Shingrix® Vaccine Clinical Trials, Dosage, Efficacy, Indication, Side Effects
GlaxoSmithKline plc (GSK) Shingrix® is a non-live, adjuvanted recombinant shingles vaccine (herpes zoster) consisting of the varicella-zoster virus glycoprotein E antigen and the AS01B adjuvant system, a proprietary adjuvant containing QS-21 and MPL with liposomes. Shingrix is up to 90% effective in various clinical trials, says GSK. On October 20, 2017, the US Food and Drug Administration (FDA) authorized Shingrix (STN: 125614). GSK announced on July 26, 2021, that the FDA had approved Shingrix to prevent shingles in adults (18 years and older) at increased risk of shingles due to immunodeficiency or immunosuppression caused by a known disease or therapy.
On January 26, 2018, the U.S. Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) recommended the use of the Shingrix Herpes Zoster Vaccine. On February 25, 2021, the ACIP Herpes Zoster (HZ) Work Group presented the results of a comprehensive risk-benefit analysis of Shingrix, including a review of post-marketing data. The CDC analysis of clinical trials and observational studies confirms the benefits of Shingrix vaccination in preventing HZ, severe disease, and complications.
The UK Health Security Agency confirmed in September 2021 that seniors with weakened immune systems would be offered the Shingrix vaccine to help protect them against shingles. On August 18, 2021, Public Health England announced that GPs should provide the non-live shingles vaccine, Shingrix, to all eligible individuals who are clinically contraindicated from receiving the live vaccine Zostavax due to immunocompromising conditions.
The European Medicines Agency (EMA) issued an approval EMEA/H/C/004336 on March 21, 2018. On April 24, 2023, GSK confirmed that Shingrix was approved in India for adults aged 50 and above. Beginning in January 2024, Zhifei will have exclusive rights to import and distribute Shingrix in the Chinese market. GSK announced on October 9, 2023, that it had reached an exclusive agreement with Chongqing Zhifei Biological Products, Ltd. (Zhifei) to co-promote Shingrix in China for an initial three-year period, with the potential to extend the partnership should all parties agree. Beginning September 1, 2023, about 900,000 adults in the United Kingdom became eligible for Shingrix vaccinations.
London, England-based GlaxoSmithKline is the producer of Shingrix. GSK's top priority is patient safety.
World Health Organization Recommendation for Shingrix
In March 2025, the WHO Strategic Advisory Group of Experts (SAGE) recommended that countries where herpes zoster is an essential public health problem consider using the recombinant herpes zoster vaccine (Shingrix) in a two-dose schedule with a minimum 2-month interval between doses to prevent the disease in older adults, those with chronic conditions, and the immunocompromised. SAGE advised countries to conduct cost-effectiveness analyses to inform decision-making.
Shingles Herpes Zoster Vaccine Protection
The Annals of Internal Medicine published a study on October 13, 2025, that concluded the Recombinant zoster vaccine is effective in older adults, including immunocompromised adults, and two doses were more effective than 1. Prior ZVL recipients should be revaccinated with RZV. A real-world study published in Clinical Infectious Diseases on June 23, 2025, estimated that it was 74% effective against herpes zoster infection and 84% effective against postherpetic neuralgia in adults aged 50 and older. The Annals of Internal Medicine published the findings from a U.S. CDC-funded study - Effectiveness of Recombinant Zoster Vaccine Against Herpes Zoster in a Real-World Setting - on January 9, 2024. After a single dose, VE was 70% during the first year, 45% during the second year, 48% during the third year, and 52% after the third year. After two doses, VE was 79% in the first year, 75% in the second year, and 73% in the third and fourth years. A study published by the BMJ in September 2023 concluded that the effectiveness of the live zoster vaccine (ZOSTAVAX™) waned substantially. After ten years, protection was low against herpes zoster but higher against postherpetic neuralgia.
GSK announced on October 19, 2022, that interim data from a phase 3 clinical trial demonstrated overall efficacy of greater than 80% over the follow-up period of approximately six to 10 years after the initial vaccination. On January 21, 2022, the CDC's Morbidity and Mortality Weekly Report confirmed the Advisory Committee on Immunization Practices' previously recommended two doses (0.5 mL each) for the prevention of herpes zoster and related complications in immunocompromised or immunosuppressed adults aged 19 years and older. Additionally, the US CDC has published updated Shingrix vaccination schedules for 2022.
Shingrix Vaccine Efficacy
While numerous studies have found Shingrix to be highly effective, its protection may not last for the entirety of one's life. For many people, Shingrix provides at least 85% protection against shingles for up to four years after completing the two-dose series. Protection wanes over time and may reach 70% after ten years. Administering a third dose is investigational. Adding a third dose of the Shingrix vaccine may improve immune response and protection in patients.
