Shingles vaccination in older adults: is it effective and safe?

Sarah Chapman revisits this blog to look at the latest Cochrane evidence, from November 2019, on the safety and effectiveness of the shingles vaccination for older adults.

Herpes zoster or ‘shingles’ is a painful condition caused by the reactivation of varicella zoster virus (VZV), the virus that causes chicken pox. Older adults are particularly susceptible to shingles, which can last for weeks or months and have a significant impact on quality of life.

NHS shingles vaccination programme

Here in the UK, the NHS offers vaccination against shingles to people in their 70s, whether or not they have had shingles before. The NHS uses the attenuated live zoster vaccine (LZV). It is given as a single injection into the arm and, unlike the flu jab, it is given once only and at any time of year. There is also a newer vaccine against shingles, the recombinant zoster vaccine (RZV), which is given in two doses, two to six months apart. Both LZV and RZV have been approved for clinical use.

The latest evidence on shingles vaccination

A Cochrane Review looking at the effectiveness and safety of vaccination to prevent herpes zoster in older adults was updated in November 2019. The review now includes 24 studies with 88,531 people, most aged sixty and over. The studies only included people who had no illnesses which compromise the immune system. The two shingles vaccines tested were LZV and RZV.

What does the research show?

There is evidence from one large study with 38,546 people comparing LZV with placebo (a fake vaccine without the active ingredient) and from two studies with almost 30,000 people comparing RZV with placebo. People in the studies were followed up for around three years.

For both LZV and RZV, there is moderate-certainty evidence that:

  • older adults vaccinated with LZV or RZV are probably less likely to get shingles than those vaccinated with placebo, for up to three years (and possibly longer, though this is uncertain).
  • there are probably more adverse effects (such as soreness at the injection site or headache) associated with vaccination with LZV and RZV than with placebo, but that these are mostly mild to moderate and short-lived, lasting for one to three days
  • people vaccinated with LZV or RZV are probably no more or less likely to experience serious adverse events than those who have a placebo vaccination

There is more information about shingles and the shingles vaccination on this NHS website.

Gagliardi  AMZ, Andriolo  BNG, Torloni  MR, Soares  BGO, de Oliveira Gomes  J, Andriolo  RB, Canteiro Cruz  E. Vaccines for preventing herpes zoster in older adults. Cochrane Database of Systematic Reviews 2019, Issue 11. Art. No.: CD008858. DOI: 10.1002/14651858.CD008858.pub4.

Sarah Chapman has nothing to disclose.

Page last updated 12 November 2019


Sarah Chapman

About Sarah Chapman

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Sarah's work as a Knowledge Broker at Cochrane UK focuses on disseminating Cochrane evidence through social media, including Evidently Cochrane blogs, blogshots and the ‘Evidence for Everyday’ series for nurses, midwives, allied health professionals and patients. A former registered general nurse, Sarah has a particular interest making evidence accessible and useful to practitioners and to others making decisions about health. Before joining Cochrane, Sarah also worked on systematic reviews for the University of Oxford and the Royal College of Nursing Institute, and obtained degrees in History from the University of Oxford and in the history of women’s health and illness in early modern England (MPhil., University of Reading).

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