Shingles Vaccination Guidelines

Introduction to Shingles Vaccination

The American College of Physicians and other international guidelines recommend starting shingles vaccination at age 50 years with the recombinant zoster vaccine (Shingrix) administered as a two-dose series 2-6 months apart, due to its superior efficacy of 97.2% compared to the live-attenuated zoster vaccine (Zostavax) 1

The Advisory Committee on Immunization Practices (ACIP) previously recommended starting vaccination at age 60 years with Zostavax, but current guidelines from 2025 recommend starting at age 50 years with Shingrix, reflecting its higher efficacy and effectiveness across all age groups 50 and older 1
The Centers for Disease Control and Prevention (CDC) and other guideline societies consistently recommend vaccination starting at age 50, with a two-dose series of Shingrix, due to its high effectiveness in preventing herpes zoster (shingles) 1

The standard vaccination schedule for Shingrix is two doses administered intramuscularly, with the second dose given 2-6 months after the first dose, and a minimum interval of 4 weeks between doses 1
For immunocompromised patients, a shorter schedule with the second dose given 1-2 months after the first dose is recommended, as Shingrix is the only appropriate vaccine for this population due to the contraindication of live-attenuated Zostavax 1
Adults aged 18 years and older who are immunocompromised should receive Shingrix, regardless of age, including those with HIV, cancer, autoimmune diseases, and solid organ or stem cell transplant recipients 1

Prior shingles history does not change vaccination recommendations, as having had shingles once does not provide reliable protection against future episodes, with a 10-year cumulative recurrence risk of 10.3% 1
Adults who previously received Zostavax should receive the full two-dose Shingrix series, with a minimum interval of 2 months between Zostavax and Shingrix, due to the decline in Zostavax efficacy to 14.1% by year 10 1
The American Academy of Family Physicians and other guideline societies recommend waiting at least 2 months after acute shingles symptoms resolve before vaccinating with Shingrix 1

Most adverse events associated with Shingrix are mild to moderate in intensity and resolve within 4 days, including injection-site reactions and systemic symptoms such as myalgia, fatigue, and headache 1
Despite these side effects, Shingrix has an excellent safety profile with no increased risk of serious adverse events or death compared to placebo, according to the FDA and CDC 1