Shingrix Vaccination and Dementia
On December 2, 2025, the journal Cell published the results from a study that found that, among individuals living with dementia at baseline, HZ vaccination not only led to a decrease in deaths due to dementia but also a reduction in overall mortality. Specifically, we observed a decrease, which was larger among women than men, in both deaths due to dementia and all-cause mortality, but no effect on fatalities for which dementia was not mentioned as the underlying or a contributing cause on the death certificate. Our findings thus imply that HZ vaccination among individuals living with dementia increased remaining life expectancy. This reduction in deaths due to dementia is unlikely to be a result of averted shingles episodes, given that shingles has a low mortality rate.56 Instead, this study suggests that the HZ vaccine may slow dementia disease progression. Nonetheless, identifying the exact mechanism for this effect is, in our view, an important area of future research.
On June 25, 2025, a study was published, "Lower risk of dementia with AS01-adjuvanted vaccination against shingles and respiratory syncytial virus infections," suggesting that the AS01 adjuvant itself plays a direct role in reducing the risk of dementia. AS01 might protect against dementia via specific immunological pathways. In particular, stimulation of toll-like receptor 4 with monophosphoryl lipid A (MPL; one of the components of the AS01 system) has been shown to improve Alzheimer's disease pathology in mice. In addition, the two main ingredients of AS01, MPL and QS-21 (a purified plant extract derived from Quillaja saponaria), act synergistically to activate macrophages and dendritic cells19 and trigger an age-independent cytokine cascade that culminates in the production of interferon gamma (IFN-γ). IFN-γ might attenuate amyloid plaque deposition and is negatively correlated with cognitive decline in cognitively unimpaired older adults. These neuroprotective mechanisms may reach their full potential at or below the AS01 dose administered in a single vaccine. This saturation effect could also explain why the level of protection against dementia appears similar between the AS01 shingles vaccine (given in two doses) and the AS01 RSV vaccine (administered as a single dose).
In March 2025, Reuters reported that GSK's Chief Scientific Officer, Tony Wood, said data from the state-run National Health Service's database would be used to examine whether the Shingrix vaccine reduces the risk of dementia. In July 2024, a University of Oxford-led study concluded that receiving the recombinant Shingrix vaccine is associated with a 17% increase in diagnosis-free time, translating into 164 additional days lived without a diagnosis of dementia in those subsequently affected.
On May 25, 2023, a study reported causal evidence that herpes zoster vaccination reduces the risk of dementia.
Zoster Vaccination and Cardiovascular Events
On August 30, 2025, an analysis concluded that HZ vaccination (ZVL or RZV) was associated with a significantly lower rate of CV events. The potential cardioprotective effect of HZ vaccination could further reduce the disease burden in adults, warranting additional research. A study published in May 2025 showed that among people who received the live vaccine, there was a 23% lower risk of cardiovascular events overall, with a 26% lower risk of major cardiovascular events (a stroke, heart attack or death from heart disease), a 26% lower risk of heart failure and a 22% lower risk of coronary heart disease. The protective effect was most substantial two to three years after the shingles vaccine was given, but researchers found that the protection lasted for up to eight years.
Shingrix Co-Administration with RSV Vaccine
A GSK plc-sponsored Phase 3 clinical trial (NCT05966090) met the primary endpoint, demonstrating a non-inferior immune response for RSVPreF3 OA and Shingrix vaccines when co-administered compared with separate vaccine administration.
Shingrix Vaccine Price
In May 2024, a research letter published in JAMA: The Journal of the American Medical Association disclosed that shingles vaccinations covered by Part D rose by 46% compared to the previous year before the implementation of the IRA policy in January 2023. "These findings add to the robust evidence base that lowering patient out-of-pocket costs increases the uptake of high-value clinical services," commented study co-author A. Mark Fendrick, professor of internal medicine and public health at the University of Michigan.
Shingrix Availability 2025
The Shingrix vaccine is available in 45 countries as of 2025, including India, Japan, Finland, the UK, the US, and China. On July 17, 2025, GSK announced that the US FDA approved a prefilled syringe presentation of Shingrix. The new prefilled syringe eliminates the need to reconstitute separate vials before administration, simplifying the process for healthcare professionals.
NHS England has announced that, starting in September 2025, immunosuppressed adults aged 18 to 49 will become newly eligible to receive the vaccine from their GP. The vaccine is currently available to people aged 65 to 79 and to severely immunosuppressed individuals aged over 50, following the NHS's expansion of the program two years ago.
Shingrix Indication
Shingrix is a non-live vaccine used to prevent shingles (herpes zoster). Shingrix is not used to avoid primary varicella infection (chickenpox).
Shingrix Vaccination For Zostavax Patients
The CDC recommends considering the patient's age and the time since they received Zostavax to determine when to vaccinate with Shingrix. Studies examined the safety of Shingrix vaccination five or more years after the Zostavax vaccination. Shorter intervals were not studied, but no theoretical or data concerns indicate that Shingrix would be less safe or effective if administered less than five years after a patient received Zostavax.
