Shingrix vs Zostavax: Which Is Better?

Shingles, also known as herpes zoster, is a reactivation of the varicella-zoster virus (VZV). VZV is what causes chickenpox. In other words, once the symptoms of chickenpox clear up, the VZV stays dormant within the body.

Later in life, about 33% of people who had chickenpox previously develop shingles. This condition happens when the VZV becomes active and causes a painful rash, usually along a nerve. Since it is on a nerve, the rash is often painful but can also be tingly or itchy and lead to more serious complications like postherpetic neuralgia (PHN).

There are two vaccines that are available to help prevent a shingles outbreak and the subsequent complications of shingles:

  • Zostavax. The Food & Drug Administration (FDA) approved Zostavax in 2006 as a shingles vaccine; however, as of 2018, it is no longer approved in the United States as a shingles vaccine.
  • Shingrix. The FDA approved Shingrix in 2017 as a shingles vaccine.

This article will discuss the differences between these two vaccines as well as the expert recommendations regarding shingles vaccination.

Older adult getting a vaccine

Kathrin Ziegler / Getty

Effectiveness

The Zostavax shingles vaccine, approved by the FDA in 2006, uses a weakened live shingles virus to cause the body's immune system to generate protection against a shingles infection. Zostavax is a one-injection vaccination. The research indicates Zostavax reduces an individual from having a shingles outbreak by 51% and reduces PHN by 67%.

Shingrix was approved by the FDA in 2017 as a vaccine to prevent a shingles infection. Shingrix, a two-injection vaccination, is a recombinant zoster vaccine which means it does not contain any components of the actual shingles virus. Instead, recombinant vaccines target specific components of the virus, allowing for a focused immune response. Shingrix has shown a 90% effective rate at preventing shingles and PHN, with protection staying consistently above 85% for at least the first four years after receiving the complete vaccination series.

Major Differences

The major differences between Zostavax and Shingrix are outlined below:

Major Differences Between Zostavax and Shingrix
 Vaccine  Type of Vaccine Number of Vaccinations Needed Amount of Protection Against Shingles & PHN Who Is Eligible for the Vaccination? Who Should Not Receive this Vaccination?
 Zostavax Weakened live virus One (1) intramuscular injection 51% effective against shingles, 67% effective against PHN As of 2018, Zostavax is no longer approved in the United States as a shingles vaccine. It is available in Canada. - A person with a weakened immune system (i.e., HIV/AIDS, treatment with drugs that affect the immune system like steroids, cancer treatment). - Pregnant women . - Severe or life-threatening allergy to gelatin, neomycin, or any components of the vaccine.
Shingrix  Recombinant zoster vaccine  Two (2) intramuscular injections, separated by 2 to 6 months 90% effective against shingles & PHN with at least 85% lasting coverage against both for at least the first 4 years after vaccination - People at least 50 years old. - People who received Zostavax before Shingrix was available. - People with severe allergic reactions to any component of the vaccine or after the first dose of Shingrix . - People currently with active shingles infection. - Women who are pregnant or breastfeeding.

Similarities

Zostavax and Shingrix do have a few similarities:

  • Both are vaccines intended to prevent a shingles infection.
  • Both vaccines are administered as an injection into the muscle.
  • While both vaccines have the potential for serious adverse reactions, most reactions consist of a sore arm around the injection site.
  • Additional side effects include tiredness, headache, mild fever, and nausea; most of these tend to resolve on their own within two to three days of vaccination.

Which Is Better?

The Advisory Committee on Immunization Practices (ACIP) is a group of medical and public health experts that develop vaccine usage recommendations in the United States. ACIP also includes experts from several professional organizations, such as the American Academy of Pediatrics and the American Academy of Family Physicians.

ACIP reviewed several resources, including research and patient outcomes and cost effectiveness studies, for both Zostavax and Shingrix. ACIP then utilized an evidence-based analysis to develop the committee's final recommendations. ACIP recommended Shingrix be used as the primary vaccine for shingles due to the high level of evidence reviewed by the committee.

Do I Need to Get a Shingles Vaccine?

Since 1 out of every 3 people in the United States will develop a shingles infection, the Centers for Disease Control and Prevention (CDC) recommend anyone at least 50 years of age or older receive the shingles vaccine. Additionally, the risk of developing a significant complication, such as postherpetic neuralgia (PHN), is as high as 1 out of every 10 people affected by shingles.

With the Shingrix vaccination being incredibly effective at reducing the risk of a shingles infection, many healthcare professionals, such as primary care physicians, highly encourage people to receive the vaccine. It is important for you to have that discussion with your healthcare provider, such as a primary care physician, and decide if the vaccine is the right choice based on your personal medical history.

Summary

Shingles is an infection that occurs in adults, years after a childhood chickenpox infection. In addition to causing a painful, itchy or tingly rash, shingles can also cause postherpetic neuralgia (PHN) or other significant medical complications.

Because there is no definitive testing that can identify if individuals have the varicella-zoster virus (VZV) dormant, many healthcare professionals and experts highly encourage a shingles vaccine. The Shingrix vaccine is the only shingles vaccine available in the United States and offers significant protection against shingles; while over 90% effective initially, Shingrix has been shown to be at least 85% effective against both shingles and PHN.

A Word From Verywell 

Ultimately, it is important for you to discuss the risks and benefits of receiving a shingles vaccination with your healthcare provider.

Frequently Asked Questions

  • At what age do you need to get a shingles vaccine?

    Shingles is the reactivation of the varicella-zoster virus (VZV); therefore, it is typically a disease in adults. Zostavax is FDA approved for people who are at least 60 years of age. Shingrix is FDA approved for people at least 50 years of age.

  • How often do you need to get a shingles vaccine?

    Zostavax is a one-injection vaccination. Shingrix is a two-injection vaccination. The Shingrix vaccinations should be separated by two to six months between the injections. Shingrix has been shown to remain effective at least 85% in reducing the risk of shingles infection and PHN for at least four years after vaccination. Ultimately, your healthcare provider will work with you to determine if additional shingles vaccinations are appropriate, based on your health and medical history.

  • Why was Zostavax taken off the market?

    Zostavax is available globally, although it is not readily available in the United States. Zostavax is made from a weakened live shingles virus, while Shingrix is made from a recombinant zoster vaccine and contains no shingles virus, weakened or otherwise. Shingrix is considered safer, can be used in adults at a younger age, and has better short and long-term efficacy than Zostavax, which is why the Advisory Committee on Immunization Practices (ACIP) endorses the use of Shingrix significantly more than Zostavax.

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7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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