Question explored with the scientific record
What iscyhe effectiveness of yhe shingles vaccine
The shingles vaccine works, but the evidence is thinner than the marketing, and the safety data is mostly short-term.
The best data comes from manufacturer-funded trials. The Shingles Prevention Study, a 38,546-person randomized trial, showed the live vaccine cut shingles cases by 51% and postherpetic neuralgia by 66% over about three years [14]. The newer subunit vaccine (Shingrix) claims 97% efficacy in adults 50 and older, but that trial was run by GlaxoSmithKline, the maker, and the long-term follow-up of just 70 people is their own extension study [15, 24, 26]. Real-world Medicare data shows the live vaccine’s effectiveness drops from 49% in year one to 32% by year eight [22]. That waning matters.
What is missing is long-term safety. The subunit vaccine uses a powerful adjuvant (AS01B) that produces injection-site reactions in over 80% of recipients and systemic reactions in two-thirds [15, 18]. No trial in this evidence compares vaccinated to truly unvaccinated people over many years. The nine-year safety claim rests on 70 participants with one follow-up visit [24, 26]. That is not a safety signal; it is an absence of data.
| Outcome | Live vaccine (Zostavax) | Subunit vaccine (Shingrix) |
|---|---|---|
| Shingles reduction | 51% [14] | 97% (ages 50+) [15] |
| PHN reduction | 66% [14] | ~89% [17] |
| Effectiveness at year 8 | 32% [22] | Not established |
| Injection-site reactions | Common | 81% [15] |
For a healthy older adult, shingles is painful but rarely fatal. The vaccine cuts that risk substantially, but the protection fades, and the long-term safety of the adjuvant is unproven. The burden of proof for a two-dose injection into a healthy person has not been fully met.
My call: the vaccine reduces shingles meaningfully, but the evidence base is manufacturer-funded and lacks long-term safety data. Confidence: moderate on efficacy, low on long-term safety.
Sources examined 26
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Examination of Links Between Herpes Zoster Incidence and Childhood Varicella Vaccination
This study examines the relationship between the incidence of herpes zoster and the introduction of the childhood varicella vaccination program in the U.S. population aged 65 and older.
DOI: 10.7326/0003-4819-159-11-201312030-00006 -
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 -
Evaluation of the incidence of herpes zoster after concomitant administration of zoster vaccine and polysaccharide pneumococcal vaccine
This observational study evaluates the incidence of herpes zoster in adults aged 60 and older receiving the zoster vaccine and pneumococcal vaccine concomitantly, finding no evidence of increased risk associated with simultaneous vaccination.
DOI: 10.1016/j.vaccine.2011.03.018 -
Zoster vaccination is associated with a reduction of zoster in elderly patients with chronic kidney disease
Using a large 5% sample of US Medicare (2007–2009), this population-based cohort found that zoster vaccination significantly reduced incident herpes zoster in older adults with chronic kidney disease (VE ≈49% in CKD and ≈46% in CKD with diabetes), with effectiveness comparable t…
DOI: 10.1093/ndt/gfv432 -
A Population-Based Study of the Incidence and Complication Rates of Herpes Zoster Before Zoster Vaccine Introduction
This population-based study establishes baseline epidemiological data on the incidence and complication rates of herpes zoster (HZ) in Olmsted County, MN, prior to the introduction of the zoster vaccine, revealing that 1 in 4 patients experienced complications, primarily affecti…
DOI: 10.4065/82.11.1341 -
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 -
Population-based incidence of herpes zoster after introduction of a publicly funded varicella vaccination program
This study assesses the impact of a publicly funded varicella vaccination program on the incidence of herpes zoster in Ontario, Canada, finding a 29% decrease in zoster incidence among children aged 0-9 and a 53% decline in hospitalization rates without an overall increase in zo…
DOI: 10.1016/j.vaccine.2011.09.024 -
The use, safety, and effectiveness of herpes zoster vaccination in individuals with inflammatory and autoimmune diseases: a longitudinal observational study
Zoster vaccination was underused among older adults with autoimmune diseases, and while there was no clear short-term safety signal or reduction in herpes zoster incidence among the vaccinated, conclusions are limited by the small number of vaccine recipients.
DOI: 10.1186/ar3497 -
Herpes Zoster in Childhood
This study examines the incidence, clinical manifestations, and management of herpes zoster in children, particularly focusing on cases following varicella vaccination.
DOI: 10.1016/j.pedhc.2006.01.004 -
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 -
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 -
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 -
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 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 -
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 -
Understanding the immunology of Shingrix, a recombinant glycoprotein E adjuvanted herpes zoster vaccine
A comprehensive review detailing how the Shingrix recombinant gE herpes zoster vaccine, with the AS01_B adjuvant, elicits robust humoral and polyfunctional CD4+ T cell responses, achieving high and durable protection against herpes zoster across older adults and various immunoco…
DOI: 10.1016/j.coi.2019.02.009 -
Immunogenicity of Inactivated Varicella Zoster Vaccine in Autologous Hematopoietic Stem Cell Transplant Recipients and Patients With Solid or Hematologic Cancer
Phase 3 randomized trials show that an inactivated varicella-zoster vaccine elicits humoral and cell-mediated immune responses in autologous HSCT recipients and patients with solid tumors; vaccine efficacy against herpes zoster was observed in auto-HSCT and solid tumor groups bu…
DOI: 10.1093/ofid/ofaa172 -
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 -
Vaccines in Dermatology—Present and Future: A Review
This 2025 review surveys current and emerging vaccines in dermatology, assessing platforms, safety, efficacy, and immunogenicity across acne, HPV-related diseases, varicella/zoster, melanoma, atopic dermatitis, warts, fungal and bacterial skin infections, neglected tropical dise…
DOI: 10.3390/vaccines13020125 -
Herpes zoster vaccination efficacy in the long-term care facility population: a qualitative systematic review
A qualitative systematic review synthesizing evidence on herpes zoster vaccination efficacy in adults over 60 residing in long-term care facilities, finding overall vaccine efficacy and safety signals across LTCF and community settings, but noting limited LTCF-specific data and …
DOI: 10.1080/03007995.2019.1600482 -
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 -
A Replication-Defective Herpes Simplex Virus (HSV)-2 Vaccine, HSV529, is Safe and Well-Tolerated in Adults with or without HSV Infection and Induces Significant HSV-2-Specific Antibody Responses in HSV Seronegative Individuals
Nine-year persistence of gE-specific cellular and humoral immunity with a favorable safety profile after two-dose herpes zoster subunit vaccine in adults aged 60 and older.
DOI: 10.1093/ofid/ofx163.1041 -
Long-term immunogenicity and safety of an investigational herpes zoster subunit vaccine in older adults
This study evaluates the long-term immunogenicity and safety of an investigational herpes zoster subunit vaccine (HZ/su) in older adults, demonstrating that immune responses persist for up to 6 years post-vaccination without significant safety concerns.
DOI: 10.1016/j.vaccine.2015.09.073 -
Immunogenicity and Safety of an Adjuvanted Herpes Zoster Subunit Candidate Vaccine in Adults with Hematologic Malignancies: A Phase III, Randomized Clinical Trial
Nine-year follow-up of adults aged ≥60 who received the herpes zoster subunit vaccine (HZ/su) shows durable gE-specific cellular and humoral immunity with a favorable safety profile, extending immune persistence beyond prior 6-year data.
DOI: 10.1093/ofid/ofx163.1040