Question explored with the scientific record
Should I get the shingles vaccine?
The short version: the adjuvanted subunit vaccine, Shingrix, prevents shingles and post-herpetic neuralgia better than the old live vaccine, but the evidence stops at three to four years for hard outcomes, and the safety profile for a healthy 60+ adult is not trivial.
The trials you are being shown were funded by the manufacturers. The ZOE-50 and ZOE-70 trials that reported 97.2% and 89.8% efficacy against shingles came from GlaxoSmithKline [7, 9]. A 2025 real-world Italian study, which had no control group and relied on self-reported outcomes, reported 26 cases of shingles among 787 vaccinated high-risk patients over roughly two years, and noted that about 44% of participants reported an adverse event after each dose [18]. Local reactions like soreness and swelling were the most common (39% of doses), but systemic reactions like fever, fatigue, and muscle aches hit 15% of doses, and neurological symptoms occurred in 4% [18]. Also note that the old live vaccine (Zostavax) loses nearly all effectiveness by year eight (dropping from 68.7% to 4.2%), while the newer Shingrix had efficacy tracked only out to about 3.7 years in the pivotal trials [15].
Here is how the key numbers compare, all from manufacturer-funded studies:
| Endpoint | Shingrix (subunit) | Zostavax (live) | Source |
|---|---|---|---|
| Shingles prevention, 50+ | 97.2% (95% CI 93.7–99.0%) | ~69.8% at age 50–59 | [7, 9] |
| Shingles prevention, 70+ | ~89.8% | 37.6% | [7, 9] |
| PHN risk reduction 70+ | ~88.8% | Not reported for that age | [15] |
| Duration tracked | ~3.7 years | ~8 years (wanes to ~4.2%) | [15] |
| Grade 3 systemic AEs (any) | ~17% in trials | Lower (live virus) | [9] |
The evidence does not tell you what happens beyond four years with the subunit vaccine, because the longest published follow-up cuts off there. The safety data from real-world use shows a high rate of temporary but significant reactions. A healthy 70-year-old faces about a 1 in 10 chance of shingles over their remaining lifetime [1], and about a 1 in 50 to 1 in 30 chance of PHN [8].
My call: the vaccine prevents a painful but rarely fatal illness, at the cost of frequent moderate reactions and no long-term safety data beyond four years. For someone who has already had shingles or is immunocompromised, the benefit is clearer; for a healthy adult, the trade-off is a genuine judgment call the evidence does not resolve.
Sources examined 18
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P1-337 Social inequality in mortality: causality or selection?
A retrospective cohort study of 227,277 immunocompetent adults aged 60+ within Kaiser Permanente Southern California estimates long-term cumulative risks of herpes zoster by age, sex, and race, finding higher-than-previously-expected risk and implications for vaccination in an a…
DOI: 10.1136/jech.2011.142976f.29 -
Shingles vaccine after auto-HSCT decreases risk
The study demonstrates that a four-dose peri-transplant course of an investigational inactivated varicella zoster virus vaccine significantly reduces the incidence of herpes zoster in patients undergoing autologous hematopoietic stem cell transplantation.
DOI: 10.1016/S0140-6736(18)30909-7 -
Vaccination against Herpes Zoster and Postherpetic Neuralgia
A large randomized, double-blind, placebo-controlled trial in adults aged 60 and older showing that a live attenuated varicella-zoster vaccine reduces the burden of herpes zoster–related illness and postherpetic neuralgia, with substantial reductions in PHN incidence and overall…
DOI: 10.1086/522159 -
Herpes Zoster Vaccine in the Long-Term Care Setting: A Clinical and Logistical Conundrum
This study evaluates the evidence and logistical barriers surrounding the use of the herpes zoster vaccine in long-term care facilities, highlighting the need for further research and consideration of patient characteristics in vaccination decisions.
DOI: 10.4140/TCP.n.2016.33 -
Herpes zoster and vaccination: A clinical review
This clinical review evaluates the effectiveness of the herpes zoster vaccine in preventing herpes zoster and its complications, highlighting its cost-effectiveness particularly in individuals aged 70 and older, while also addressing issues related to insurance coverage.
DOI: 10.2146/ajhp090118 -
Can India Let Go The Opportunity To Minimize Million Shingles Cases Annually? As India Launches Shingrix Zoster Vaccine in April 2023
Herpes zoster imposes a substantial burden on adults over 50 in India with varied clinical presentations and PHN risk, and the 2023 Shingrix Zoster Vaccine launch is framed as a potential public-health intervention.
