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 that never fully goes away. The good news? There’s a vaccine that works better than anything we’ve had before. It’s called Shingrix, the recombinant zoster vaccine (RZV), and it’s now the only shingles vaccine available in the U.S. and many other countries. But who actually needs it? And is it worth the two shots and the temporary side effects?

Who is officially recommended to get Shingrix?

The Centers for Disease Control and Prevention (CDC) gives a clear answer: if you’re 50 or older, get Shingrix. No exceptions. That’s about 85 million adults in the U.S. alone. You don’t need to have had shingles before. You don’t need to be sick. You don’t even need to think you’re at risk. If you’re 50+, your immune system is naturally weakening, and the varicella-zoster virus - the same one that gave you chickenpox as a kid - is quietly waiting to reactivate. Shingrix cuts your risk of getting shingles by more than 90%.

But here’s something many people don’t know: the recommendation doesn’t stop at 50. 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 also a candidate. The CDC updated this guidance in 2018 after studies showed these high-risk groups were getting shingles at younger ages and with worse outcomes. For them, the second dose can even be given just 1 to 2 months after the first, instead of waiting 2 to 6 months, to get protection faster.

Why Shingrix over the old vaccine?

There used to be another shingles vaccine called Zostavax. It was a live virus shot. It worked okay - about 51% effective at preventing shingles. But it had major flaws. It didn’t work well in older adults. It didn’t work at all for people with weakened immune systems. And in 2020, it was pulled off the market entirely. Shingrix replaced it for good reasons.

Shingrix isn’t a live virus. It’s made from a piece of the virus (glycoprotein E) plus a powerful immune booster (AS01B). This means it’s safe for people with autoimmune diseases, cancer, or those on immunosuppressants. It’s also way more effective. For people aged 50 to 59, it’s 97% effective. For those 70 and older, it’s still 91% effective. That’s not a small improvement - it’s a game-changer. And it doesn’t just prevent the rash. It cuts the risk of postherpetic neuralgia (the long-lasting nerve pain that can last for years) by 90%.

What about if you already had shingles or got Zostavax?

Even if you’ve had shingles, you can still get Shingrix. The virus stays in your body after the outbreak, and you can get it again. The CDC says you should wait at least one year after your shingles episode before getting vaccinated. No need to wait longer.

If you got Zostavax in the past, you still need Shingrix. The CDC recommends getting two doses of Shingrix at least five years after your Zostavax shot. Why? Because Zostavax’s protection fades over time, and Shingrix gives you stronger, longer-lasting defense. Don’t assume you’re covered just because you got the old shot.

What’s the schedule? Two doses, not one.

Shingrix isn’t a one-and-done vaccine. You need two shots. The second dose should be given 2 to 6 months after the first. If you’re immunocompromised, you can get the second dose as early as 1 to 2 months later. Missing the second dose means you won’t get full protection. Studies show the first shot alone only gives about 70% effectiveness. The second shot pushes it over 90%.

It’s not uncommon for people to skip the second shot because they feel fine after the first. But shingles doesn’t wait. The risk builds over time. If you’re 65 and only got one shot, you’re still at high risk. Set a reminder. Talk to your pharmacist. Make it part of your routine.

What are the side effects? And are they worth it?

Let’s be honest: Shingrix can make you feel awful - for a day or two. About 80% of people get pain, redness, or swelling at the injection site. Half of people report muscle aches, fatigue, or headaches. One in five get a fever or chills. These aren’t mild. Some people say they couldn’t work or take care of their kids for 48 hours.

But here’s the thing: these side effects are temporary. They peak within 24 to 48 hours and are gone by day 3. No one has reported long-term damage from them. Compare that to shingles: 1 in 5 people get postherpetic neuralgia. That pain can last for months or years. It can make walking, dressing, or sleeping unbearable. The temporary discomfort of the vaccine is a small price to pay.

People who’ve had shingles often say they’d do it again in a heartbeat. They know what they’re avoiding.

Who should NOT get Shingrix?

There are only a few reasons not to get it. If you’ve had a severe allergic reaction (like anaphylaxis) to any ingredient in Shingrix - or to a previous dose - don’t get it. That’s rare. If you’re sick with a high fever right now, wait until you’re better. The vaccine is safe if you have a cold or mild illness.

It’s not recommended for pregnant women, though there’s no evidence it’s harmful. If you’re breastfeeding, it’s fine. It’s also not approved for children or teens under 19 unless they’re immunocompromised.

How much does it cost? Is it covered?

Shingrix costs about $175 for the full two-dose course. That’s less than the old Zostavax, which was $200 for one shot. Most private insurance plans cover it fully under preventive care. Medicare Part D covers it too - but you might pay a copay depending on your plan. Some pharmacies offer discounts if you pay out-of-pocket. Don’t let cost stop you. Talk to your pharmacist. Ask if your plan has a vaccine benefit. The cost of treating shingles - doctor visits, pain meds, lost work days - is far higher.

What’s the bottom line?

If you’re 50 or older, get Shingrix. If you’re 19 or older and immunocompromised, get Shingrix. It’s the most effective shingles vaccine ever made. It’s safe for nearly everyone. It prevents the worst complications. And while the side effects are real, they’re short-lived and far less dangerous than shingles itself.

Don’t wait until you’ve had an outbreak. Don’t assume you’re immune because you had chickenpox. Don’t skip the second shot. The virus is already in your body. Shingrix is your best defense.

What if I’m not sure I qualify?

Ask your doctor. Bring up your medical history - especially if you’ve had cancer, take steroids, have diabetes, or have any chronic condition. Your doctor can check your vaccination record and tell you if you need it. Pharmacies in most states can also give you the shot without a prescription if you meet the CDC guidelines. No need to wait for an appointment.