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 risk of long-term nerve damage called postherpetic neuralgia. The good news? There's a vaccine that works better than anything we've had before. The recombinant zoster vaccine, sold under the brand name Shingrix, is now the gold standard for preventing shingles - and it's not just for older adults. If you're wondering whether you or someone you care about should get it, here's exactly who needs it, why, and what to expect.

Who Exactly Should Get the Recombinant Zoster Vaccine?

The answer is simpler than you might think: almost everyone over 50. The recombinant zoster vaccine is a two-dose vaccine recommended by the CDC for all adults aged 50 and older, regardless of whether they've had shingles before or received the old Zostavax vaccine. That means even if you got shingles last year, you still need Shingrix. The virus that causes shingles - varicella-zoster - never leaves your body after chickenpox. It just hides in your nerves. So having one outbreak doesn't protect you from another. Shingrix reduces your risk of getting shingles again by more than 90%.

But here's the bigger shift: it's not just for people 50 and up anymore. If you're 19 or older and your immune system is weakened - whether from cancer treatment, HIV, organ transplant, autoimmune diseases like rheumatoid arthritis, or long-term steroid use - you're also a candidate. Before Shingrix, people with weakened immune systems couldn't get vaccinated at all. The old Zostavax vaccine used a live virus and was too risky. Shingrix doesn't contain live virus. It's made from a piece of the virus (glycoprotein E) and a powerful adjuvant that boosts your immune response. That makes it safe for people who were previously left unprotected.

Why Shingrix Over the Old Vaccine?

The old shingles vaccine, Zostavax, is gone. It was discontinued in the U.S. in November 2020. Why? Because Shingrix is simply better. Zostavax was only about 51% effective at preventing shingles. For people over 70, its effectiveness dropped to below 40%. And it offered just 67% protection against the worst complication - postherpetic neuralgia.

Shingrix? It's in a different league. Clinical trials show it's over 97% effective at preventing shingles in people aged 50 to 59. For those 60 to 69, it's 97.4%. Even for people 70 and older - who are at highest risk - it's still 91.3% effective. For postherpetic neuralgia? It cuts the risk by 91% in younger adults and 89% in older adults. That’s not a small improvement. That’s the difference between a 1 in 5 chance of shingles and a 1 in 20 chance.

It also lasts longer. Studies show protection stays above 90% for at least seven years after the second dose. Some experts believe it could last 15 to 20 years. That’s not just better - it’s a game-changer.

How the Vaccine Works - And What You Need to Know

Shingrix isn't a single shot. It's two doses, given 2 to 6 months apart. If you're immunocompromised, the second dose can be given as early as 1 to 2 months after the first. This isn't a suggestion - it's a requirement. Skipping the second dose cuts your protection dramatically.

Each dose is 0.5 mL and injected into your upper arm. It's not a skin prick like a flu shot. It goes deep into the muscle. You'll need to schedule two appointments. That's one reason some people don't complete the series. But don't delay the second shot. If you miss the window, just get it when you can. You don't need to restart the whole series.

The vaccine must be kept cold - between 2°C and 8°C (36°F to 46°F). If it warms up too much, it becomes ineffective. That's why pharmacies and clinics store it properly. You don't have to worry about this - just make sure you get it from a licensed provider.

What Side Effects to Expect (And What to Ignore)

Shingrix is effective - and it lets you know it. About 80% of people have pain, redness, or swelling at the injection site. Around 45% feel muscle aches. Forty percent get tired. One in three has a headache. Some get chills, fever, or stomach upset. These aren't rare side effects - they're common.

Here's the key: they're temporary. Most symptoms peak within 24 to 48 hours and fade within two to three days. You might need to take it easy for a day or two. Some people call it "Shingrix flu." But it's not shingles. You won't get a rash. You won't be contagious. This is your immune system doing its job.

Severe reactions are rare. If you've ever had a life-threatening allergic reaction to any vaccine ingredient, don't get it. That's the only true contraindication. If you're sick with a fever, wait until you're better. But don't skip it because you're nervous about sore arms. The pain of shingles lasts months. The pain from the shot lasts hours.

Who Should Skip It?

Very few people should avoid Shingrix. You should not get it if:

• You've had a severe allergic reaction (like anaphylaxis) to any component of the vaccine
• You're currently sick with a moderate or severe illness (wait until you recover)
• You tested negative for varicella-zoster immunity (extremely rare - most adults over 50 had chickenpox)

That's it. If you're over 50, or 19+ and immunocompromised - and you're not allergic - you should get it. Even if you're healthy. Even if you think you're "too young." Even if you're not sure you had chickenpox. The CDC says: if you're 50+, get Shingrix. Period.

Cost and Coverage - Is It Worth It?

Shingrix costs about $175 for both doses. That sounds steep, but most insurance covers it fully. Medicare Part D covers 100% of the cost for eligible adults. Most private insurers do too. If you're uninsured, some pharmacies offer discount programs. The price of one shingles outbreak - doctor visits, missed work, pain medication, lost sleep - can easily exceed $1,000. Prevention is cheaper.

And if you got Zostavax before? You still need Shingrix. The CDC recommends waiting at least five years after Zostavax before getting Shingrix. But if you got Zostavax less than five years ago, you can still get Shingrix now. It's safe. It's effective. And you'll get better protection.

What Happens If You Don't Get It?

One in three people in the U.S. will get shingles in their lifetime. By age 85, that risk jumps to 50%. And shingles doesn't just hurt - it can blind you, paralyze your face, or cause brain inflammation. Postherpetic neuralgia can last for years. It's the leading cause of chronic pain in older adults.

Right now, only about 35% of adults over 60 have been vaccinated. That's far below the Healthy People 2030 goal of 70%. Most people who get shingles didn't get the vaccine. They assumed they were safe. Or they were scared of side effects. Or they forgot. Don't be one of them.

Next Steps - What to Do Now

Check your vaccination record. Did you get two doses of Shingrix? If not, schedule an appointment. Talk to your doctor, pharmacist, or local clinic. Most pharmacies offer it without a prescription. Bring your insurance card. Ask if they have it in stock - it's widely available now.

If you're 19 to 49 and have a condition that weakens your immune system - like diabetes on insulin, lupus, or are on biologic drugs - talk to your specialist. You might be eligible too.

And if you've had shingles already? Get vaccinated. It won't cure your current pain, but it will prevent the next one. And there will be a next one if you don't.

Final Thought

Shingles isn't something you "get over." It's something you prevent. The recombinant zoster vaccine is the most effective tool we have. It's safe, it's covered, and it works. If you're 50 or older - or 19+ and immunocompromised - don't wait. Get both doses. Your future self will thank you.