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 condition called postherpetic neuralgia that can last years. If you’re over 50, or even younger and immunocompromised, the recombinant zoster vaccine-better known as Shingrix-isn’t just a good idea. It’s the best protection you’ve got.

Why Shingrix Is the Only Shingles Vaccine You Need

Back in 2017, everything changed. The old shingles vaccine, Zostavax, was pulled off the U.S. market because it simply didn’t work well enough. It cut shingles risk by about half-okay, but not great. Shingrix, the new recombinant zoster vaccine, changed the game. It’s not a live virus. It doesn’t contain any part of the actual virus. Instead, it uses a single protein from the virus (glycoprotein E) plus a powerful immune booster called AS01B. The result? Over 90% effectiveness at preventing shingles, no matter your age.

That’s not a typo. For people aged 50 to 59, Shingrix is 97.2% effective. For those 70 and older, it’s still 91.3%. And for the worst part of shingles-long-term nerve pain-it’s 91% effective in younger adults and 89% in older ones. Zostavax? It only managed 67% against that pain. Shingrix doesn’t just prevent shingles. It prevents the pain that lingers after.

And here’s the kicker: Zostavax is gone. Since November 2020, it’s no longer available in the U.S. If you got it years ago, you still need Shingrix. The CDC says so. Doctors say so. There’s no exception.

Who Exactly Should Get Shingrix?

The CDC’s recommendation is simple: Everyone 50 and older. No exceptions. No “if you’re healthy” or “if you had shingles before.” Even if you’ve had shingles, even if you’re 85, even if you think you’re too old for it-get Shingrix. The virus that causes shingles (varicella-zoster) never leaves your body. It just hides. And it can wake up again.

But it doesn’t stop at 50. If you’re 19 or older and your immune system is weakened-whether by cancer treatment, HIV, organ transplant, or even long-term steroids-you’re at higher risk. And you need Shingrix even more. The CDC updated its guidelines in 2018 to include this group. For them, the second dose can be given as early as one month after the first, instead of waiting six months. Speed matters when your body can’t fight back.

There are only two reasons not to get it: you’ve had a severe allergic reaction to Shingrix before, or you’re allergic to any ingredient in it. If you’re sick with a fever right now, wait until you’re better. But if you’re on antibiotics, have a cold, or take blood pressure meds? Go ahead. Those don’t matter.

What to Expect When You Get the Shot

Shingrix isn’t gentle. It’s not supposed to be. About 80% of people get pain, redness, or swelling at the injection site. Nearly half feel muscle aches. Forty percent get tired. One in three gets a headache. One in five feels feverish. One in four shivers.

It’s not the vaccine being dangerous. It’s the vaccine working. That AS01B adjuvant is turning your immune system on full blast. That’s why it’s so effective. Most people feel like they’ve been hit by a truck for two or three days. Some can’t work. Some can’t cook dinner. But then it’s over.

Compare that to shingles. One out of every three people over 60 gets shingles. One in five gets long-term nerve pain. That pain can last years. It can make you cry, can’t sleep, can’t wear clothes. The temporary discomfort of the shot? That’s nothing compared to living with that.

How the Vaccine Is Given

Shingrix isn’t a one-and-done. You need two shots. The first one starts the process. The second one makes it stick. The standard gap is 2 to 6 months. That’s the sweet spot for maximum protection.

But if you’re immunocompromised, you don’t have to wait. You can get the second shot as soon as one month after the first. Your doctor will adjust it based on your health. Each shot is 0.5 mL, injected into your upper arm muscle. The needle size depends on your weight-shorter needle if you’re under 130 pounds, longer if you’re heavier. Your nurse will know.

And here’s something many people don’t realize: if you got Zostavax before, you still need two doses of Shingrix. The CDC says so. Even if you got Zostavax last year. Even if you thought you were covered. Shingrix is better. Much better. Get it within five years of your last Zostavax shot, if you can.

Cost and Insurance Coverage

Shingrix costs about $175 for both doses. That’s not cheap. But if you’re on Medicare Part D, you pay nothing. Most private insurance plans cover it too. You might pay a copay, but it’s rare to pay full price.

Pharmacies like CVS, Walgreens, and Rite Aid can give you the shot. So can your doctor’s office. Some clinics even offer walk-in appointments. If you’re unsure if your plan covers it, call your insurer. Ask: “Does my plan cover Shingrix under the preventive services benefit?” If they say no, ask them to check again. It’s required by law for most plans to cover it fully.

And if you’re uninsured? The Vaccines for Children program doesn’t cover adults, but some state health departments or community clinics offer free or low-cost vaccines. Ask your local health department. Don’t let cost stop you.

What About Long-Term Protection?

Right now, we know Shingrix works for at least seven years. Studies are still tracking people who got it in 2017. Early data suggests protection could last 15 to 20 years. That’s longer than most vaccines. No booster is recommended yet. No one is saying you’ll need a third shot.

That’s different from the flu shot. This isn’t something you get every year. This is a one-time, two-dose shield. Once you’re done, you’re protected for a long time.

Why So Many People Still Skip It

Despite all this, only about 35% of adults over 60 have gotten both doses. That’s way below the Healthy People 2030 goal of 70%. Why?

One reason: side effects. People hear “pain,” “fatigue,” “fever,” and they think, “I’ll pass.” They don’t realize how much worse shingles is.

Another reason: confusion. Some think if they had chickenpox as a kid, they’re already protected. Nope. Chickenpox and shingles are the same virus. Having chickenpox means you’re at risk for shingles later.

And some just forget the second shot. That’s the biggest problem. You get the first one, feel fine, and never go back. But without the second dose, your protection drops to around 70%-not 90%. You’re leaving yourself vulnerable.

Set a reminder. Put it on your phone. Tell a family member. Make it a habit. Two shots. Six months apart. That’s it.

Final Thought: It’s Not About Age. It’s About Risk.

You don’t have to be old to get shingles. You just have to have had chickenpox. And almost everyone has. The virus lives in your nerves. It’s waiting. The older you get, the more likely it is to wake up. But so do other things-cancer, diabetes, autoimmune disease, even stress. All of those can trigger it.

Shingrix is the most effective tool we have. It’s safe. It’s covered. It’s the only option left. And if you’re over 50-or under 50 and immunocompromised-there’s no reason not to get it. The pain of the shot? Temporary. The pain of shingles? Not worth the risk.