Zoster (shingles) vaccines (Shingrix® [RZV] and Zostavax® [ZVL]) – frequently asked questions

The herpes zoster (shingles) vaccine Shingrix® replaced Zostavax® on the National Immunisation Program on 1 November 2023.

Zoster (shingles)

Key points

  • Shingrix® replaced Zostavax® on the National Immunisation Program (NIP) on 1 November 2023 and is the preferred vaccine for the prevention of herpes zoster (shingles). It is the only funded zoster vaccine that is available for free for eligible groups under the NIP.
  • 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 a an adjuvanted recombinant varicella-zoster virus (VZV) glycoprotein E (gE) subunit (non-live) vaccine given in a two-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 NIP, 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. 
  • While Shingrix® is free for eligible groups under the NIP, immunisation providers may still charge administration or consultation fees for giving the vaccine.
  • Zostavax® is a live-attenuated VZV vaccine that is given as a single dose. It is available in Australia for people aged 50 years and over but contraindicated in anyone with immunocompromise. Careful screening with this pre-screening checklist is recommended prior to Zostavax® being administered. Zostavax® production is being discontinued and supply in Australia will soon cease.

Zostavax® is contraindicated (should not be used) in people who are currently or soon to be severely immunocompromised from either primary or acquired medical conditions or medical treatment. 

Rarely, disseminated varicella-zoster virus infection with the vaccine (Oka) strain can occur in patients after receiving Zostavax® vaccine. There have been reports of fatal disseminated vaccine-related varicella-zoster virus infection in Australia, including in patients on low-dose immunosuppressive medication. The risk increases with the degree of immunosuppression. 

Careful pre-screening and a risk-based assessment are required before administration of any dose of Zostavax®. If appropriate, the assessment should include medical specialist consultation and, potentially, screening for pre-existing antibody to varicella-zoster virus. In such cases, vaccination should be deferred until such advice and/or results have been obtained. Any patient who experiences a disseminated vesicular (chickenpox-like) rash 2–4 weeks after vaccine administration should seek medical attention immediately and ensure that their treating health professional is aware of their recent zoster vaccination.

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 3 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.

What shingles vaccines are available in Australia?

There are two shingles vaccines registered for use in Australia: 

  • Shingrix® (recombinant zoster vaccine, or RZV) is an adjuvanted recombinant VZV glycoprotein E (gE) subunit (non-live) vaccine. It is the preferred shingles vaccine and is recommended to be given as a two-dose course, 2–6 months apart, or 1–2 months apart for those who are immunocompromised. It is approved for use in adults aged 18 years and over. It is the only shingles vaccine available for free under the National Immunisation Program (NIP) for certain eligible groups. 
  • Zostavax® (zoster vaccine live, or ZVL) is a live-attenuated VZV vaccine. It is approved for use in adults aged 50 years and over as a single-dose course. Zostavax® is no longer available for free under the NIP and is not the preferred shingles vaccine. It should not be given to people who are immunocompromised. Careful screening with this pre-screening checklist is recommended prior to giving Zostavax®. This vaccine will cease to be supplied in Australia in the near future. 
Who is recommended to receive a 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. 

Shingrix® can be given to immunocompromised people aged 18 years and over because it is not a live vaccine. Not all people who are recommended to receive a shingles vaccine are funded under the NIP. Factors that should be considered before receiving a shingles vaccine are detailed in the Australian Immunisation Handbook.

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

A two-dose course of Shingrix® is available free under the NIP for: 

  • people aged 65 years and over 
  • Aboriginal and Torres Strait Islander people aged 50 years and over 
  • immunocompromised people aged 18 years and over with the following medical conditions:
    • haematopoietic stem cell transplant 
    • solid organ transplant
    • haematological malignancy (blood cancer) 
    • advanced or untreated human immunodeficiency virus (HIV).

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 a shingles vaccine are required?

Shingrix® is given as a two-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.

Zostavax® is administered as a single dose of 0.65 mL given by subcutaneous injection.

Are booster doses of a shingles vaccine recommended?

Booster doses are not currently recommended for shingles vaccines.

What are the common side effects after receiving shingles vaccines?

