What is the minimum age for receiving the shingles vaccine (Shingrix) in adults?

Minimum Age for Shingles Vaccine (Shingrix)

You must be at least 50 years old to receive Shingrix, unless you are immunocompromised, in which case you can receive it starting at age 18. 1, 2

Standard Age Recommendation

• The FDA approved Shingrix for adults aged 50 years and older as the standard indication for herpes zoster prevention 2
• The Advisory Committee on Immunization Practices (ACIP) recommends vaccination starting at age 50 years with the two-dose Shingrix series, administered 2-6 months apart 1, 3
• This represents a change from older guidelines that previously recommended starting vaccination at age 60 years with the now-inferior live-attenuated vaccine (Zostavax) 1

Why Age 50 Is the Threshold

• Herpes zoster incidence increases substantially with age, making vaccination most beneficial starting at age 50 when risk begins to rise significantly 4
• The pivotal clinical trials (ZOE-50 and ZOE-70) that established Shingrix's 97.2% efficacy specifically enrolled adults aged 50 years and older, not younger populations 1, 5
• Multiple international guidelines from the United States, Canada, Taiwan, and the United Kingdom consistently recommend age 50 as the starting point for immunocompetent adults 4

Critical Exception: Immunocompromised Adults

If you are immunocompromised, you can receive Shingrix starting at age 18 years. 6, 2

This includes adults who:

• Have HIV/AIDS or other immunodeficiency diseases 6
• Are receiving immunosuppressive therapy (chemotherapy, high-dose steroids ≥20 mg/day prednisone equivalent, JAK inhibitors, biologics) 6
• Have hematologic malignancies or solid organ cancers 6
• Are solid organ or hematopoietic stem cell transplant recipients 6
• Have autoimmune diseases requiring chronic immunosuppression 6

For immunocompromised patients under age 50, the vaccination schedule is shortened: first dose at Month 0, second dose at 1-2 months (rather than the standard 2-6 months) 6, 2

Important Caveats

• Do not confuse shingles vaccine with chickenpox (varicella) vaccine - Shingrix is not indicated for prevention of primary varicella infection 6, 2
• If someone has never had chickenpox and is not immune to varicella-zoster virus, they need varicella vaccine first, not Shingrix 6
• Prior history of shingles does not change the age recommendation - you still need to wait until age 50 (or age 18 if immunocompromised) 1
• The live-attenuated vaccine (Zostavax) remains contraindicated in immunocompromised patients of any age; only Shingrix is appropriate for this population 6