Shingles Vaccine: Who Needs It, How Well It Works, and What to Expect

You remember how miserable a relative was with shingles, or you saw the band of painful blisters yourself, and now you are wondering whether the shingles vaccine is worth it. The good news: there is a highly effective vaccine, and for most adults over 50 the answer is a straightforward yes.

This guide walks through what the shingles vaccine is, who should get it, how many doses you need, how protective it really is, and what side effects to expect, so you can have an informed conversation with your clinician.

What is the shingles vaccine?

The shingles vaccine protects against herpes zoster, the painful, blistering rash caused when the varicella-zoster virus, the same virus that causes chickenpox, reactivates later in life. After a childhood chickenpox infection, the virus stays dormant in your nerves. As immunity to it naturally declines with age, it can wake up and travel along a nerve to the skin, producing the classic one-sided band of blisters.

The vaccine recommended in the US today is Shingrix, a recombinant zoster vaccine. It is a nonliving vaccine, meaning it does not contain live virus. It works by combining a piece of the virus with an adjuvant that boosts your immune response. The older live vaccine, Zostavax, is no longer sold in the US.

Who should get the shingles vaccine?

The CDC recommends the shingles vaccine for two main groups. Answering the most common question first: yes, healthy adults are advised to get it starting at age 50, even if they have already had shingles and even if they cannot remember having chickenpox.

Because Shingrix is nonliving, it can also be given to people with weakened immune systems, who are at higher risk of shingles and its complications.

• All healthy adults aged 50 and older
• Adults aged 19 and older who are immunocompromised or on treatments that weaken the immune system
• People who previously received the older Zostavax vaccine (they should still get Shingrix)

How many doses do you need, and on what schedule?

The shingles vaccine is given as two doses. For healthy adults, the second dose is given 2 to 6 months after the first.

Completing both doses matters: the strong, durable protection seen in clinical trials comes from the full two-dose series, not a single shot. If you are immunocompromised, your clinician may adjust the timing, so confirm your schedule with them.

How well does the shingles vaccine work?

Shingrix is one of the most effective adult vaccines available. In the pivotal ZOE-50 and ZOE-70 trials, it was 97.2% effective at preventing shingles in adults aged 50 and older, and 89.8% effective in adults 70 and older.

It also strongly protects against postherpetic neuralgia (PHN), the lingering, sometimes debilitating nerve pain that can follow a shingles rash. Shingrix prevented PHN in about 91% of adults 50 and older and about 89% of adults 70 and older.

Protection is long-lasting. Extension data from the original trials show 89.0% efficacy against shingles up to 10 years after vaccination, with effectiveness plateauing from year 6 to year 8. In people with weakened immune systems, efficacy is lower and varies by condition, ranging from 68% to 91%. Even when a vaccinated person does develop shingles, symptoms are usually milder and the risk of PHN is lower.

What are the side effects?

Most side effects from the shingles vaccine are mild to moderate and short-lived. Because Shingrix prompts a robust immune response, it is normal to feel temporarily under the weather, especially after the second dose.

A 2023 Cochrane review of 13 studies and 69,916 participants found that both available vaccines cause mild-to-moderate injection-site and body-wide reactions, and confirmed both are probably effective at preventing shingles for at least three years.

• Soreness, redness, or swelling at the injection site
• Muscle aches or tiredness
• Headache
• Fever, chills, or an upset stomach
• These reactions typically resolve within a few days

When should you talk to a doctor?

Talk to a clinician about timing the vaccine if you are pregnant, currently have a shingles outbreak, or are acutely ill, and if you have a weakened immune system, since that affects both your risk and the recommendation. If you have had a serious allergic reaction to a previous dose or any vaccine component, tell your clinician before the next dose.

Separately, if you think you already have shingles, seek care promptly rather than waiting. Antiviral treatment works best when started early, ideally within the first few days of the rash. Get urgent care if the rash is near your eye, if you have severe pain, or if you feel very unwell, as these can signal complications that need fast treatment.