Shingrix vs. Zostavax: Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

As of November 2020, Zostavax has been discontinued in the U.S.

Additionally, in March 2021, the FDA approved a safety labeling change for Shingrix. The label now contains a warning about a possible increased risk of Guillain-Barré Syndrome (GBS) with Shingrix. However, the FDA affirms the benefits of the vaccine continue to outweigh the risks. Read more about the FDA warning here. 

The article below comparing Shingrix and Zostavas has been preserved for informational purposes only. 

Shingrix and Zostavax are vaccines that can be given to prevent herpes zoster, more commonly known as shingles. A shingles vaccine is recommended for adults once they turn 50, and it can help prevent the rash and other complications associated with shingles. 

Most people have been infected with the varicella-zoster virus if they’ve ever had chickenpox. After chickenpox resolves, the varicella-zoster virus lies dormant in the body for years, if not forever. Later in life, the virus can reactivate as shingles and cause a painful rash that usually wraps around the face or torso.

Although Shingrix and Zostavax work in similar ways to prevent shingles, there are some important differences between the two.

What are the main differences between Shingrix and Zostavax?

Shingrix (What is Shingrix?) is a recombinant, adjuvanted zoster vaccine that was first FDA-approved in 2017. It contains a certain protein called the varicella-zoster glycoprotein E (gE) antigen to produce an immune response in the body. Shingrix also contains an adjuvant, or added ingredient, to help boost the body’s immune response to the virus. The adjuvant suspension in Shingrix contains an extract from the Quillaja saponaria tree, known to modulate immune activity. Because Shingrix is an inactivated or non-live vaccine, it can be used in immunocompromised patients or those with a weakened immune system.

Shingrix is administered as an injection into the muscle (intramuscular). It is given in two separate doses with a period of two to six months between the first and second doses. The second dose is necessary to ensure long-term effectiveness. Immunocompromised or immunodeficient individuals may require a shorter vaccine schedule and can get the booster one to two months after the first shot. 

Shingrix is currently the preferred shingles vaccine, according to the Centers for Disease Control and Prevention (CDC). 

Zostavax, approved in 2006, is a live, attenuated herpes zoster vaccine. In other words, Zostavax contains a weakened version of the actual virus to produce an immune response. For this reason, Zostavax is not recommended for those who are immunocompromised. Otherwise, the vaccine may cause a symptomatic infection, even weeks following vaccination.

Zostavax is administered as a single injection underneath the skin (subcutaneous). It comes in a frozen version and a refrigerator-stable version. The frozen version must be kept frozen during transport and storage to ensure its effectiveness, while the refrigerator-stable Zostavax can be kept in a refrigerator until it needs to be used. Zostavax is no longer available in the U.S. as of November 2020.

Conditions treated by Shingrix and Zostavax

Shingrix and Zostavax are FDA-approved to prevent shingles (herpes zoster). Both vaccines are indicated to prevent shingles in adults aged 50 years and older. However, unlike Zostavax, Shingrix is also approved to prevent shingles in immunocompromised or immunodeficient adults aged 18 years and older. 

Shingrix and Zostavax are approved for preventative purposes only. They are not approved to treat shingles. In addition, they are not used to prevent primary varicella infection, also known as chickenpox. 

Postherpetic neuralgia is a common type of nerve pain that arises with shingles. Because Shingrix and Zostavax can prevent shingles, they can also prevent postherpetic neuralgia (PHN) and other painful complications from shingles. However, these vaccines are not labeled to treat PHN.

Is Shingrix or Zostavax more effective?

Shingrix and Zostavax have both been proven to prevent shingles. However, Shingrix is a newer vaccine that is considered more effective than Zostavax. Shingrix is even recommended for those who have already received the Zostavax vaccine in the past.

Clinical trials have shown that Shingrix is around 97% effective at preventing shingles in adults aged 50 to 69 years old. Shingrix is also effective in preventing shingles in older adults—in adults over the age of 70, Shingrix was found to be around 90% effective. 

