Shingles Vaccine: 2 Key Options, Shingrix Vs Zostavax

Shingles, also known as herpes zoster, is a painful rash caused by reactivation of the varicella-zoster virus, the same virus responsible for chickenpox. After chickenpox, the virus lies dormant in nerve tissues and can reactivate later in life, particularly in older adults or those with weakened immune systems. The

shingles vaccines

, primarily

Shingrix

(the current preferred option) and the now-discontinued

Zostavax

, are designed to prevent this reactivation and reduce the risk of complications like postherpetic neuralgia (PHN), a chronic nerve pain that can persist for months or years. Shingrix is a recombinant vaccine with over 90% efficacy, approved for adults 50+ and immunocompromised individuals 18+, while Zostavax was a live vaccine used previously but phased out due to lower efficacy and limitations.

About shingles vaccines

Shingles vaccines work by boosting the immune system’s ability to recognize and fight the varicella-zoster virus, preventing or lessening the severity of outbreaks.

Zostavax

, approved in 2006, is a live attenuated vaccine containing a weakened form of the virus, effective at about 51-70% in preventing shingles but unsuitable for immunocompromised people as it could cause infection.

Shingrix

, approved later, is a non-live recombinant vaccine using a virus protein (glycoprotein E) combined with an adjuvant to elicit a strong immune response. It demonstrates 97% efficacy in ages 50-69 and remains effective over 90% even in those 70+, with longer-lasting protection compared to Zostavax, whose efficacy wanes after 5 years. In the UK, Shingrix replaced Zostavax on the NHS schedule from September 2021, offered to those aged 65-80 and at-risk groups under 65. Both vaccines prevent shingles and indirectly reduce PHN risk, but neither treats active shingles or chickenpox.

Types of medicine

Two main shingles vaccines have been available:

• Zostavax: Live attenuated vaccine, single subcutaneous dose, 70% effective in 50-69 year-olds but dropping to 18-41% in 80+. Discontinued in the US in 2020 and UK in 2021.
• Shingrix: Recombinant zoster vaccine (RZV), two intramuscular doses 2-6 months apart, 97% effective in 50-69 year-olds and 91% in 70+, suitable for immunocompromised adults 18+. Preferred by CDC and NHS.

Vaccine	Type	Doses	Efficacy (50-69 yrs)	Efficacy (70+ yrs)
Zostavax	Live attenuated	1	70%	41% waning
Shingrix	Recombinant	2	97%	91%

Who can have the shingles vaccine?

In the UK,

Shingrix

is recommended by the NHS and JCVI for:

• Adults turning 65 (routine single dose).
• Those aged 66-79 if not previously vaccinated (catch-up until March 2024, extended).
• Adults 50+ in at-risk groups (e.g., respiratory, heart, kidney disease; diabetes; immunosuppression).
• Immunocompromised adults 18+ at clinician discretion.

Pregnant women should avoid vaccination; breastfeeding is generally safe for Shingrix. Zostavax was contraindicated in pregnancy, immunosuppression, and severe allergy. Consult GP for eligibility; private options exist if not NHS-eligible.

Who should not have the shingles vaccine?

• Acute illness (postpone).
• Known allergy to vaccine components (e.g., neomycin in Zostavax).
• For Zostavax: Immunocompromised states (HIV, chemotherapy, steroids).
• Shingrix: History of severe allergic reaction to prior dose; caution in Guillain-Barré syndrome (GBS) history (rare risk noted in FDA labeling).

How is the shingles vaccine given?

**Shingrix**: Two doses (0.5 mL each) injected into the upper arm muscle, 2-6 months apart. If delayed, resume without restarting. Zostavax was one subcutaneous dose under the skin. Administered by GP or clinic; arm soreness common post-Shingrix.

When is the shingles vaccine given?

NHS timing:

• 65th birthday invitation.
• Catch-up for 66-79.
• At-risk from 50+.

Post-Zostavax: Wait 60 days min, ideally 5+ years for optimal response. Year-round availability, no seasonal restriction.

Non-NHS shingles vaccination

Private clinics offer Shingrix (~£200-300 total for two doses) for non-eligible adults 50+, those post-80, or revaccination seekers. Check CQC registration; not cheaper abroad due to specialist handling.

Side effects of the shingles vaccine

Shingrix causes more side effects than Zostavax due to stronger response, but mild and resolve in 2-3 days:

• Common (>1/10): Injection site pain/redness/swelling, muscle pain, fatigue, headache, shivering, fever, nausea.
• Less common: Itching, flu-like symptoms.
• Rare: GBS (1 extra case per 100,000 doses), benefits outweigh risks.

Zostavax: Milder, mainly local reactions. Paracetamol safe; seek help for severe symptoms.

Interactions of the shingles vaccine

• Can co-administer with flu/pneumococcal vaccines (different sites).
• Avoid antivirals (e.g., aciclovir) 24h before/after (less relevant for Shingrix).
• Immunosuppressants: Defer if possible; Shingrix usable in mild cases.

Alternatives to the shingles vaccine

No direct alternatives; antivirals (aciclovir, valaciclovir) treat active shingles but don’t prevent. Hygiene/stress management reduce risk but less effective than vaccination.

Frequently Asked Questions (FAQs)

Q: Is Shingrix better than Zostavax?

Yes, Shingrix is 97% effective vs. Zostavax’s 70% in 50-69 year-olds, with better protection in older adults and immunocompromised; recommended even after Zostavax.

Q: How long does Shingrix protection last?

At least 7-10 years with sustained high efficacy (>80-90%); longer than Zostavax’s ~5 years.

Q: Can I get Shingrix if I had Zostavax?

Yes, CDC recommends Shingrix 2+ months after, ideally 5+ years for best response.

Q: Does the vaccine prevent PHN?

Indirectly yes, by preventing shingles; Shingrix reduces PHN risk by ~90%.

Q: Is Shingrix safe for immunocompromised?

Yes, unlike Zostavax; 68-91% effective in weakened immunity.