Zoster (shingles) vaccine: frequently asked questions (FAQs)

Vaccine vial with a clipboard behind
Vaccine vial with a clipboard behind

Zoster (shingles)

Key points

  • Herpes zoster – commonly known as shingles – presents as a painful rash of fluid-filled blisters on one side of the face or body, often in a strip or band-like pattern. It is caused when the virus that causes chickenpox (varicella) reactivates.
     
  • Shingrix is an adjuvanted recombinant varicella-zoster virus (VZV) glycoprotein E (gE) subunit (non-live) vaccine given in a 2-dose schedule. Doses are given 2–6 months apart in immunocompetent people and 1–2 months apart in immunocompromised people. 
     
  • Shingrix is registered and recommended for use in people aged 50 years and over and immunocompromised people aged 18 years and over. Under the National Immunisation Program, it is available free for people aged 65 years and over, Aboriginal and Torres Strait Islander people aged 50 years and over, and immunocompromised people aged 18 years and over with certain medical conditions. 
     
  • In December 2024, Zostavax was deregistered in Australia and the vaccine was removed from the Australian Immunisation Handbook.

Last updated: 14 February 2025

FAQs

What is shingles?

Shingles is a reactivation of the varicella-zoster virus (VZV) in someone who has previously had chickenpox (varicella) disease. 

Shingles commonly presents as a painful rash of fluid-filled blisters on one side of the face or body, often in a strip or band-like pattern. 

Other symptoms can include headache, malaise, itching, tingling or severe pain.

Who can get shingles, and how common is it?

People are at risk of developing shingles if they have previously had chickenpox (i.e. VZV infection). In Australia, most adults will be at risk even if they don’t remember having had chickenpox in the past.

Around 20–30% of people will have shingles in their lifetime – most after the age of 50 years – and around half of all people who live to 85 years of age will develop shingles.

What are the complications of shingles, and what is post-herpetic neuralgia (PHN)?

Shingles is usually a self-limiting illness that lasts 10–15 days, but in rare cases it can lead to serious complications – including pneumonia, hearing problems, blindness and encephalitis – or death.

The most common complication of shingles is post-herpetic neuralgia (PHN). PHN can be diagnosed when the nerve pain at the site of the rash continues for more than three months. It can have a severe effect on quality of life and be difficult to treat.

Older people – particularly those aged over 70 years – are more likely to experience complications from shingles.

What shingles vaccines are available in Australia?

There is only one shingles vaccine available in Australia: Shingrix. 

Shingrix is an adjuvanted recombinant VZV glycoprotein E (gE) subunit (non-live) vaccine. It is recommended to be given as a 2-dose course, 2–6 months apart, or 1–2 months apart for those who are immunocompromised. 

The shingles vaccine is approved for use in: 

  • adults aged 50 years and over
  • those with increased risk of herpes zoster (e.g. due to immunocompromise), from 18 years of age and over.
Who is recommended to receive the shingles vaccine? ?

All people aged 50 years and over, and those aged 18 years and over who are immunocompromised, are recommended to receive the Shingrix vaccine to prevent shingles and its complications.

Because it is not a live vaccine, Shingrix can be given to immunocompromised people aged 18 years and over.

Factors that should be considered before receiving a shingles vaccine are detailed in the recommendations section of the Australian Immunisation Handbook zoster (herpes zoster) chapter.

Who is eligible to receive a free shingles vaccine under the NIP?

A 2-dose course of Shingrix is available free of charge under the NIP for: 

While Shingrix is free for eligible groups under the NIP, immunisation providers may still charge administration or consultation fees for giving the vaccine.

How many doses of the shingles vaccine are required?

Shingrix is given as a 2-dose schedule, with each dose administered 2–6 months apart in immunocompetent people and 1–2 months apart in people who are immunocompromised or expected to become immunocompromised.

Each vaccine dose – which is 0.5 mL – is given by intramuscular injection, preferably in the deltoid muscle.

Are booster doses of the shingles vaccine recommended?

Booster doses are not currently recommended for the shingles vaccine.

What are the common side effects after receiving the shingles vaccine?

Injection site reactions, such as pain, swelling and redness, are common after vaccination with the shingles vaccine. Australian data from AusVaxSafety surveys show up to 82% of had experienced these reactions and that 47% of people had experienced at least one adverse event, with the most common being a local reaction.

Other generalised symptoms that may occur after vaccination with Shingrix include fatigue, muscle aches, headache, shivering, fever and gastrointestinal symptoms. These symptoms are typically mild and resolve within a few days.

See also the Australian Government resource Following vaccination – what to expect and what to do.

Are there any rare side effects after receiving the shingles vaccine?

There is a very rare risk of Guillain-Barré syndrome (GBS) – a condition in which the body’s immune system attacks the peripheral nerves causing weakness, numbness or paralysis – following receipt of Shingrix vaccine. 

A US study of people aged over 65 years found an excess of six GBS cases per million doses in the first 6 weeks following receipt of the first dose of Shingrix. No increase in risk was observed following the second dose. GBS may also be triggered by shingles itself.

Can a person receive the singles vaccine if they have had GBS?

Shingrix is generally not recommended for people with a history of GBS whose first episode occurred within 6 weeks of receiving any vaccine (such as an influenza vaccine or a previous dose of Shingrix vaccine).

People with a history of GBS not associated with vaccination should discuss the risks and benefits of receiving Shingrix vaccine with a health professional.

Can a person receive other vaccines at the same time as the shingles vaccine?

