The Shingles Vaccine: Who Needs It, What It Costs, and Why It Matters

If you have ever had chickenpox, the virus that caused it is still inside you. It lies dormant in your nerve cells, sometimes for decades. When it wakes up, it causes shingles, a painful, blistering rash that strikes about one in three Americans during their lifetime.

Shingles is not just a rash. It can cause weeks of burning, stabbing pain. In some cases, the pain lasts months or even years after the rash heals, a condition called postherpetic neuralgia. It can also cause vision loss if it affects the eye, hearing problems, and, rarely, brain inflammation.

The good news: there is a highly effective vaccine that can prevent shingles. And as of 2023, it is available at no cost to Medicare beneficiaries.

Who Should Get the Shingles Vaccine?

The CDC recommends the shingles vaccine (Shingrix) for:

All adults aged 50 and older, whether or not they remember having chickenpox
Adults 19 and older who have weakened immune systems due to disease or medications (such as chemotherapy, organ transplant drugs, or long-term steroids)
People who previously received the older shingles vaccine (Zostavax), which was discontinued in 2020. Shingrix is much more effective and is recommended even if you had Zostavax years ago.

You should get vaccinated even if:

You do not remember having chickenpox. About 99% of Americans born before 1980 carry the virus, even if they had a mild case they do not recall.
You have already had shingles. The vaccine helps prevent a second episode.
You are in good health. Shingles does not only strike people who are sick or frail. It can happen to anyone whose immune system weakens, which happens naturally with age.

How Effective Is Shingrix?

Shingrix is one of the most effective vaccines available for any disease in older adults:

Over 90% effective at preventing shingles in adults 50 and older
Over 90% effective at preventing postherpetic neuralgia (the long-lasting pain)
About 85% effective in adults over 70 after four years
Protection remains strong for at least seven years based on current data, and studies are ongoing to measure long-term durability

By comparison, the old Zostavax vaccine was only about 51% effective and its protection faded significantly after five years. Shingrix is a major improvement.

How the Vaccine Is Given

Shingrix requires two shots:

First dose: Given at your doctor’s office or pharmacy
Second dose: Given two to six months after the first dose

Both doses are needed for full protection. The first dose alone provides only partial immunity. Do not skip the second shot.

If more than six months pass between your first and second dose, you do not need to start over. Just get the second dose as soon as you can.

Side Effects: What to Expect

Shingrix causes more noticeable side effects than many vaccines. This is because it contains an ingredient called an adjuvant that strongly activates your immune system. That strong immune response is what makes the vaccine so effective, but it also means you will likely feel some effects.

Common side effects (lasting one to three days):

Sore arm at the injection site (the most common side effect, reported by about 78% of people)
Muscle aches
Fatigue and tiredness
Headache
Mild fever or chills
Nausea

About one in six people report side effects strong enough to interfere with normal activities for a day or two. Most people describe it as feeling like a mild flu that passes within 48 hours.

Tips for managing side effects:

Schedule your shot before a day when you can rest at home
Use an ice pack on the sore arm
Take over-the-counter pain relief like acetaminophen (Tylenol) or ibuprofen (Advil) if needed
Stay hydrated

Serious side effects are very rare. The vaccine does not contain live virus and cannot cause shingles.

What Does It Cost?

If you have Medicare Part D or Medicare Advantage with drug coverage: Shingrix is covered at no cost to you. The Inflation Reduction Act eliminated all cost-sharing for recommended adult vaccines under Part D starting in 2023.

If you have private insurance: Most private health plans cover Shingrix with no copay under the Affordable Care Act’s preventive services mandate.

If you are uninsured: The retail cost is about $200 to $250 per dose ($400 to $500 for both doses). Some pharmacies offer discount programs. GlaxoSmithKline, the manufacturer, has a patient assistance program for people who cannot afford the vaccine.

If you have Original Medicare without Part D: This is a gap in coverage. Part B does not cover the shingles vaccine. You would need a Part D plan or would have to pay out of pocket. If you do not have Part D, consider enrolling during the next open enrollment period (October 15 to December 7).

What Shingles Actually Looks Like

Knowing the early signs of shingles can help you get treatment quickly if you do develop it, even after vaccination (no vaccine is 100% effective).

Early symptoms (one to five days before the rash):

Pain, tingling, burning, or itching on one side of the body or face
Sometimes headache, fever, and general feeling of being unwell
Sensitivity to touch in a specific area

The rash:

Usually appears as a band or strip of blisters on one side of the torso, but can also appear on the face, neck, or around one eye
Blisters fill with fluid, then crust over in 7 to 10 days
The rash typically heals in two to four weeks
It almost always affects only one side of the body

If you suspect shingles, see your doctor within 72 hours. Antiviral medication (valacyclovir or acyclovir) can shorten the outbreak and reduce the risk of long-lasting pain if started early. The sooner you start treatment, the better it works.

Postherpetic Neuralgia: The Worst Part

For many people, the rash is not the worst part of shingles. The worst part is the pain that lingers after the rash heals.

Postherpetic neuralgia (PHN) affects about 10 to 18 percent of people who get shingles. The risk increases with age. Among people over 60 who get shingles, about 20 percent develop PHN.

The pain is described as burning, stabbing, or throbbing. It can last months or, in some cases, years. It can be severe enough to interfere with sleep, daily activities, and quality of life. Some people find even the touch of clothing against the affected skin unbearable.

Treatment for PHN includes prescription nerve pain medications, lidocaine patches, and sometimes nerve blocks. But prevention through vaccination is far preferable to treatment after the fact.

Common Questions

Can I get Shingrix if I am on blood thinners? Yes. Inform the person giving the injection that you are on blood thinners. They may apply pressure to the injection site for a bit longer.

Can I get Shingrix at the same time as my flu shot or COVID booster? Yes. The CDC says Shingrix can be given at the same visit as other vaccines, though in a different arm. Some people prefer to space vaccines out to manage side effects, and that is fine too.

Is there anyone who should NOT get Shingrix? You should not get Shingrix if you are currently having a shingles outbreak (wait until it clears), if you have a severe allergy to any component of the vaccine, or if you are pregnant. People with mild illnesses like a cold can still get vaccinated.

I had chickenpox vaccine as a child, not actual chickenpox. Do I need Shingrix? If you are 50 or older, yes. People who received the chickenpox vaccine still carry a small amount of the virus and can develop shingles, though at lower rates. The CDC recommends Shingrix for everyone 50 and older.

The Bottom Line

Shingles is painful, common, and preventable. The Shingrix vaccine is over 90% effective, now free for Medicare beneficiaries, and available at most pharmacies without an appointment. If you are 50 or older and have not been vaccinated, talk to your doctor or pharmacist about scheduling your two doses.

Do not wait for shingles to strike. Once the virus reactivates, all you can do is manage the damage. Prevention is far better.

Reported by Dr. James Patterson with additional research from the SeniorDaily editorial team. For corrections or updates, please contact us.