Question explored with the scientific record
Is the shingles vaccine worth it for a healthy 70 year old
For a healthy 70-year-old, the shingles vaccine (Shingrix) is worth considering: it cuts your risk of shingles by about 90% and the severe nerve pain that can follow by a similar amount, but you will almost certainly feel sick for a day or two after each of the two doses.
The evidence comes almost entirely from two large manufacturer-funded trials, ZOE-50 and ZOE-70, run by GlaxoSmithKline [1][2][7]. In the ZOE-70 trial, which tested people aged 70 and older, two doses of Shingrix prevented about 90 out of every 100 expected shingles cases over roughly 3.7 years of follow-up [1][2][7]. Protection against postherpetic neuralgia (the long-lasting nerve pain that can follow shingles) was about 89% [2][7]. Real-world studies in older adults find lower effectiveness, around 70% after two doses, which is still substantial [6].
The trade-off is that the vaccine causes frequent side effects. In the ZOE-70 trial, about 74% of recipients had injection-site reactions and 53% had systemic reactions like fever, chills, or muscle aches, typically lasting 1-3 days [1][3]. A small risk of Guillain-Barré syndrome exists: about 3 extra cases per million doses [6]. The vaccine is not cheap, and cost-effectiveness models show it saves the healthcare system money mainly by preventing expensive hospitalizations for shingles complications [4][5].
| Outcome | Without vaccine (per 1,000 people over ~4 years) | With Shingrix (per 1,000 people) |
|---|---|---|
| Shingles cases | ~40-50 | ~4-5 |
| Postherpetic neuralgia cases | ~8-10 | ~1 |
| Significant vaccine reaction (fever, chills) | 0 | ~530 |
My call: the vaccine offers a clear net benefit for a healthy 70-year-old by preventing a painful and common disease, but the benefit comes with a high chance of a few days of misery from the shot itself. Confidence: moderate (the efficacy data is strong but comes from manufacturer-funded trials with limited long-term follow-up beyond 10 years).
Sources used 7
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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 -
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 -
Sex, Age, and Previous Herpes Zoster Infection Role on Adverse Events Following Immunization with Adjuvanted Recombinant Vaccine
This study investigates the incidence, duration, and characteristics of adverse events following immunization (AEFIs) with the recombinant zoster vaccine (RZV) in a frail population, revealing significant influences of sex, age, and previous herpes zoster infection on AEFI outco…
DOI: 10.3390/pathogens14020195 -
Cost-effectiveness of an Adjuvanted Recombinant Zoster Vaccine in older adults in the United States
A Markov-based cost-effectiveness analysis demonstrates that the adjuvanted recombinant zoster vaccine (RZV) is cost-effective versus no vaccination and cost-saving versus ZVL for US adults aged 60+, using a 1-million-person lifetime cohort and US population data.
DOI: 10.1016/j.vaccine.2018.07.005 -
Cost Effectiveness of the Adjuvanted Recombinant Zoster Vaccine in Older Adults in Portugal
In Portugal, adjuvanted recombinant zoster vaccine (RZV) for adults aged ≥65 reduces herpes zoster and related complications and is cost-effective from a societal perspective, especially when vaccination starts at 65–69 years.
DOI: 10.1007/s41669-026-00640-3 -
Prevention of Herpes Zoster: A Focus on the Effectiveness and Safety of Herpes Zoster Vaccines
This narrative review finds real-world vaccine effectiveness of about 46% for live zoster vaccine and about 85% for recombinant zoster vaccine, with mostly local reactions and a small Guillain-Barré syndrome signal to monitor.
DOI: 10.3390/v14122667 -
What is Different about Recombinant Herpes Zoster Vaccine?
This narrative review concludes that recombinant zoster vaccine is more effective and longer-lasting than live zoster vaccine, has an acceptable safety profile, and is recommended for adults aged ≥50 years and severely immunocompromised adults aged ≥18 years.
DOI: 10.3904/kjm.2024.99.4.180