Yes, people can receive Shingrix at the same time as most other live and inactivated vaccines, including influenza, COVID-19 and respiratory syncytial virus (RSV) vaccines, if the vaccines are given at different injection sites. 

Immunisation providers may consider giving Shingrix at different visits to other vaccines to reduce the potential for mild to moderate reactions. However, this should not delay overdue or opportunistic vaccination, especially in people at high risk of severe disease.

AusVaxSafety survey data show 44% of respondents who received Shingrix at the same time as at least one other vaccine experienced at least one adverse event, compared to 47% of respondents who received Shingrix alone.

For more information on these considerations, see the co-administration with other vaccines section in the Australian Immunisation Handbook zoster (herpes zoster) chapter.

What are the options for individuals who are not eligible for a shingles vaccine under the NIP and want to be protected? 

For adults who are not eligible for NIP-funded vaccine, Shingrix can only be accessed through private prescription. 

What should be done if it has been 6 months or more since the first dose of Shingrix was administered?

Two doses of the Shingrix vaccine are recommended, 2–6 months apart for immunocompetent people and 1–2 months apart for those who are immunocompromised. 

If it has been 6 months or more since the first dose of Shingrix was administered, the second dose should be given as early as practicable to ensure optimal protection.

There is no need for the first dose to be given again if the interval between doses has been longer than recommended.

Should a person receive the shingles vaccine if they have already had shingles?

Yes, the vaccine is recommended for those who have previously had shingles; however, people should wait at least 12 months after an episode of shingles to receive a shingles vaccine.

Those who are immunocompromised can receive Shingrix from 3 months after an episode of shingles.

Second or subsequent episodes of shingles are rare, with only around a 1–5% chance of another episode later in life. However, people who are immunocompromised are more likely to have shingles again.

Should a person receive a shingles vaccine if they have had a chickenpox (varicella) vaccine?

If a person received a chickenpox vaccine at the recommended age (18 months) and has no history of chickenpox, they may not require shingles vaccine, but they can consider it. 

If the person’s history for the chickenpox virus or vaccine is unknown, it is safe and recommended for them to receive a shingles vaccine.

The Australian Immunisation Handbook zoster (herpes zoster) section on people previously vaccinated with varicella vaccine gives recommendations on who requires shingles vaccination, and when. 

Should a person receive a shingles vaccine if they aren’t sure if they have previously had chickenpox, and should a blood test be done to check for past infection?

Most Australians have had VZV infection by the time they are 30 years of age – even if they cannot recall having had it at a younger age – and so are recommended to receive a shingles vaccine.

In general, no blood (serology) test is required prior to administering Shingrix. The Australian Immunisation Handbook section on serological testing before and after zoster vaccination gives recommendations on who requires serological testing, and when.

How can shingles be managed if symptoms occur after vaccination? 

Suspected shingles after Shingrix should be reviewed by a doctor. A shingles diagnosis can be confirmed by appropriate laboratory testing, with the healthcare provider specifically noting the vaccine history on the pathology request form. Antivirals and analgesics (pain relief) can be used as appropriate and should not be delayed until testing results are available. 

Why is the shingles vaccine funded for certain groups but not others?

The risk of developing shingles varies widely among people based on a range of factors, including: 

  • age
  • underlying medical conditions
  • therapies that affect the immune system. 

The Pharmaceutical Benefits Advisory Committee provides advice and recommendations to the Australian Government Department of Health and Aged Care to inform these decisions.

For further information, see National Immunisation Program (NIP) vaccine listing process.

If a person has already received a dose of Zostavax, can they receive Shingrix? And if so, will it be funded under the NIP?

Yes, a person can receive Shingrix if they have already received a dose of Zostavax. They are recommended to wait at least 12 months after the dose of Zostavax before receiving their first dose of Shingrix. They will still need to receive 2 doses of Shingrix.

If a person in an eligible group purchased their dose of Zostavax privately, they can receive Shingrix for free under the NIP after waiting 12 months.

If a person received a dose of Zostavax for free under the NIP, they can receive Shingrix through private funding after waiting 12 months. Alternatively, they must wait at least 5 years from when they received Zostavax to be eligible to receive Shingrix for free under the NIP.

While Shingrix is free for eligible groups under the NIP, immunisation providers may still charge administration or consultation fees for giving the vaccine.

If a person has already received a dose of Shingrix that they paid for privately, can they receive their second dose of Shingrix as an NIP-funded dose?

Yes – if they are currently eligible for a funded Shingrix dose, they can receive their second dose of Shingrix for free on the NIP. 

The second dose is recommended 2–6 months after the first dose for people who are not immunocompromised, and 1–2 months after the first dose for those who are immunocompromised.

What is the scientific evidence behind the Australian Immunisation Handbook and Australian Technical Advisory Group on Immunisation (ATAGI) recommendations for Shingrix?

Current ATAGI recommendations for shingles vaccination – which are included in the Australian Immunisation Handbook zoster (herpes zoster) chapter – were made following thorough review of evidence, including Australian data, by immunisation experts. 

NCIRS supported this work through use of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The GRADE assessments for Shingrix are available here. 

What should be done if the second dose of Shingrix was administered less than 2 months after the first dose in a person with no immunocompromise?

In this situation, the second dose does not need to be repeated; however, the vaccine may be less effective with a shorter interval.

What are the vaccine recommendations for people who have no antibodies to the chickenpox virus?

People who have blood test results showing no antibodies to the VZV should receive the chickenpox (varicella) vaccine.

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