Zostavax has a 70% efficacy rate in preventing shingles in adults aged 50 to 69 years old, according to the Zoster Efficacy and Safety Trial (ZEST). Results from the Shingles Prevention Study showed that, overall, Zostavax is 51% effective against shingles in adults older than 60 years old. However, the effectiveness of Zostavax decreases in older age groups. Zostavax is 64% effective in adults aged 60 to 69 years old, 41% effective in adults aged 70 to 79 years old, and 18% effective in adults aged 80 years and older.

Your healthcare provider will recommend Shingrix over Zostavax, as Shingrix is the preferred shingles vaccine and Zostavax is no longer available. Shingrix is especially recommended for immunocompromised patients since it is a non-live vaccine. Ask your doctor or pharmacist about the right shingles vaccine for you.

Coverage and cost comparison of Shingrix vs. Zostavax

For adults aged 50 years and older, only plans with Medicare Part D coverage will cover the Shingrix vaccine. However, there may still be a copay even with Medicare Part D coverage. The average cash price for one Shingrix dose is $167, though you may be able to use a prescription discount card to lower this cost. Check with your local pharmacy to see if you can use a Shingrix SingleCare card. Like Shingrix, Zostavax is primarily covered by Medicare Part D plans or Medicare Advantage plans with Medicare Part D coverage. The copay for Zostavax with insurance can vary. With an average cash price of $278, Zostavax can be expensive with or without insurance. Using a prescription discount card for Zostavax may be able to reduce this cost.

Common side effects of Shingrix vs. Zostavax

The most common side effects of Shingrix and Zostavax involve reactions at the site of injection. After a Shingrix or Zostavax injection, you may experience pain, redness, or swelling around the injection site. You may also feel soreness or itching around the area of the injection. 

Compared to Zostavax, Shingrix has been reported to cause more systemic reactions like headache, fever, muscle pain (myalgia), and fatigue. While these side effects may be bothersome, they are usually mild and disappear on their own within a few days.

*not reported
Frequency is not based on data from a head-to-head trial. This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.
Source: DailyMed (Shingrix), DailyMed (Zostavax)

Drug interactions of Shingrix vs. Zostavax

Immunosuppressive drugs, such as cyclosporine and tacrolimus, may decrease the effectiveness of vaccines. Steroids, like prednisone, and chemotherapy can also have immunosuppressive effects that can alter how well vaccines work. 

People who are on immunosuppressive therapy should avoid Zostavax altogether; Zostavax contains the live varicella-zoster virus, which could result in an infection. The risk of a vaccine-related infection may be increased if the body’s immune system is suppressed. 

Antiviral drugs, such as acyclovir and famciclovir, may interfere with the effects of the Zostavax vaccine. The Advisory Committee on Immunization Practices (ACIP) recommends that people who are on antiviral drugs stop taking antiviral medications 24 hours before getting a Zostavax vaccine. Treatment with antiviral drugs should not be resumed for at least 14 days after vaccination with Zostavax. Clinical studies have found that getting both the Zostavax and Pneumovax vaccine at the same time may lead to a reduced immune response to Zostavax. The administration of Zostavax and Pneumovax should be separated by at least four weeks.

Consult a healthcare professional for other possible drug interactions

Warnings of Shingrix and Zostavax

Shingrix and Zostavax can cause hypersensitivity, or allergic, reactions in people with allergies to vaccine ingredients. Zostavax may cause severe allergic reactions in those with a known allergy to gelatin or neomycin. Severe allergic reactions can lead to severe rash and trouble breathing (anaphylaxis). 

A postmarketing study found that Shingrix may be associated with an increased risk of Guillain-Barré syndrome (GBS). The observational study found that there was an increased risk of GBS during the 42 days following vaccination with Shingrix. As a rare, nervous system disorder, GBS can cause muscle weakness and paralysis. While some people may experience permanent nerve damage, most people recover from GBS without complications.

Zostavax should be avoided in people who take immunosuppressive agents and those who are affected by medical conditions that weaken the immune system. In some cases, people who get vaccinated with Zostavax may transmit the vaccine virus to susceptible individuals. People with an acute illness, such as an infection with fever, and those with an active untreated tuberculosis infection should avoid Zostavax. In addition, pregnancy should be avoided for three months after getting vaccinated with Zostavax. 

