Shingles (Herpes Zoster) is a painful rash caused by the reactivation of the varicella zoster virus, the same virus responsible for chickenpox. After recovery, the virus remains dormant in nerve tissues near the spinal cord and brain. If the immune system weakens, the virus can travel to the skin, causing the characteristic blistered rash and sometimes severe, long-lasting nerve pain. Vaccination is the primary way to prevent this infection and its most common complication, postherpetic neuralgia. The current standard for protection is the recombinant zoster vaccine, Shingrix.
Recommended Eligibility Criteria
Vaccination recommendations are primarily based on age, reflecting the increased risk as the immune system naturally declines. Adults aged 50 years and older should receive the Shingrix vaccine. This recommendation applies regardless of whether they recall having chickenpox or a prior episode of shingles. There is no upper age limit for receiving the vaccine, as protection remains strong even in older age groups.
A separate, higher-risk group includes adults who are immunocompromised due to certain diseases or therapies. For these individuals, the recommendation begins at age 19 and older. This includes people with conditions like HIV, hematologic malignancies, or those undergoing immunosuppressive treatments. This population is at a significantly higher risk for severe shingles, making the vaccine important for protection.
The Required Number of Doses and Timing
The standard recommendation for the Shingrix vaccine is a series of two doses. Receiving both doses is necessary to achieve the high level of protection demonstrated in clinical trials, which shows the vaccine is over 90% effective at preventing shingles in adults 50 years and older. Each dose is administered as an injection into the muscle, typically in the upper arm.
For most healthy adults aged 50 and older, the second dose should be given between two and six months after the first dose. This timeframe allows the immune system to build a robust and long-lasting response. If the six-month window is missed, the person should still get the second dose as soon as possible, as the series does not need to be restarted.
Immunocompromised individuals often follow an accelerated schedule to ensure quicker protection against severe outcomes. For these adults, the second dose is generally given one to two months after the first. No booster doses are currently recommended beyond the initial two-dose series, as protection has been shown to persist for at least eight years.
Navigating Previous Shingles History or Vaccination
Prior history with the varicella zoster virus, either as a shingles episode or a previous vaccination, does not negate the need for the Shingrix series. Patients who have already experienced shingles should still receive the vaccine to help prevent future occurrences. The first dose of Shingrix should be administered after the shingles rash has completely resolved, typically waiting at least two months after the acute illness has passed.
If an individual previously received the older, live-attenuated shingles vaccine, Zostavax, they are still recommended to receive the two-dose Shingrix series. Those who received Zostavax should transition to the current vaccine for stronger, more durable protection. It is advised to wait at least eight weeks after receiving Zostavax before starting the Shingrix series.