Shingles isn’t just a rash. For many people, it’s months of burning pain, sleepless nights, and a quality of life that never fully returns. The good news? There’s a vaccine that works - and it’s not the old one. Shingrix, the recombinant zoster vaccine, is now the only shingles vaccine recommended in the U.S. and Australia, and it’s far more effective than anything before it. But who exactly should get it? And is it worth the discomfort? Let’s cut through the noise.
Who Needs the Recombinant Zoster Vaccine?
If you’re 50 or older, you should get Shingrix - no exceptions. That’s the clear, simple rule from the CDC, the WHO, and every major medical association. Age is the biggest risk factor. As your immune system weakens over time, the varicella-zoster virus - the same one that gave you chickenpox as a kid - wakes up and causes shingles. About 1 in 3 people will get shingles in their lifetime. By 80, that risk jumps to nearly 50%.
But it’s not just about age. If you’re 19 or older and your immune system is weakened - whether from cancer treatment, HIV, organ transplant, or long-term steroid use - you’re at even higher risk. Shingrix is safe for these people because it’s not a live virus. The old vaccine, Zostavax, could actually make you sick if your immune system was already compromised. Shingrix doesn’t carry that risk.
Why Shingrix Over the Old Vaccine?
Shingrix replaced Zostavax for one simple reason: it works way better. Zostavax was only about 51% effective at preventing shingles. Shingrix? It’s over 90% effective - even in people over 70. For postherpetic neuralgia, the long-term nerve pain that can last years after the rash clears, Shingrix is 91% effective in people 50-69 and 89% effective in those 70+.
And Zostavax isn’t even available anymore. It was pulled from the U.S. market in 2020 and is no longer used in Australia either. So if someone tells you to get Zostavax, they’re giving outdated advice. Shingrix is the only game in town now.
How Many Shots Do You Need?
You need two doses. Not one. This trips up a lot of people. The first shot gives you a strong start. The second shot, given 2 to 6 months later, is what makes the protection last. Skipping the second dose cuts your protection in half.
There’s one exception: if you’re immunocompromised, you can get the second dose as early as 1 to 2 months after the first. That’s because your immune system needs that boost faster. Your doctor will know if this applies to you.
What Are the Side Effects?
Let’s be honest - Shingrix can make you feel awful for a day or two. About 80% of people get pain, redness, or swelling at the injection site. More than 40% feel muscle aches, fatigue, or headaches. Around 1 in 6 people say the side effects were bad enough to miss work or cancel plans.
But here’s what most people don’t tell you: those symptoms usually fade in 2 to 3 days. And if you’ve had shingles before, you know how much worse it is than the shot. Many patients who’ve had shingles say they’d take the side effects again in a heartbeat.
What If You Already Had Shingles?
Even if you’ve had shingles, you still need Shingrix. The virus stays in your nerves after the rash heals. It can come back - and it often does. The CDC says you should wait until the rash is completely gone before getting vaccinated. After that, there’s no waiting period. Get both doses, no matter your history.
What If You Got Zostavax Before?
If you got Zostavax in the past, you still need Shingrix. The protection from Zostavax fades over time, and Shingrix gives you much stronger, longer-lasting defense. The CDC recommends waiting at least 8 weeks after Zostavax before getting Shingrix. But don’t wait longer than 5 years. The longer you wait, the more risk you’re taking.
Who Shouldn’t Get It?
There are only two reasons not to get Shingrix:
- You had a severe allergic reaction (anaphylaxis) to a previous dose of Shingrix or any of its ingredients.
- You’re currently sick with a moderate or severe illness, like a high fever or pneumonia. Wait until you’re better.
That’s it. Pregnancy, breastfeeding, allergies to eggs or gelatin, or having a chronic condition like diabetes or high blood pressure? None of those are reasons to skip it. In fact, those conditions make you more vulnerable to complications from shingles - so getting the vaccine is even more important.
How Much Does It Cost?
Shingrix costs about $175 for both doses in the U.S. In Australia, it’s covered under the National Immunisation Program for people aged 65 and over, and for certain immunocompromised adults aged 18-64. For others, it’s available privately for around AUD $200-$250 per dose.
Most private insurance plans in the U.S. cover it fully under preventive care. Medicare Part D covers it too, though you might pay a copay depending on your plan. In Australia, if you’re not eligible for the free vaccine, talk to your doctor about bulk billing options or pharmacy discounts.
Where Can You Get It?