Syncope, or fainting, may be associated with vaccine administration. Monitoring should be set in place for a period after the vaccine is given to ensure safety and reduce the risk of falling. 

Ask your doctor or pharmacist about other precautions before getting a shingles vaccine.

Frequently asked questions about Shingrix vs. Zostavax

What is Shingrix?

Shingrix is a recombinant vaccine used to prevent herpes zoster, or shingles, in adults aged 50 years or older. Approved in 2017, Shingrix is an inactivated vaccine that does not contain the live varicella-zoster virus. It is administered in two doses, with two to six months between the first dose and second dose. Shingrix is manufactured by GlaxoSmithKline. 

What is Zostavax?

Zostavax is a live attenuated zoster vaccine that was FDA-approved in 2006. As a live attenuated vaccine, Zostavax contains a live, weakened version of the varicella-zoster virus. Zostavax is administered in a single dose in adults aged 50 years or older. It is manufactured by Merck. As of November 2020, Zostavax has been discontinued in the U.S. 

Are Shingrix and Zostavax the same?

Both Shingrix and Zostavax can decrease the risk of shingles. However, they differ in effectiveness, administration, and side effects. Shingrix is a recombinant zoster vaccine and Zostavax is a live vaccine. Meaning, Shingrix contains an inactivated form of the varicella-zoster virus and Zostavax contains a live, weakened form of the virus. Another difference is that Shingrix is injected into the muscle while Zostavax is injected underneath the skin. Compared to Zostavax, Shingrix is a newer, more effective shingles vaccine. 

Is Shingrix or Zostavax better?

Shingrix is more effective than Zostavax. Shingrix is 97% effective at preventing shingles in adults aged 50 to 69 years old, whereas Zostavax is only 70% effective at preventing shingles in the same age group. Shingrix consistently prevents shingles in older adults, while the effectiveness of Zostavax decreases with increasing age. However, Shingrix may cause more systemic side effects than Zostavax. 

Can I use Shingrix or Zostavax while pregnant?

The Centers for Disease Control and Prevention (CDC) does not recommend Shingrix or Zostavax in women who are pregnant. There are not enough studies to determine the safety of Shingrix or Zostavax in pregnant women. Consult your doctor or healthcare provider before getting a shingles vaccine. 

Can I use Shingrix or Zostavax with alcohol?

Drinking alcohol does not alter the effectiveness of Shingrix or Zostavax. It is generally safe to drink in moderation after getting vaccinated with a shingles vaccine.

Does Shingrix require two shots?

Shingrix is approved as a two-dose vaccine. It is not recommended to skip the second dose of Shingrix. Typically, the second Shingrix dose is administered two to six months after the first dose in adults aged 50 years and older. However, in people who are immunocompromised, the second dose can be given one to two months after the first dose. 

What happens if you don’t get a second Shingrix shot?

The second Shingrix shot is important to ensure complete protection with the vaccine. Skipping the second dose of Shingrix may lead to reduced protection from shingles. However, you don’t need to worry if more than six months have passed before you receive the booster shot. Just make sure you receive the second shot as close to the two- to six-month timeframe as possible. 

How long does the Shingrix last?

Clinical trials have shown that Shingrix remains effective for at least four years after the second dose. It is suggested that Shingrix lasts even longer than that. Still, more studies are being conducted on the effectiveness of Shingrix in the long term. 

Does Shingrix cause Guillain-Barré Syndrome? 

Shingrix may be associated with an increased risk of Guillain-Barré syndrome, a rare nervous system disorder. The FDA required that the vaccine label be changed to include this information and reflect the potential risk of Guillain-Barré syndrome. A postmarketing observational study found that there may be an increased risk of Guillain-Barré syndrome during the 42 days following vaccination. Still, the FDA asserts the benefits of the vaccine outweigh the potential risk of adverse effects. 

How long is Zostavax effective?

Protection from shingles lasts around five years after vaccination with Zostavax. After five years, the effectiveness of Zostavax may decrease over time. The CDC recommends getting the new shingles vaccine, Shingrix, even if you have already received the Zostavax vaccine in the past.