When Did the Shingles Vaccine Come Out?

The first shingles vaccine, Zostavax, received FDA approval in May 2006 for adults aged 60 and older. A second, more effective vaccine called Shingrix replaced it after gaining FDA approval in October 2017, and the CDC began recommending Shingrix as the preferred option in early 2018. Zostavax was voluntarily discontinued in the United States in November 2020, making Shingrix the only shingles vaccine available in the country today. The story behind these two vaccines, and why the first one was phased out, involves some interesting science about how the immune system handles a virus most of us already carry.

The Virus Behind Shingles

Shingles is caused by varicella zoster virus (VZV), the same virus responsible for chickenpox. After a person recovers from chickenpox, VZV does not leave the body. It retreats into nerve cells near the spine and brain, where it can stay dormant for decades. As the immune system weakens with age, stress, or illness, the virus can reactivate and travel along nerve fibers to the skin, producing the painful, blistering rash known as shingles. This relationship between primary infection and later reactivation was established in the 20th century and is the reason shingles overwhelmingly affects older adults.

About one in three people who had chickenpox will eventually develop shingles. The risk climbs steeply after age 50, and the most feared complication is postherpetic neuralgia (PHN), a burning nerve pain that can persist for months or even years after the rash clears. Preventing shingles, or at least reducing its severity, was the driving motivation behind developing a vaccine.

Zostavax and What It Got Right

Zostavax was a live-attenuated vaccine, meaning it contained a weakened but still living form of VZV. The idea was straightforward: give the immune system a controlled re-exposure to the virus it already harbored, boosting the body’s defenses enough to keep the dormant virus in check. Zostavax was initially approved for adults 60 and older, and the recommendation was later expanded to include adults 50 and up.

In its landmark trial, the Shingles Prevention Study, Zostavax reduced the overall burden of illness from shingles by about 61% and cut the incidence of postherpetic neuralgia by roughly two-thirds in adults 60 and older.

Those numbers were encouraging, and the vaccine clearly helped. But problems emerged once researchers tracked how well it held up over time.

Why Zostavax Protection Faded

The central weakness of Zostavax was durability. Protection was strongest in the first year after vaccination and then dropped substantially. In a large cohort study, effectiveness against shingles was about 68% during the first year, fell to roughly 47% in the second year, and continued declining more gradually after that.

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A real-world study using electronic health records painted a similar picture over a longer horizon. Vaccine effectiveness against shingles started near 67% in year one and slid to about 15% by years ten through twelve. Protection against postherpetic neuralgia held up somewhat better but still dropped from 83% in the first year to around 41% by the same late window. Protection against hospitalization for shingles started high, near 90%, and fell to about 53% over five to eight years.

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A systematic review and meta-analysis that pooled results from multiple post-licensure studies confirmed this pattern, estimating effectiveness of about 60% in the first year, waning to roughly 51% by year six and becoming statistically imprecise by year seven.

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There was also a practical limitation: because Zostavax contained live virus, it could not safely be given to people with weakened immune systems, the very population most vulnerable to shingles. Patients on immunosuppressive medications, organ transplant recipients, and people undergoing chemotherapy were all left without an option. These shortcomings set the stage for a fundamentally different approach.

How Shingrix Changed the Game

Shingrix, known technically as the recombinant zoster vaccine (RZV), took a different design path. Instead of using live virus, it pairs a single VZV protein, glycoprotein E, with a powerful adjuvant called AS01B that stimulates strong cellular and antibody responses.

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Because no live virus is involved, Shingrix can be given to immunocompromised individuals, closing the gap Zostavax left open.

The clinical trial results were striking. In the ZOE-70 trial, which enrolled adults 70 and older, Shingrix was about 90% effective against shingles. That figure held remarkably steady regardless of whether participants were in their 70s or 80 and above. When data from the two pivotal trials were pooled for adults 70 and older, efficacy against shingles was about 91%, and efficacy against postherpetic neuralgia was roughly 89%.

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This represented a major leap over Zostavax. Not only was the initial protection substantially higher, but it held up in the oldest age groups, where shingles risk is greatest and where Zostavax had performed worst.

Does Shingrix Protection Last?

The durability question that dogged Zostavax was the obvious next concern. So far, follow-up data stretching past a decade are reassuring. An extension study of the original trial participants found that between roughly five and seven years after vaccination, Shingrix still prevented shingles with about 84% efficacy. Across the full follow-up from vaccination to about seven years, overall efficacy remained above 90%, and annual estimates plateaued above 84% through year six.

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Longer follow-up extended the picture further. An interim analysis tracking participants out to a mean of about 9.6 years after vaccination showed efficacy of roughly 82% during that later window alone. Annual estimates stayed at or above 83% through year eight, dipping to about 73% in years nine and ten.

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The most recent data extend to 11 years, with overall efficacy against shingles from vaccination onward sitting at about 88%. Protection against postherpetic neuralgia and other complications remained sustained over that full period.

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Some decline is clearly happening in the later years, and researchers are watching closely to determine whether and when a booster dose might be needed. But compared to Zostavax, which was losing meaningful protection by year two or three, the trajectory is dramatically better. Immune measurements from extension studies show that antibody levels against glycoprotein E remained roughly six times above pre-vaccination levels through year eight, and relevant T-cell responses also stayed elevated above baseline during the same window.

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What to Expect After the Shot

Shingrix earns its effectiveness, and your arm will probably remind you. The vaccine is notably more reactogenic than many routine adult vaccines. In pooled data from the two pivotal trials, about 78% of Shingrix recipients reported injection-site pain, compared with about 11% of those who received a placebo. Muscle aches, fatigue, and headache were also common, reported by roughly 45%, 45%, and 38% of vaccine recipients respectively. Most of these symptoms were mild to moderate and resolved within two to three days. The intensity did not get meaningfully worse after the second dose compared to the first.

