The shingles vaccine is recommended for all adults 50 and older, regardless of whether they remember having chickenpox. It’s also recommended for adults as young as 19 if they have a weakened immune system. The vaccine, called Shingrix, is given as two doses and provides strong protection against shingles and the severe nerve pain that can follow it.
Adults 50 and Older
The CDC recommends two doses of Shingrix for every adult aged 50 and up. This applies even if you’ve already had shingles, already had the older vaccine (Zostavax, which was discontinued in 2020), or aren’t sure whether you had chickenpox as a child. More than 99% of Americans born before 1980 carry the virus that causes shingles, so the assumption is that nearly everyone in this age group is at risk.
The two doses are spaced 2 to 6 months apart. Both doses are needed for full protection. In real-world studies, Shingrix was about 85.5% effective at preventing shingles overall. For adults between 50 and 79, effectiveness was roughly 87%. For those 80 and older, it dipped slightly to about 80%, which is still strong protection for a group at higher risk of complications.
Adults 19 and Older With Weakened Immune Systems
In 2021, the FDA expanded eligibility for Shingrix to include adults 18 and older who are immunocompromised, and the CDC’s advisory committee now recommends it starting at age 19. This is a meaningful expansion because people with weakened immune systems are far more likely to develop shingles, and their cases tend to be more severe.
The specific groups covered by this recommendation include:
- Organ transplant recipients, including both solid organ transplants and bone marrow or stem cell transplants
- People undergoing cancer treatment, including chemotherapy, radiation, or other immunosuppressive therapies
- People living with HIV
- People with autoimmune or inflammatory conditions who take medications that suppress the immune system
- Anyone on immunosuppressive therapy, including medications used for conditions like lupus, rheumatoid arthritis, or inflammatory bowel disease
If you’re about to start a treatment that will suppress your immune system, the ideal time to get vaccinated is before that treatment begins. For people taking certain therapies that target immune cells, the recommendation is to receive a dose about four weeks before the next scheduled treatment. Your prescribing doctor can help with timing.
If You’ve Already Had Shingles
Having shingles once does not protect you from getting it again. The virus stays dormant in your nerve cells and can reactivate more than once. Vaccination after an episode of shingles is still recommended. The general guidance is to wait until the rash has fully resolved before getting your first dose, but there’s no required minimum waiting period beyond that.
If You Got the Older Vaccine
Zostavax, the live shingles vaccine used from 2006 to 2020, was less effective and its protection faded within a few years. If you received Zostavax at any point, you should still get the two-dose Shingrix series. Shingrix is a different type of vaccine (it does not contain live virus) and provides substantially stronger, longer-lasting immunity.
Who Should Not Get Shingrix
The only firm contraindication is a history of a severe allergic reaction (anaphylaxis) to any ingredient in the vaccine or to a previous dose of Shingrix. If you had a mild reaction like soreness or fatigue after the first dose, that’s not a reason to skip the second one. Those side effects are common and reflect your immune system responding to the vaccine.
There is not enough safety data on Shingrix during pregnancy, so it is generally deferred in pregnant individuals. Shingrix does not contain a live virus, which makes it safe for immunocompromised people, unlike the older Zostavax vaccine.
What It Costs
For people on Medicare Part D, Shingrix is covered with no out-of-pocket cost. This applies to all vaccines recommended by the CDC’s Advisory Committee on Immunization Practices, and Shingrix is on that list. The zero-cost coverage applies even if you receive the vaccine from an out-of-network provider. Most private insurance plans also cover Shingrix for eligible adults, though the specifics vary by plan. Without insurance, the vaccine runs roughly $150 to $200 per dose.
Why It Matters
About one in three Americans will develop shingles in their lifetime. The rash itself is painful, but the bigger concern is postherpetic neuralgia, a condition where burning or stabbing nerve pain persists for months or even years after the rash heals. The risk of this complication rises sharply with age. Shingles can also affect the eyes, potentially causing vision loss, and in rare cases lead to stroke or other neurological problems. Vaccination is the most effective way to reduce all of these risks.