The shingles vaccine (Shingrix) is safe for older adults. In large clinical trials that specifically enrolled people aged 70 and older, serious adverse events occurred at the same rate in vaccinated participants as in those who received a placebo: 1.1% in each group. After follow-up periods of 3.5 to 4 years, the number and types of serious events remained similar between the two groups. The vaccine does cause short-term side effects that can feel rough for a day or two, but the overall safety profile is reassuring even for people well into their 70s, 80s, and beyond.
What the Clinical Trials Found
Shingrix was tested in two major trials, called ZOE-50 and ZOE-70, that together enrolled tens of thousands of older adults. ZOE-70 focused specifically on people aged 70 and older. Within the first 30 days after vaccination in ZOE-50, 103 serious adverse events occurred in the vaccine group compared to 128 in the placebo group, out of roughly the same number of participants. That means the vaccine group actually had slightly fewer serious events than the group that got a dummy shot.
One death in ZOE-70 was considered potentially related to the vaccine. Beyond that single case, long-term monitoring over several years showed no meaningful difference in serious health problems between vaccinated and unvaccinated participants.
Common Side Effects and How Long They Last
Shingrix is known for being “reactogenic,” which is the clinical way of saying it tends to cause noticeable short-term side effects. These are not dangerous, but they can be uncomfortable. The most common reactions include pain, redness, and swelling at the injection site, along with systemic symptoms like fever, chills, headache, and body aches.
These side effects typically resolve within 72 hours. You don’t need to take pain relievers or fever reducers before your appointment, but you can take them afterward if the symptoms bother you. Some people feel well enough to go about their normal day, while others prefer to rest for a day or two. The second dose tends to produce a stronger reaction than the first in many people, which sometimes discourages people from completing the series. But the CDC encourages finishing both doses even if the first one caused significant discomfort, as long as the reaction wasn’t a severe allergic response like anaphylaxis.
The Guillain-Barré Question
Post-marketing surveillance identified a small but real increase in Guillain-Barré syndrome (GBS), a rare neurological condition that causes temporary muscle weakness, in the weeks following Shingrix vaccination. A study of Medicare beneficiaries found roughly 3 excess GBS cases per million doses administered, with a more conservative analysis suggesting it could be as high as 5 per million doses. The increased risk window was limited to the 42 days after vaccination.
To put that in perspective: for every million people vaccinated, 3 to 5 additional cases of GBS occurred that wouldn’t have happened otherwise. GBS is serious but usually temporary, and for the vast majority of older adults, the risk of shingles itself (which can cause lasting nerve pain, vision loss, and hospitalization) far outweighs this very small possibility.
Safe for People With Weakened Immune Systems
One major advantage of Shingrix over the older shingles vaccine (Zostavax, now discontinued) is that it does not contain a live virus. Zostavax couldn’t be given to people with weakened immune systems, including those on chemotherapy, organ transplant recipients, or people taking immune-suppressing medications. That was a significant limitation, because these are exactly the people at highest risk for shingles.
Shingrix can be given to immunocompromised adults. In fact, the CDC specifically recommends it for people aged 19 and older who have weakened immune systems, not just those 50 and up. For immunocompromised patients, the second dose can be given as early as 1 to 2 months after the first (instead of the standard 2 to 6 months) so they can get full protection faster. When possible, vaccination should happen before starting immunosuppressive therapy, since the immune response will be stronger.
Since Shingrix isn’t a live vaccine, it can also be given while a person is taking antiviral medications. However, it should not be given during an active shingles outbreak. You need to wait until the rash and symptoms have cleared.
Getting It Alongside Other Vaccines
Many older adults get their flu shot and shingles vaccine around the same time, which raises a reasonable question about whether combining them increases side effects. An analysis of reports to the federal Vaccine Adverse Event Reporting System (VAERS) from 2018 through 2024 found no new safety signals when Shingrix was given alongside influenza vaccines. The side effect profile matched what would be expected from either vaccine given alone.
Who Should Not Get Shingrix
The only firm contraindication is a history of severe allergic reaction (anaphylaxis) to any ingredient in the vaccine or to a previous dose of Shingrix. There are no age-based upper limits, and having had shingles before or having received the older Zostavax vaccine are not reasons to skip it. In both of those situations, two doses of Shingrix are still recommended.
If you’ve started the two-dose series but more than six months have passed since your first shot, you don’t need to start over. Just get the second dose when you can.
Why It Matters More as You Age
Shingles risk rises sharply with age because the immune system’s ability to keep the chickenpox virus dormant weakens over time. About 1 in 3 people will develop shingles in their lifetime, and the risk of the most dreaded complication, postherpetic neuralgia (persistent burning nerve pain that can last months or years), also increases with age. The short-term discomfort of vaccination is a trade-off against a disease that can significantly affect quality of life in older adults, sometimes permanently.