Shingrix Shingles Vaccine: Who Needs It, How Well It Works, Doses

Patients who have had shingles often tell me it was "the worst pain of my life". Some still have burning pain that keeps them awake months after the rash has gone. That's why I recommend the shingles vaccine to almost every patient aged 50 and over, as well as to people with weakened immunity.

What is shingles, and why does risk rise with age?

Shingles (herpes zoster) is caused by the same virus as chickenpox (varicella-zoster virus). After we recover from chickenpox as children, the virus doesn't leave; it hides in the nerve ganglia. When immunity falls with age, stress or illness, the virus comes back as a blistering rash in a band along a nerve on one side of the body, with burning pain.

About 1 in 3 people who have had chickenpox will get shingles during their lifetime. Important complications include:

• Postherpetic neuralgia: pain that continues for months or years, more common at older ages
• Shingles in the eye, which can cause eye inflammation or loss of vision
• Facial weakness and hearing problems if the nerve near the ear is affected
• A temporarily increased risk of stroke after shingles

What kind of vaccine is Shingrix?

Shingrix is a non-live recombinant zoster vaccine, made from a virus protein together with an adjuvant (an immune booster), so it can be given even to people with weakened immunity. This is different from the older live attenuated vaccine (Zostavax), which protected less well and has been discontinued in many countries.

How well does it protect?

Long-term follow-up found effectiveness was still about 80% around 10 years after vaccination. Booster doses are not currently recommended.

In addition, observational research in 2024–2025 found that people who received a shingles vaccine had lower rates of dementia diagnosis. This is interesting, but it is still observational data and shouldn't be the main reason to get vaccinated.

Who should be vaccinated?

• All adults aged 50 and over, whether or not they remember having chickenpox
• Adults aged 18 and over with weakened immunity, or whose immunity will be weakened, for example people living with HIV, taking immunosuppressants, receiving chemotherapy, having organ or bone marrow transplants, or certain biologic medicines; see also HIV treatment and the TLD regimen
• People who have already had shingles should also be vaccinated, because it can come back. Wait until the rash has completely healed.
• People who previously had Zostavax can have Shingrix at least 8 weeks later

Who shouldn't be vaccinated or should wait: people who have had a severe allergic reaction to the vaccine or its components, people who currently have shingles, or those with an acute high fever. There isn't enough data on pregnancy, so vaccination is usually postponed until after the birth.

Shingrix

Age 50 and over

• Everyone
• Fine even if you can't recall having chickenpox

Age 18+ with weak immunity

• HIV, immunosuppressants
• Chemotherapy, organ transplant

Had shingles before

• It can recur
• Wait until the rash has fully healed

Had Zostavax

• Can be vaccinated, at least 8 weeks later

Postpone if you currently have shingles, a high fever, or are pregnant.

How it's given

• An injection into the upper arm muscle, 2 doses 2–6 months apart
• For people with weakened immunity, the doctor may give the second dose sooner, 1–2 months after the first
• If you are late for the second dose, you don't need to start again; just have the second dose as soon as possible
• It can be given at the same time as other vaccines, such as influenza and pneumococcal, in different arms

1. Dose 1
   Injected into the upper arm muscle

   Possible sore arm, tiredness, low fever for 1–3 days; best before a day off

2. 2–6 months
   Dose 2

   Weak immunity: may be just 1–2 months apart; if late, no need to restart

3. Both doses
   High protection against shingles

   About 97% at ages 50–69 and about 90% at 70+ (ZOE-50/70)

4. ≈ 10 years
   Still about 80% protection

   Booster doses are not currently recommended

Side effects to know about

Shingrix triggers a strong immune response, so symptoms after vaccination are common but usually pass within 1–3 days:

• Pain, swelling and redness in the injected arm, in most people
• Tiredness, muscle aches, headache, chills and low fever, in about half
• Some people need a day off work, so consider getting it before a day off
• A very small increase in Guillain-Barré syndrome (GBS) has been reported after vaccination. If you develop leg weakness that spreads upwards or numbness in your hands and feet within 6 weeks, see a doctor immediately.

If you get shingles, what should you do?

See a doctor as soon as possible. Antiviral medicine works best when started within 72 hours of the rash appearing. Go immediately if the rash is on your face, around the eye or on the tip of the nose, or if the rash spreads all over the body in someone with weakened immunity. While there are blisters, keep the rash covered and avoid contact with pregnant women, babies and people with weakened immunity who have never had chickenpox.

Getting the shingles vaccine with Dr. Kris Clinic

I can assess whether the vaccine suits you, plan your second dose and coordinate your full set of adult vaccines, for you and for your parents at home. English-speaking consultations are available. For the bigger picture of care at this age, read Men's health after 50.