Shingrix is the best shingles vaccine available, and since November 2020, it’s the only one. Zostavax, the older live vaccine, was pulled from the U.S. market after Shingrix proved far more effective across every age group. Even before Zostavax was discontinued, the CDC had already switched its recommendation to Shingrix exclusively. If you’ve been putting off the vaccine or wondering whether to get it, the decision is straightforward: Shingrix is what you’ll be offered, and the data behind it is strong.
Why Shingrix Replaced Zostavax
The two vaccines work in fundamentally different ways. Zostavax used a weakened, live form of the varicella-zoster virus (the same virus that causes chickenpox and shingles) to stimulate immunity. Shingrix takes a different approach: it contains a single protein from the virus’s outer surface, paired with a powerful immune-boosting ingredient that trains your body to recognize and fight the virus. Because Shingrix doesn’t contain any live virus, it can be given to people with weakened immune systems, something Zostavax couldn’t safely do.
The performance gap between the two vaccines isn’t subtle. In clinical trials of adults 60 and older, Zostavax reduced the risk of shingles by about 51%. For people 70 and older, that number dropped to just 38%. Shingrix, by contrast, reduced shingles risk by 97% in adults 50 and older, and held at nearly 98% for those 70 and older. That’s a dramatic difference, especially for older adults who are most vulnerable to severe shingles.
Zostavax also lost effectiveness faster. Within about four to eight years after vaccination, its protection against shingles fell from 51% to roughly 40%. Shingrix maintains much stronger protection over time.
How Long Shingrix Protection Lasts
Long-term follow-up data now extends to 10 years after vaccination. Through the first eight years, Shingrix maintained at least 83% efficacy against shingles. By years nine and ten, protection dipped to around 73%, which is still considerably higher than Zostavax ever achieved, even in its first year. When researchers calculated the cumulative efficacy from vaccination through 10 years, the overall figure was 89%. No booster dose is currently recommended.
Protection Against Nerve Pain
Shingles is miserable on its own, but the complication people fear most is postherpetic neuralgia, a burning nerve pain that can persist for months or years after the rash clears. The risk of this complication rises sharply with age. In clinical trials, Shingrix reduced the risk of postherpetic neuralgia by about 91% in adults 50 and older, and by 89% in those 70 and older. Among vaccinated participants under 70, postherpetic neuralgia didn’t develop at all. By comparison, Zostavax reduced postherpetic neuralgia risk by about 67%, and that number eroded to 60% within a few years.
What Getting the Vaccine Feels Like
Shingrix is given as two shots in the upper arm. The second dose comes two to six months after the first. For people with weakened immune systems, the window is shorter: one to two months between doses. You need both doses for full protection.
Side effects are common and tend to be more noticeable than with most vaccines. About 78% of people experience pain at the injection site. Roughly 1 in 10 people report side effects severe enough to interfere with daily activities for a day or two, including significant muscle pain, fatigue, headache, shivering, or fever. These reactions are a sign of the immune-boosting ingredient doing its job, and they typically resolve within two to three days. The side effects can be unpleasant, but they’re short-lived and not dangerous.
Planning your shots for a day when you can take it easy the next morning is a practical move many people appreciate in hindsight.
Who Should Get Shingrix
The CDC recommends Shingrix for all adults 50 and older, regardless of whether they remember having chickenpox or whether they previously received Zostavax. If you got Zostavax years ago, you should still get the Shingrix series. Adults 19 and older with weakened immune systems (from conditions or treatments that suppress immunity) are also recommended to receive it.
The only people who should avoid Shingrix are those who’ve had a confirmed severe allergic reaction to a previous dose or to any component of the vaccine. Having a current active shingles outbreak is a reason to wait, not a reason to skip it entirely.
Cost and Insurance Coverage
Most private insurance plans cover Shingrix with no or low out-of-pocket cost. For Medicare beneficiaries, Shingrix is covered under Part D (the prescription drug benefit), not Part B. Since Shingrix is recommended by the CDC’s Advisory Committee on Immunization Practices, Part D plans are required to cover it with zero cost-sharing. This applies even if you receive the vaccine from an out-of-network provider, though you may need to pay the administration fee upfront and get reimbursed by your plan afterward.
Without insurance, the two-dose series typically runs between $300 and $400 total. Many pharmacies stock and administer it without needing a separate doctor’s visit.