Injection site reactions, such as pain, swelling and redness, are common after vaccination with either shingles vaccine. These reactions occur in up to 82% of Shingrix® recipients and around 50% of Zostavax® recipients. 

Other generalised symptoms that are more common 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. 

Rarely (0.1%), Zostavax® recipients may also develop a chickenpox-like rash locally, at the injection site. Some Zostavax® recipients may develop a more widespread rash of fluid-filled blisters around 2–4 weeks after vaccination; this can be an indication of disseminated infection. Individuals who develop a rash in the weeks after receiving Zostavax® should contact their doctor without delay for prompt review, testing and (if needed) treatment.  

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

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

Yes, people can receive Shingrix® or Zostavax® at the same time as most other live and inactivated vaccines if the vaccines are given at different injection sites. 

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.

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

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

For adults aged 50–64 years who are not eligible for NIP-funded vaccine, Shingrix® or Zostavax® vaccines can be purchased through private prescription. 

Adults aged 18 years and over who are at increased risk of shingles due to immunocompromise and are not currently able to access NIP-funded vaccine can only access Shingrix® through private prescription. 

Supply of the Zostavax® vaccine is expected to be limited and will soon cease. If there is any uncertainty about the level of immunocompromise, Zostavax® should not be administered.

What should be done if it has been more than 6 months since Dose 1 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 practical to ensure optimal protection.  

There is no need for Dose 1 to be given again if the spacing 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 around a 1–5% chance of another episode later in life. However, people who are immunocompromised are more likely to have shingles again. 

Can a person who is immunocompromised or expecting to become immunocompromised receive Zostavax®?

Shingrix® is the preferred shingles vaccine and can be administered to people who are immunocompromised. Zostavax® is contraindicated (should not be used) in anyone with severe immunocompromise. 

People aged 50 years and over with mild immunocompromise can consider Zostavax® if Shingrix® is not accessible and they wish to protect themselves. In circumstances where Zostavax® is being considered, careful assessment using the live shingles vaccine (Zostavax®) screening for contraindications tool should be undertaken. If there is any uncertainty about the level of immunocompromise, Zostavax® should not be administered. 

For further details, refer to the contraindications and precautions section in the Australian Immunisation Handbook.

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 zoster vaccine.  

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

The Australian Immunisation Handbook section on people previously vaccinated with varicella vaccine gives recommendations on who requires zoster 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 old – 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 provides recommendations on who requires serological testing, and when.

How can shingles be managed if symptoms occur after vaccination? 

Suspected shingles after either Shingrix® or Zostavax® should be reviewed by a doctor. A shingles diagnosis can be confirmed by appropriate laboratory testing, with the health care 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. 

If the suspected shingles occurs after receipt of Zostavax®, the possibility of disseminated vaccine virus infection (see below) should also be considered.

What should be done if there is a widespread rash after receiving Zostavax®?

If a non-localised rash occurs around 2–4 weeks after receipt of Zostavax®, there is a possibility of disseminated infection, especially in vaccine recipients who are immunocompromised. This type of rash may be due to the Oka vaccine virus strain.  

If disseminated VZV infection is suspected, healthcare providers should:  

  • undertake appropriate diagnostic testing 
  • initiate empirical antiviral treatment 
  • consult an infectious diseases specialist 
  • where relevant, stop immunosuppressive medication.  

The relevant state or territory health authority and the Therapeutic Goods Administration should also be notified.

Why are the shingles vaccines funded for certain groups but not others?

The Australian Department of Health and Aged Care decides which vaccines to fund under the NIP and for which population groups. The Pharmaceutical Benefits Advisory Committee provides advice and recommendations to the 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 two 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® may be 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®?

The ATAGI recommendations included in the Australian Immunisation Handbook were made following a thorough review of global evidence and Australian shingles data by a group of immunisation experts guided by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The GRADE assessments for Shingrix® are available here. 

What should be done if Dose 2 of Shingrix® was administered less than 2 months after Dose 1 (in a person with no immunocompromise)?

Dose 2 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 varicella-zoster virus should receive the chickenpox (varicella) vaccine.

Useful links

News & events

  • 22417 views