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- 1 Shingles vaccine for pensioners
- 2 How does Shingrix compare with the older shingles vaccine in effectiveness and safety?
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How does Shingrix compare with the older shingles vaccine in effectiveness and safety?
The short version: Shingrix beats the old live vaccine on protection, and the old one carries a live-virus risk the new one cannot.
The old vaccine (Zostavax) was a single dose of weakened live virus. In the big trial it cut shingles by about 51% and lingering nerve pain by about 67% in people 60 and over [4][3]. Protection was weaker in the oldest: 64% in the 60s versus 38% over 70 [3]. It also faded fast, falling to about 27% against eye shingles by year five [5], and in older patients with autoimmune disease it was no longer significant by years six and seven [6].
Shingrix is two doses of a protein plus an adjuvant, no live virus. It cut shingles by 97% at 50-plus and 90% at 70-plus, with 91% against nerve pain [2], and held 84% at year 8 [4]. Real-world Medicare data put it lower, about 70% after two doses [4].
| Zostavax (live) | Shingrix (recombinant) | |
|---|---|---|
| Shingles cut, 60+ | 51% | 90% (70+) |
| Nerve pain cut | 67% | 91% |
| Protection at ~5-8 yrs | ~27% (eye shingles, yr 5) | 84% (yr 8) |
| Serious VAERS reports | 27.6% of reports | 2.9% of reports |
On safety, the live vaccine can, rarely, cause vaccine-strain infection, which is why its VAERS reports are so much more often serious [7]. Shingrix mostly means a sore arm and a day of flu-like symptoms [1]. Both carry a small Guillain-Barré signal that passive reporting cannot turn into a true rate [4][7].
My call: Shingrix is the better vaccine on both counts, and the old one has little reason to be chosen now. Confidence: moderate.
Sources used 7
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Healthy ageing: Herpes zoster infection and the role of zoster vaccination
This narrative review concludes that adjuvanted recombinant zoster vaccine prevents herpes zoster and postherpetic neuralgia, has a reassuring safety profile, and is a key action for healthy ageing.
DOI: 10.1038/s41541-023-00757-0 -
Zoster Vaccine Recombinant, Adjuvanted
In a narrative review of clinical trial data, adjuvanted recombinant zoster vaccine (Shingrix) showed high efficacy against herpes zoster and postherpetic neuralgia in adults 50 years and older, with mainly transient local and systemic reactions.
DOI: 10.1177/0018578718767103 -
Shingles vaccine: prevention made possible
A sponsored symposium report discusses herpes zoster and postherpetic neuralgia burden and summarizes the Shingles Prevention Study, which showed the live attenuated Oka/Merck vaccine reduced HZ incidence, burden of illness, and PHN incidence in adults aged 60 or older.
DOI: 10.1002/fps.40 -
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 -
Effectiveness of Live Zoster Vaccine in Preventing Herpes Zoster Ophthalmicus (HZO)
A US Markov model estimated HZ/su would avoid more HZ and PHN cases than ZVL; a KPNC cohort found zoster vaccine VE against HZO similar to HZ with waning; an immunogenicity study characterized VZV-specific T-cell responses after vaccination.
DOI: 10.1093/ofid/ofx163.1035 -
Longterm Effectiveness of Herpes Zoster Vaccine among Patients with Autoimmune and Inflammatory Diseases
Among older Medicare patients with autoimmune/inflammatory diseases, live herpes zoster vaccination was associated with significantly lower HZ risk through about 5 years, but protection waned and was not significant in years 6-7.
DOI: 10.3899/jrheum.160685 -
Safety profile of herpes zoster vaccines in the United States: a descriptive and disproportionality analysis of adverse events reported to the vaccine adverse event reporting system (VAERS), 2017–2024
In 69,822 US VAERS reports (2017-2024), herpes zoster vaccine adverse-event reporting was dominated by transient reactogenicity and injection-site reactions, with serious reports uncommon overall (6.6%) and for Shingrix (2.9%) but more frequent for Zostavax (27.6%), largely driv…
DOI: 10.3389/fmed.2026.1920596