Shingles Vaccination: Who Should Get the Recombinant Zoster Vaccine

Shingles isn’t just a rash. For many people, it’s months of burning pain, sleepless nights, and a condition called postherpetic neuralgia that can last years. The good news? There’s a vaccine that works-really well. Shingrix, the recombinant zoster vaccine, is now the only shingles vaccine available in the U.S. and the most effective one ever made. But who should get it? And is it right for you?

Who Exactly Needs the Shingles Vaccine?

If you’re 50 or older, you should get Shingrix-even if you think you’ve never had chickenpox. Nearly everyone born before 1980 was exposed to the varicella-zoster virus, even if they never showed symptoms. Once you’ve had it, the virus stays in your nerves for life. As you age, your immune system weakens, and that virus can wake up as shingles. The CDC recommends two doses of Shingrix for everyone 50 and up, no exceptions.

What if you already had shingles? You still need it. Having shingles doesn’t give you lasting immunity. The virus can come back. The CDC says you can get Shingrix as soon as your rash clears, even if it was just last month.

What about if you got the old shingles vaccine, Zostavax? You still need Shingrix. Zostavax was discontinued in 2020 because it only worked about half as well. Even if you got Zostavax five years ago, you should get two doses of Shingrix now. It’s not a booster-it’s a full replacement.

What If You’re Under 50?

You might still need it. If you’re 19 or older and your immune system is weakened-whether from cancer treatment, HIV, organ transplant, or long-term steroid use-you’re at higher risk for severe shingles. The CDC recommends Shingrix for adults 19 and up who are immunocompromised. That includes people with autoimmune diseases like lupus or rheumatoid arthritis who take immunosuppressants. If you’re unsure, talk to your doctor. Your immune status matters more than your age.

People with chronic conditions like diabetes, COPD, or kidney disease are also at higher risk. While not officially recommended for all under-50s with these conditions, many doctors still advise vaccination based on individual risk. Don’t assume you’re too young. Shingles can strike at any age if your immune system is under stress.

How Effective Is Shingrix?

It’s not just good-it’s outstanding. In clinical trials, Shingrix prevented shingles in 97% of people aged 50-59, 97% of those 60-69, and 91% of those 70 and older. That’s far better than Zostavax, which only prevented about 51% of cases. For the worst complication-postherpetic neuralgia-Shingrix is 91% effective in people 50-69 and 89% effective in those 70+.

Protection lasts at least seven years, and studies suggest it could last 15 to 20 years. There’s no current recommendation for a third dose. You don’t need to repeat the series unless you got only one dose and never finished it.

How Is It Given?

Shingrix is two shots. The second dose goes in 2 to 6 months after the first. If you’re immunocompromised, the second dose can be given as early as 1 to 2 months later. That’s important-you don’t want to wait too long if your immune system is declining.

Each shot is injected into the upper arm. It’s not a subcutaneous shot like some vaccines-it’s deep into the muscle. The needle size depends on your weight: a 5/8-inch needle for people under 130 pounds, a 1-inch needle for heavier adults. The vaccine must be refrigerated and mixed right before use. That’s why you can’t just walk into a pharmacy and get it on the spot. Pharmacies and clinics keep it on ice until the moment it’s needed.

What Are the Side Effects?

Shingrix causes more side effects than most vaccines. That’s because it’s designed to trigger a strong immune response. About 80% of people have pain, redness, or swelling at the injection site. More than 40% feel tired, achy, or get headaches. One in six people say the side effects were bad enough to miss work or normal activities for a day or two.

But here’s the thing: these symptoms don’t last. Most go away in 2 to 3 days. You might feel like you’ve got the flu, but it’s not the flu. It’s your immune system doing its job. If you’ve had shingles before, many people say the temporary discomfort is worth it. One patient told me, “I spent three weeks in pain from shingles. Two days of feeling awful from the shot? Easy choice.”

Severe allergic reactions are rare. If you’ve ever had a life-threatening reaction to any part of the vaccine, don’t get it. If you’re very sick with a fever, wait until you’re better. Otherwise, side effects are a sign it’s working-not a reason to skip it.

Cost and Insurance Coverage

Shingrix costs about $175 for both doses. That’s less than the old Zostavax vaccine, which was $200 for just one shot. But the real difference is coverage. Medicare Part D covers the full cost for eligible adults. Most private insurance plans do too. You should pay nothing out of pocket if you’re in the recommended age group.

If you’re uninsured or underinsured, check with your local health department. Many offer vaccines at low or no cost through federal programs. Pharmacies like CVS and Walgreens often have vaccine assistance programs. Don’t let cost stop you. The cost of treating shingles-doctor visits, pain meds, missed work-is far higher.

Why Not Just Wait?

Some people think, “I’m healthy. I’ll wait until I’m 60.” But shingles doesn’t wait. It can strike suddenly. One study found that 1 in 3 people will get shingles in their lifetime. By age 80, that risk jumps to 1 in 2. And the older you are when you get it, the worse it gets.

Shingles can lead to vision loss if it hits your eye. It can cause hearing problems or facial paralysis. In rare cases, it leads to brain inflammation or death. The pain can linger for years. There’s no cure for postherpetic neuralgia-only ways to manage it.

Waiting means risking something you can’t undo. Vaccination is the only way to prevent it.

What About the Newer Vaccines?

There aren’t any. Shingrix is the only shingles vaccine available in the U.S. since Zostavax was pulled from the market in 2020. No other live or non-live alternatives are approved. Some countries have other vaccines, but in the U.S., Shingrix is it. Don’t be fooled by claims of “newer” or “better” options-there aren’t any.

Researchers are studying whether a single-dose version could work in the future, but nothing is close to approval. For now, two doses of Shingrix is the gold standard.

What If You’re Not Sure?

Ask your doctor. But come prepared. Know your medical history. Bring a list of medications. Tell them if you’ve had shingles, if you’re on immunosuppressants, or if you’ve had a bad reaction to vaccines before. If your doctor says you don’t need it, ask why. The CDC guidelines are clear: almost everyone 50+ should get it. If your doctor hesitates, get a second opinion.

Don’t rely on memory. If you’re not sure whether you had Zostavax or even shingles, assume you didn’t. The CDC says it’s safe to vaccinate even if you’re unsure. Better to get the shots than risk missing protection.

Final Thought: This Isn’t Optional

Shingles isn’t a joke. It’s a serious, painful, potentially disabling disease. And the vaccine that prevents it is safe, effective, and covered by insurance. If you’re 50 or older, or if you’re 19+ and immunocompromised, you should get Shingrix. No ifs, ands, or buts.

Don’t wait for a rash. Don’t wait for pain. Don’t wait for a doctor to remind you. Make the call. Schedule the appointment. Get both doses. Your future self will thank you.