About one in three Americans will develop shingles in their lifetime, and the risk rises sharply after 50. The pain — a band of burning, blistering rash following a single nerve — can last weeks, and roughly 10 to 18% of patients develop postherpetic neuralgia, a chronic nerve pain that can persist for months or years. The current shingles vaccine Shingrix is over 90% effective in preventing the disease across age groups and is one of the most consequential additions to adult immunization in the past decade.
This guide covers what shingles is, how Shingrix works, its efficacy and side effect profile, dosing schedule, Medicare and private insurance coverage, and who should and should not receive it. For related senior health topics, see our healthy aging guide and pneumonia vaccine guide. Broader senior topics live in our medical conditions library.
What Shingles Is and Why Vaccination Matters
Shingles, also called herpes zoster, is the reactivation of the varicella-zoster virus that causes chickenpox. After a chickenpox infection (or previously, vaccination with the varicella vaccine), the virus stays dormant in nerve ganglia for decades. As cellular immunity wanes with age, immunosuppression, or stress, the virus can reactivate, traveling along a nerve and producing a painful, blistering rash in the dermatome it serves.
Beyond the acute illness, shingles can lead to postherpetic neuralgia (PHN), zoster ophthalmicus (when it affects the eye, with risk of vision loss), Ramsay Hunt syndrome (facial paralysis with ear involvement), and rare but serious neurologic complications including encephalitis. According to the CDC’s shingles overview, there are about 1 million cases per year in the US, with risk rising steeply after 50.
How Shingrix Works
Shingrix (recombinant zoster vaccine, RZV) is a non-live, adjuvanted subunit vaccine. It contains glycoprotein E from the varicella-zoster virus combined with the AS01B adjuvant system, which boosts the immune response — particularly important in older adults whose immune systems respond less robustly to standard vaccines.
Shingrix replaced Zostavax (a live attenuated vaccine, discontinued in the US in 2020) because Shingrix is substantially more effective and works well even in older adults. The non-live formulation also makes it safer for many immunocompromised people for whom live vaccines were contraindicated.
Who Should Get It
The CDC Advisory Committee on Immunization Practices (ACIP) recommends Shingrix for all adults 50 and older for prevention of shingles and its complications, regardless of prior shingles history or prior Zostavax vaccination. ACIP also recommends Shingrix for adults 19 and older who are or will be immunodeficient or immunosuppressed due to disease or therapy, including patients with HIV, hematologic malignancies, solid organ transplants, and those on chemotherapy or immunosuppressive medications.
People who have previously had shingles can still benefit from vaccination, since recurrence is possible. Generally, the vaccine is given after the rash and acute pain have resolved.
Efficacy
Shingrix demonstrated remarkable efficacy in pivotal trials. In adults 50 to 69 years old, two-dose efficacy against shingles was approximately 97%. In adults 70 and older — a population where most vaccines work less well — efficacy was approximately 91%. Efficacy against postherpetic neuralgia exceeded 88% across age groups.
Real-world studies and post-marketing data have confirmed strong, durable protection. Long-term follow-up shows efficacy remains above 73% at year 7 and possibly longer. CDC data show that vaccinated adults who do develop shingles experience milder disease with shorter duration and lower rates of PHN.
Dosing Schedule
Shingrix is given as two intramuscular doses, typically in the deltoid. The standard schedule is the second dose 2 to 6 months after the first. For immunocompromised adults, ACIP allows the second dose to be given as early as 1 to 2 months after the first to provide protection more quickly.
If the second dose is delayed beyond 6 months, it should still be given — there is no need to restart the series. People who previously received Zostavax should also receive the full two-dose Shingrix series, with at least 8 weeks between Zostavax and the first Shingrix dose.
Side Effects
Shingrix is reactogenic — meaning it produces noticeable short-term side effects. In trials, about 1 in 6 recipients had reactions strong enough to interfere with daily activities. The most common are injection-site pain (about 78% of recipients), redness and swelling, fatigue (45%), muscle aches (44%), headache (38%), shivering, fever, and nausea. Symptoms typically resolve within 2 to 3 days.
