Shingles Vaccine: Who Should Get It and When

Shingles isn’t just a rash. For many, it’s months of burning pain that won’t go away-even after the blisters heal. That lingering pain is called postherpetic neuralgia, and it affects nearly 1 in 5 people who get shingles. The good news? There’s a vaccine that works better than anything we’ve had before. It’s called Shingrix, and it’s the only shingles vaccine available in the U.S. right now. But who needs it? And when should you get it? The answers aren’t as simple as ‘over 60’ anymore.

Who Needs the Shingles Vaccine?

You don’t have to be old to get shingles. The virus that causes it-varicella zoster-is the same one that gives you chickenpox. After you recover, it hides in your nerves. Years later, maybe when you’re stressed, sick, or just aging, it wakes up. That’s shingles.

The CDC recommends Shingrix for everyone 50 and older, no matter if you’ve had shingles before or not. Even if you got the old vaccine (Zostavax), you still need Shingrix. Zostavax was pulled from the market in 2020 because it wasn’t strong enough. Shingrix cuts your risk of shingles by over 90% if you’re 50 to 69. For those 70 and up, it still works at 91% effectiveness.

Here’s the key change: You don’t have to wait until you’re 60 or 65. Starting at age 50 is now the standard. The American Geriatrics Society says doctors should bring it up with patients as soon as they hit 50. Why? Because your risk goes up every year after 50. By 85, one in four people will get shingles.

And if you’re immunocompromised? That’s even more important. People with diabetes, cancer, HIV, or those on steroids or biologics are at higher risk for severe shingles. Shingrix is safe for them-unlike the old vaccine, which used a live virus and could be dangerous. The CDC now says adults 19 and older with weakened immune systems should get Shingrix too.

When Should You Get It?

Shingrix isn’t a one-shot deal. It’s two doses. The second shot should be given 2 to 6 months after the first. That’s the sweet spot. If you wait longer than 6 months, you don’t need to start over. Just get the second dose as soon as you can.

But there’s a twist for certain people. If you’re about to start chemotherapy, an organ transplant, or another treatment that weakens your immune system, you can get the second dose as early as 1 month after the first. That’s a big deal. It means you can still protect yourself even if you’re heading into a high-risk period.

Don’t wait until you’re in the middle of a flare-up. If you’ve had shingles recently, wait at least until the rash is completely gone. Most doctors suggest waiting at least a year before getting vaccinated, just to be safe. But if you’re immunocompromised, talk to your doctor-some may recommend it sooner.

One of the biggest problems? People don’t come back for the second shot. Studies show about 1 in 3 people skip it. That cuts the protection in half. If you get the first dose, make a note. Set a reminder. Ask your pharmacist to call you. Kaiser Permanente used automated texts and got 89% of people to return for the second shot. You can do the same.

What Are the Side Effects?

Let’s be honest: Shingrix hurts-more than most vaccines. About 78% of people feel pain at the injection site. Nearly half get muscle aches. One in three feels tired. One in three gets a headache. Some even get a fever or nausea for a day or two.

It’s not dangerous. It’s just intense. And it’s temporary. Most side effects fade in 2 to 3 days. But here’s the catch: If you’ve got a big event coming up-a wedding, a trip, a job interview-don’t schedule your shot within 48 hours. A lot of people regret it when they’re stuck in bed after the second dose.

And here’s something surprising: People with weakened immune systems often report milder side effects than those with healthy immune systems. Why? Because Shingrix works by turning up your body’s alarm system. If your alarm is already quiet, the vaccine doesn’t trigger as big a response.

The rarest risk? A severe allergic reaction. That’s why you’re asked to wait 15 minutes after the shot. If you’ve ever had a serious reaction to any vaccine ingredient-like polysorbate 80 or any component of Shingrix-you shouldn’t get it. Talk to your doctor first.

How Much Does It Cost?

Shingrix isn’t cheap. Each dose costs around $185 to $220 out-of-pocket in 2024. But most people pay nothing. Medicare Part D covers it fully. Private insurance usually does too. If you’re on Medicaid or have no insurance, many public health clinics offer it for free or at low cost.

Here’s what most people don’t realize: Shingrix is covered under Part D, not Part B. That means you can get it at your pharmacy, not just your doctor’s office. Pharmacists are trained to give it. You don’t need a prescription if your plan covers it. Just walk in.

If you’re being charged more than $50 per dose, ask if your plan has a preferred pharmacy. Some plans have lower copays at certain chains. And if you’re struggling to pay, GlaxoSmithKline offers a patient assistance program. You can apply online.

Why Shingrix Over Anything Else?

There used to be another vaccine: Zostavax. It was a live virus shot. It only worked about half as well. It didn’t protect older adults well. And it was dangerous for people with weak immune systems. It’s gone now.

Shingrix is a different kind of vaccine. It doesn’t use the live virus. Instead, it uses a piece of the virus-glycoprotein E-plus a special booster called AS01B. That’s why it’s so effective. It doesn’t trick your body into thinking it’s infected. It shows your immune system exactly what to fight, and then gives it a powerful nudge to remember.

Studies show it protects against shingles for at least 7 years. Some experts think it could last longer. We don’t know yet. But we do know that even after 7 years, people who got Shingrix are still far less likely to get shingles than those who never got vaccinated.

And it doesn’t just prevent the rash. It cuts the risk of postherpetic neuralgia by over 90%. That’s the real win. Because shingles pain can last years. Some people can’t sleep. Some can’t wear clothes. Some can’t work. Shingrix stops that before it starts.

What’s Next for the Shingles Vaccine?

Science doesn’t stop. GlaxoSmithKline is testing a single-dose version of Shingrix in Phase II trials. If it works, it could change everything. No second shot. No missed appointments. Just one visit. That could push vaccination rates way up.

Merck is also working on a new shingles vaccine, but it’s still years away. For now, Shingrix is the only game in town.

Meanwhile, public health groups are pushing to vaccinate people earlier. The idea isn’t just to protect seniors-it’s to stop shingles before it has a chance to become a problem. If you’re 50 or older, this isn’t a ‘maybe.’ It’s a ‘when.’

What If You’re Still Unsure?

Some people hold off because they think, ‘I never got chickenpox.’ But if you were born before 1980, you almost certainly had it-even if you didn’t know it. Most adults over 50 have the virus in their nerves.

Others worry about side effects. But the fear of a few days of fatigue is nothing compared to the risk of chronic pain that lasts for years. Over 1 million cases of shingles happen in the U.S. every year. Almost all of them are preventable.

If you’re still unsure, talk to your doctor. Or your pharmacist. They’ve seen the data. They’ve seen the patients. They know how much worse shingles gets with age.

Shingrix isn’t perfect. It’s not painless. It’s not free. But it’s the best tool we have to stop a disease that can ruin your life. And if you’re 50 or older, it’s not a luxury. It’s a shield.