recombinant vaccine (Shingrix), which has superior efficacy (>90%) across all age groups 50 and older 2
• This recommendation supersedes older 2008-2014 guidelines that recommended the live-attenuated vaccine (Zostavax) starting at age 60 years 2, 3
• Multiple international guidelines from Taiwan, Canada, the United Kingdom, and the United States consistently recommend vaccination starting at age 50 2

Why the Age Threshold Changed

The shift from age 60 to age 50 occurred because:

• Shingrix demonstrates significantly higher efficacy (97.2% in adults aged 50+) compared to the older Zostavax vaccine (which had only 70% efficacy in ages 50-59 and dropped to 18% in those ≥80 years) 2
• Protection is durable, persisting for at least 8 years with minimal waning and maintaining efficacy above 83.3% during this period 2
• The pivotal ZOE-50 trial established Shingrix's 97.2% efficacy in adults aged ≥50 years 2

Important Clinical Caveat

There is conflicting guidance in older literature (2014-2025) that recommended waiting until age 60 for routine vaccination. 3, 4 However, these recommendations were based on the older, less effective Zostavax vaccine and resource allocation considerations. 3 The current FDA labeling and most recent guidelines (2026) clearly support age 50 as the appropriate threshold for Shingrix. 2, 1

Dosing Schedule

• First dose at Month 0, second dose 2-6 months later (standard schedule for immunocompetent adults) 2, 1
• Minimum interval between doses is 4 weeks (though 2-6 months is preferred) 2
• The vaccine is administered intramuscularly 2, 1

Exception for Younger Adults

Adults aged 18-49 years should receive Shingrix ONLY if they are or will be immunocompromised due to:

• Immunodeficiency disease 5, 1
• Immunosuppressive therapy (including chronic high-dose glucocorticoids ≥20 mg/day prednisone equivalent) 5
• Hematologic malignancies or solid organ transplant 5
• Autoimmune diseases requiring immunosuppressive therapy 5

For these immunocompromised patients under age 50, a shortened schedule with the second dose at 1-2 months is recommended. 5, 1

Common Pitfalls to Avoid

• Do not confuse FDA approval age (50+) with outdated ACIP recommendations (60+) from 2008-2014 that applied to the inferior Zostavax vaccine 3, 4
• Do not use Zostavax - it is no longer preferred due to significantly inferior efficacy and is contraindicated in immunocompromised patients 2
• Do not confuse varicella (chickenpox) vaccination with herpes zoster vaccination - Shingrix is not indicated for prevention of primary varicella infection 1

Expected Side Effects

• Injection-site reactions are common (pain in 78%, redness in 38%, swelling in 26%) 1
• Systemic symptoms occur frequently (myalgia 45%, fatigue 45%, headache 38%, shivering 27%, fever 21%) 1
• Most symptoms are mild to moderate intensity and resolve within 4 days 2
• No serious safety concerns have been identified in large clinical trials 2