Intro
Shingles (herpes zoster) is a painful viral rash caused by reactivation of the varicella-zoster virus — the same virus that causes chickenpox. Risk increases with age, and complications can be severe in older adults. Vaccination significantly reduces the risk of both shingles and long-term nerve pain.
Key Points
- About 1 in 3 adults will develop shingles in their lifetime.
- Risk increases after age 50.
- Postherpetic neuralgia (PHN) is the most common serious complication.
- In Australia, vaccination is funded from age 65 (earlier for eligible groups).
- Protection is long-lasting but not proven lifelong.
What Is Shingles?
After a person recovers from chickenpox, the virus remains dormant in nerve tissue. Years later, it can reactivate as shingles.
Symptoms include:
- Burning or tingling pain on one side of the body
- A blistering rash in a dermatomal pattern
- Fatigue or mild fever
The rash usually resolves within 2–4 weeks.
Why Risk Increases With Age
Immune function naturally declines over time (immunosenescence). This reduces the body’s ability to suppress latent viruses.
Complication risk increases substantially after 60, particularly:
- Postherpetic neuralgia
- Eye involvement (herpes zoster ophthalmicus)
- Hospitalisation
The Vaccine
It:
- Reduces shingles risk by >90% initially
- Strongly reduces postherpetic neuralgia
- Is suitable for many immunocompromised adults
📊 Evidence Snapshot: Durability
- Initial efficacy: >90% in adults 50+
- Maintained protection: ~80–85% at 10+ years
- No booster currently recommended
- Ongoing long-term follow-up studies continue
Protection appears durable, though not definitively lifelong.
Australian Recommendations
Current program settings:
- Funded for adults aged 65 years
- Funded for Aboriginal and Torres Strait Islander adults aged 50+
- Funded for eligible immunocompromised adults ≥18
- Adults aged 50–64 may receive it privately
Timing Strategy: When to Vaccinate?
There are two reasonable approaches for healthy adults:
Vaccinate at 50
- Protects your 50s and early 60s
- May result in some waning decades later
Vaccinate at 60–65
- Aligns peak protection with highest complication risk
- Accepts some risk in your 50s
Both strategies are medically defensible in healthy individuals.
🚨 Don’t Delay If…
You should not wait until 60 if you:
- Become immunocompromised
- Start chemotherapy or immune-modifying medication
- Receive an organ transplant
- Develop poorly controlled diabetes
- Begin long-term corticosteroids
Earlier vaccination is strongly recommended in these groups.
FAQ
Q: If I already had shingles, do I still need the vaccine?
A: Yes. Recurrence is possible.
Q: How long does protection last?
A: At least 10 years based on current follow-up data.
Q: Is a booster required?
A: No routine booster is currently recommended.
Q: Can the vaccine cause shingles?
A: No. It is not a live vaccine.
Further Reading
- Australian Immunisation Handbook (health.gov.au)
- CDC Shingles Overview (cdc.gov)
- ATAGI clinical guidance statements
Related Guides
- /guides/vaccination-overview
- /guides/infectious-diseases