DOI: 10.23880/mjccs-16000342 -
Herpes zoster subunit vaccine for the prevention of herpes zoster
This study reviews the efficacy and safety of the herpes zoster subunit vaccine (HZ/su vaccine) in preventing herpes zoster and postherpetic neuralgia in adults aged 50 and older, highlighting its superior efficacy compared to the live attenuated vaccine.
DOI: 10.2146/ajhp170399 -
Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology
This is a narrative review summarizing the epidemiology, pathophysiology, prevention, and pharmacologic management of postherpetic neuralgia, with discussion of first-line therapies (gabapentinoids, TCAs, lidocaine patches), second/third-line options (opioids, capsaicin), safety…
DOI: 10.2147/JMDH.S106340 -
Efficacy of varicella (VZV) vaccination: an update for the clinician
Varicella vaccines dramatically reduce varicella incidence and severe disease, with newer zoster vaccines offering strong, age-independent protection while research into ORF7 and neuroattenuated strategies points toward next-generation vaccines.
DOI: 10.1177/2051013616655980 -
The Epidemiological, Clinical, and Pathological Rationale for the Herpes Zoster Vaccine
This study provides a comprehensive overview of the epidemiology, clinical implications, and the rationale for the herpes zoster vaccine, emphasizing the increasing incidence of herpes zoster (HZ) and postherpetic neuralgia (PHN) in older adults and the need for effective preven…
DOI: 10.1086/522152 -
Herpes zoster after COVID-19 vaccination, aspect of pain medicine: a retrospective, single-center study
This retrospective study evaluates the incidence and clinical features of herpes zoster (HZ) following COVID-19 vaccination, finding that HZ related to vaccination presents similar characteristics to other HZ cases, with no significant differences in pain severity or treatment o…
DOI: 10.17085/apm.22207 -
Herpes Zoster (Shingles) and Postherpetic Neuralgia
This review discusses the clinical manifestations, diagnosis, treatment options, and prevention strategies for Herpes Zoster (Shingles) and its complication, Postherpetic Neuralgia (PHN), emphasizing the importance of early recognition and vaccination.
DOI: 10.4065/84.3.274 -
Herpes zoster vaccine effectiveness and manifestations of herpes zoster and associated pain by vaccination status
This study evaluates the effectiveness of the herpes zoster vaccine in preventing herpes zoster and its associated pain, finding a significant reduction in incidence and symptoms among vaccinated individuals aged 60 and older.
DOI: 10.1080/21645515.2015.1016681 -
S2k guidelines for the diagnosis and treatment of herpes zoster and postherpetic neuralgia
Formal consensus S2k guidelines detailing the diagnosis, antiviral treatment, vaccination, and pain-management strategies for herpes zoster and postherpetic neuralgia, integrating multidisciplinary input from dermatology, ophthalmology, ENT, neurology, virology, and infectious d…
DOI: 10.1111/ddg.14013 -
Preventing Shingles and Its Complications in Older Persons
This study discusses the efficacy of a new adjuvanted herpes zoster subunit vaccine (HZ/su) in preventing shingles and its complications in older adults, highlighting its superior efficacy compared to the previously used live attenuated vaccine (Zostavax).
DOI: 10.1056/nejme1610652 -
Meningitis Caused by the Live Varicella Vaccine Virus: Metagenomic Next Generation Sequencing, Immunology Exome Sequencing and Cytokine Multiplex Profiling
This study reports two new cases of varicella vaccine meningitis in immunocompetent children, utilizing metagenomic next-generation sequencing, immunology exome sequencing, and cytokine multiplex profiling to investigate the underlying mechanisms and potential risk factors assoc…
DOI: 10.3390/v13112286 -
Immunogenicity and Safety of a Candidate Subunit Adjuvanted Herpes Zoster Vaccine in Adults with Solid Tumors Vaccinated Before or During Immunosuppressive Chemotherapy Treatment: A Phase II/III, Randomized Clinical Trial
GlaxoSmithKline's adjuvanted recombinant herpes zoster vaccine (HZ/su) elicited strong humoral and CD4+ T-cell–mediated immune responses with an acceptable safety profile in renal transplant recipients on chronic immunosuppression and in adults with solid tumors undergoing chemo…
DOI: 10.1093/ofid/ofx163.1045 -
Safety profile and medium- to long-term protection of the Recombinant Zoster Vaccine (RZV) in a cohort of high-risk patients: real-world data from a General Hospital in Southern Italy, 2021–2025
A prospective real-world study in a Southern Italian hospital evaluated the safety, disease-flare potential, and medium-to-long-term protection against herpes zoster after Recombinant Zoster Vaccine (RZV) in a medically diverse, vulnerable adult population, finding acceptable sa…
DOI: 10.1080/14760584.2025.2589216