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What matters more is that serious adverse events occurred at similar rates in the vaccine and placebo groups. Post-marketing surveillance, which captures data from millions of real-world doses, has been consistent with the clinical trial safety profile. For immunocompromised patients, who were studied separately, the pattern of side effects was similar and there were no concerning differences in serious events or flares of underlying conditions.

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The short version: expect a sore arm and possibly a day or two of feeling run-down. Plan the shot for a day when you can take it easy afterward, but don’t let the side effects scare you off. They are a sign the immune system is responding to the adjuvant, and they pass quickly.

Who Should Get Shingrix and When

The standard recommendation is two doses of Shingrix for all adults 50 and older, given two to six months apart. This applies whether or not you remember having chickenpox, because most adults in the United States carry the dormant virus regardless. It also applies if you previously received Zostavax, since Shingrix provides stronger, longer-lasting protection.

In 2021, the Advisory Committee on Immunization Practices expanded the recommendation to include adults 19 and older who are or will be immunodeficient or immunosuppressed due to disease or therapy.

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This was a significant policy shift. It brought shingles vaccination to younger adults on immunosuppressive medications for conditions like lupus, rheumatoid arthritis, or inflammatory bowel disease, as well as organ transplant recipients, people with HIV, and patients undergoing cancer treatment. For these groups, shingles risk starts earlier in life, and the consequences tend to be more severe.

Real-world uptake in this younger immunocompromised group has been tracked. Early adoption data from Denmark showed that the initial wave of Shingrix recipients outside clinical trials were predominantly female, aged 60 to 79, and tended to be more educated and higher income. Over a third of early adopters would have been ineligible for the original clinical trials, largely because they were using chronic immune-modifying treatments.

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This gap between clinical trial populations and real-world recipients is worth watching, because it means much of the evidence base comes from healthier adults, even though a substantial share of actual vaccine recipients are immunocompromised.

The Paradox of Chickenpox Vaccination and Shingles Rates

One of the more counterintuitive findings in shingles epidemiology involves the childhood chickenpox vaccine, which was introduced in the United States in 1995. You might assume that vaccinating children against chickenpox would eventually reduce shingles in the broader population, since fewer people would carry latent VZV. Over the very long run, that reasoning holds. In the medium term, modeling studies suggest the opposite can happen.

The mechanism is sometimes called the “exogenous boosting” hypothesis. When adults who carry latent VZV encounter children with active chickenpox, that exposure gives their immune system a natural reminder to keep VZV in check. As childhood chickenpox cases decline due to vaccination, adults lose that periodic immune boost and may become more susceptible to reactivation. An agent-based modeling study found that shingles incidence across all ages increased at 10 and 25 years after the introduction of chickenpox vaccination, with results sensitive to assumptions about how long exogenous boosting lasts.

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A separate modeling study explored how to balance these competing effects. It found that chickenpox vaccine coverage above 35% could actually increase shingles incidence unless shingles vaccination coverage was simultaneously high or shingles vaccine protection lasted a lifetime. A trade-off emerged where mid-level chickenpox coverage minimized the combined burden of both diseases. Only when shingles vaccine either provided lifelong immunity or reached higher uptake than current levels could large reductions in both chickenpox and shingles be achieved simultaneously.

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This does not mean the chickenpox vaccine was a mistake. Chickenpox itself caused hospitalizations and deaths, particularly in infants and immunocompromised people, and preventing it has clear benefits. But it does mean that shingles vaccination is not just an optional extra for older adults. It may be increasingly important precisely because the natural immune boosting that previous generations received from routine childhood chickenpox exposure is disappearing.

Cost and Access Around the World

Shingrix is not cheap. In the United States, the two-dose series typically costs between $300 and $400 at retail, though most private insurance plans and Medicare Part D cover it with relatively low out-of-pocket costs. In countries without broad insurance coverage for adult vaccines, the price can be a real barrier. A cost-effectiveness analysis in Japan estimated that the two-dose Shingrix regimen, priced at about ¥30,000 (roughly $273 at the time), produced an incremental cost-effectiveness ratio in the range of $48,000 to $57,000 per quality-adjusted life year gained depending on the age group targeted. The older single-dose Zostavax, priced lower, had more favorable cost-effectiveness ratios, but the comparison was somewhat academic given Zostavax’s declining protection over time.

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Availability also varies. Shingrix has been approved in over 40 countries, but in many places it is not part of publicly funded vaccination programs, meaning patients pay out of pocket or simply do not get vaccinated. In some countries, supply constraints have caused intermittent shortages since Shingrix launched, though production capacity has expanded considerably since the early post-approval period.

What Comes After Shingrix

Even with Shingrix performing well, researchers are exploring next-generation approaches. One area generating interest is mRNA-based shingles vaccines, which would use the same platform technology that became widely known through COVID-19 vaccines. Early-stage research has been testing mRNA encoding VZV glycoprotein E, packaged in lipid nanoparticles. One recent study found that replacing cholesterol in the nanoparticle formulation with a plant-derived sterol called β-sitosterol enhanced the T-cell response in preclinical models, producing stronger and more multi-functional immune activity against VZV.

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This work is still in its early stages, far from clinical trials in humans. But the appeal is clear: mRNA vaccines are faster and cheaper to manufacture at scale, and if they could match or exceed Shingrix’s efficacy while potentially requiring only a single dose, they could help solve the global access problem. For now, though, Shingrix remains the standard, and nothing on the near-term horizon is poised to displace it. If you are 50 or older and have not been vaccinated, or if you are younger and immunocompromised, the current recommendation is straightforward: get the two doses and accept the sore arm.