The intensity of these reactions is part of why the vaccine works so well — the strong immune response that produces the side effects also produces the protection. Many recipients plan the vaccine when they have a day of rest available afterward. Acetaminophen or ibuprofen can manage symptoms; some clinicians suggest taking these pre-emptively, though pre-medication may slightly blunt vaccine response.
Serious adverse events are rare. Post-marketing surveillance has identified a small possible increased risk of Guillain-Barré syndrome (about 3 excess cases per million doses in adults 65+), which the FDA added to labeling. The CDC continues to recommend the vaccine because shingles itself can also trigger GBS, and the benefit-to-risk balance remains strongly favorable.
Cost and Insurance
Shingrix is covered under Medicare Part D as of January 2023, when the Inflation Reduction Act eliminated all out-of-pocket costs for adult ACIP-recommended vaccines under Part D. Beneficiaries now pay $0 for Shingrix at participating pharmacies. This was a substantial change — pre-2023, beneficiaries often faced copays of $40 to $200 per dose depending on plan.
Most private insurance plans cover Shingrix as a preventive service with no cost-sharing under the Affordable Care Act. Without insurance, the list price is approximately $200 to $250 per dose, or $400 to $500 for the full series. Pharmacy programs and manufacturer assistance can reduce out-of-pocket costs.
Original Medicare Part B does not cover Shingrix — it is a Part D vaccine. Beneficiaries with only Part A and Part B (no Part D plan) face the full cost. Adding a Part D plan or Medicare Advantage plan with prescription coverage is the typical solution.
Who Should Not Get Shingrix
Contraindications are limited: severe allergic reaction (anaphylaxis) to a previous dose of Shingrix or to any component of the vaccine, and current shingles infection (wait until after recovery). Pregnancy is a precaution — ACIP advises delaying until after pregnancy in most cases due to limited data.
Mild illness is not a reason to defer. Moderate or severe acute illness is generally a reason to wait until recovery. People with current immunosuppression are explicitly recommended to receive Shingrix per 2022 ACIP guidance.
When to seek emergency care: Call 911 or go to the emergency room for signs of severe allergic reaction after vaccination — difficulty breathing, swelling of the face or throat, hives, rapid pulse, or fainting. These typically occur within minutes to hours and require immediate treatment. For shingles affecting the eye (zoster ophthalmicus, with rash near the eye or tip of the nose), seek same-day ophthalmology evaluation regardless of vaccination status.
Frequently Asked Questions
Do I still need Shingrix if I already had shingles?
Yes. Recurrence is possible, and ACIP recommends vaccination after the acute episode resolves. The vaccine protects against future episodes regardless of prior shingles.
What if I previously got Zostavax?
You should still get the full two-dose Shingrix series. Wait at least 8 weeks after the Zostavax dose. Shingrix provides substantially better and more durable protection.
Can I get Shingrix at the same time as the flu shot?
Yes. ACIP allows simultaneous administration of Shingrix with other adult vaccines including flu, COVID-19, pneumococcal, and others, given at separate sites. Side effects may be additive but are not usually problematic.
How long does Shingrix protection last?
Long-term studies show protection remains above 73% at 7 years post-vaccination, with ongoing follow-up. ACIP currently does not recommend booster doses; recommendations may evolve as more data emerge.
The Bottom Line
Shingrix is one of the most effective adult vaccines available — over 90% efficacy across age groups, durable protection, and now $0 out-of-pocket for Medicare Part D enrollees. The two-dose series can produce 1 to 3 days of unpleasant but transient reactions, which is a fair trade for avoiding shingles and the chronic nerve pain that often follows it. ACIP recommends it for all adults 50 and older and for immunocompromised adults 19 and older. If you have not yet completed the series, the next pharmacy visit is a reasonable time to ask.