You don’t need to see a specialist. Most pharmacies - including CVS, Walgreens, and local pharmacies - offer Shingrix. Your GP or local health clinic can give it to you too. Many places now have standing orders, meaning a pharmacist can give you the shot without a doctor’s prescription if you meet the criteria.
Before you go, call ahead. Not every location keeps it in stock because it needs to be refrigerated and used quickly after mixing. Ask if they have it on hand and if you need to schedule an appointment.
How Long Does Protection Last?
Current data shows Shingrix stays over 85% effective for at least 7 years after the second dose. Some studies suggest protection could last 15 to 20 years. So far, there’s no recommendation for a booster dose. If that changes, health authorities will update their guidelines - and you’ll hear about it.
What If You Miss Your Second Dose?
If you miss your second dose, don’t panic. You don’t need to start over. Just get the second shot as soon as you can. The CDC says you can wait up to 6 months after the first dose. If it’s been longer than that, just get the second dose - no need to repeat the first.
Final Thought: It’s Not a Choice - It’s a Shield
Shingles isn’t a minor inconvenience. It can turn your life upside down. One woman in Melbourne, 68, got shingles after a stressful year. The rash lasted 3 weeks. The nerve pain lasted 11 months. She couldn’t sleep. She couldn’t work. She lost 12 kilograms because she couldn’t eat without pain.
She got Shingrix after she recovered. She says: "I didn’t think I needed it because I’d already had it. I was wrong. I won’t make that mistake again." If you’re 50 or older, or 19+ and immunocompromised - get both doses. The pain from the shot is temporary. The pain from shingles? Not always.
Is the recombinant zoster vaccine the same as Shingrix?
Yes. Shingrix is the brand name for the recombinant zoster vaccine (RZV). It’s the only shingles vaccine currently recommended in the U.S. and Australia. The term "recombinant zoster vaccine" refers to the type of vaccine - it uses a piece of the virus (glycoprotein E) and an adjuvant to trigger a strong immune response - not a live virus.
Can I get Shingrix if I’m over 80?
Absolutely. Shingrix is recommended for all adults 50 and older, with no upper age limit. In fact, people over 70 benefit the most because their risk of severe shingles and complications is highest. The vaccine remains 91% effective in this age group.
Can I get Shingrix at the same time as my flu shot or COVID booster?
Yes. Shingrix can be given at the same visit as other vaccines, including flu, pneumonia, or COVID-19 shots. Just use different arms. There’s no evidence it reduces effectiveness or increases side effects when given together.
Do I need Shingrix if I’ve had chickenpox?
Yes. Nearly all adults over 50 have had chickenpox, even if they don’t remember it. The virus stays dormant in your nerves and can reactivate as shingles. Having chickenpox means you’re at risk - which is exactly why you need the vaccine.
Is Shingrix safe for people with autoimmune diseases?
Yes. Shingrix is safe for people with autoimmune conditions like rheumatoid arthritis, lupus, or multiple sclerosis - even if they’re on medications that suppress the immune system. It’s not a live vaccine, so it won’t trigger disease flares. In fact, these patients are at higher risk for severe shingles and should prioritize vaccination.
How do I know if I’m immunocompromised?
You’re considered immunocompromised if you have conditions like HIV with low CD4 counts, active cancer treatment, organ or stem cell transplants, or are taking high-dose steroids, biologics, or chemotherapy. If you’re unsure, ask your doctor. If you’re on any immune-suppressing drug, you should get Shingrix.
Can I get Shingrix if I’m allergic to latex?
Yes. The vaccine itself does not contain latex. The vial stopper and syringe components may contain latex in some regions, but most providers now use latex-free equipment. Always inform the nurse or pharmacist before receiving the shot.
Is Shingrix covered by Medicare in the U.S.?
Yes. Medicare Part D covers Shingrix for all beneficiaries aged 50 and older. You may pay a copay depending on your plan, but most people pay $0 out-of-pocket. Check with your plan or pharmacy to confirm coverage.
Can I get Shingrix if I’ve had a previous allergic reaction to a vaccine?
Only if the reaction wasn’t to a component of Shingrix. If you’ve had a severe allergic reaction (anaphylaxis) to any ingredient in Shingrix - like glycerol or polysorbate 80 - you should not get it. If your past reaction was to a different vaccine, like flu or tetanus, you can still safely receive Shingrix.
What if I’m planning to travel soon?
There’s no travel restriction. But if you’re traveling to a place with limited healthcare access, it’s wise to get your first dose before you go. That way, you’re partially protected. You can get your second dose when you return, even if it’s after the ideal 2-6 month window.