Shingrix For Immunocompromised People
The US CDC recommends two doses of RZV to prevent shingles and related complications in adults aged 19 years or older who are or will be immunodeficient or immunosuppressed due to disease or therapy. However, for adults who are or will be immunodeficient or immunosuppressed due to known disease or treatment and would benefit from a shorter vaccination schedule, the second dose can be administered 1 to 2 months after the first dose. In 2024, a systematic review of studies involving multiple patient groups found that the benefits of Shingrix vaccination outweigh the safety concerns in immunocompromised populations.
On June 25, 2021, the ACIP meeting reviewed the 'Zoster Vaccines Session: Burden of Herpes Zoster in Immunocompromised Adults' presentation. In addition, the American Academy of Dermatology Journal reported that among people who had a first-time shingles attack, approximately 4% had another outbreak.
The re-administration dose of RZV should be administered 6-12 months after hematopoietic stem cell transplant (HSCT) if the transplant was allogeneic and 3-12 months after HSCT if the transplant was autologous. In addition, the CDC stated on February 17, 2022, that the Shingrix vaccine is recommended for individuals 19 years old and older with altered immunocompetence. Vaccination of Contacts of Persons with Altered Immunocompetence Household contacts and other close contacts of persons with altered immunocompetence should receive all age-and exposure-appropriate vaccines, except for the smallpox vaccine.
During the ACIP meeting on October 20, 2021, Tara Anderson, DVM, MPH, Ph.D., presented an Interpretation of the EtR regarding the Use of RZV in Immunocompromised Adults, Considerations for Use, and Proposed Policy Options. The ACIP recommends two doses of the recombinant zoster vaccine for adults aged 19 years and older who are immunodeficient or immunosuppressed due to disease or therapy to prevent herpes zoster and its complications.
Previously, Camille Nelson Kotton, M.D., Chair, ACIP Herpes Zoster Work Group, presented the Introduction Zoster Vaccines Session on September 29, 2021; Ismael R. Ortega-Sanchez, Ph.D. presented 'E'onomics of vaccinating immunocompromised 19–49-years-old adults against herpes zoster in the USA; Tara Anderson, DVM, MPH, Ph.D. presented 'P'eliminary Evidence to Recommendations Framework Regarding Use of Recombinant Zoster Vaccine in Immunocompromised Adults and Next Steps.'
Shingrix Vaccination While Pregnant
The CDC does not recommend using Shingrix during pregnancy; therefore, providers should consider delaying vaccination until after pregnancy is complete. Furthermore, pregnancy testing before vaccination with Shingrix is not recommended.
Shingrix Dosage
Shingrix is a suspension for intramuscular injection only. It is supplied in 2 vials (0.5 mL each) that must be combined before administration. Two doses are necessary to provide strong protection, up to 90%, with the first dose administered at Month 0 and the second between 2 and 6 months. The Shingrix vaccine series is administered as an injection into the upper arm muscle. Therefore, it is essential to complete the 2‑dose series to help prevent shingles. The CDC has stated that if more than six months have elapsed since the 1st Shingrix dose, administer the 2nd dose as soon as possible. Do not restart the Shingrix vaccine series.
Shingrix Side Effects
A study reported in September 2024 highlighted the importance of ongoing monitoring and research into the immunomodulatory effects of RZV, as it underscored the occurrence of rare adverse events, such as dermatomal reactions. The US FDA issued a safety communication on March 24, 2021, to inform the public and healthcare providers that the FDA has required and approved safety labeling changes to the Prescribing Information for Shingrix (Zoster Vaccine Recombinant, Adjuvanted) based on post-marketing experience. The revised label includes Guillain-Barré Syndrome (GBS) in the " Warnings and Precautions "section. In addition, a case-series cohort study published in JAMA Internal Medicine on November 1, 2021, found an increased risk of GBS within 42 days of RZV vaccination in seniors, resulting in approximately three excess cases of GBS per million vaccinations. Therefore, clinicians and patients should be aware of this risk when weighing the benefits of a vaccine that reduces the risk of herpes zoster and its complications, as the risk-benefit balance remains in favor of vaccination.
The National Institute on Aging says, 'The shingles vaccine is safe and easy, and it may keep people from getting shingles and ongoing pain called postherpetic neuralgia. GSK advises that people should not receive Shingrix if they are allergic to its ingredients or have experienced an allergic reaction to a previous dose.
Shingrix Billing Codes
SHINGRIX has broad insurance coverage for patients. The CPT Code (Product) is 90750. Additional codes are found at this GSK link. Additionally, the GSK Vaccines Reimbursement Support Center serves as a resource for physicians, physician office staff, and pharmacists to address billing, coding, and reimbursement issues related to GSK vaccines.
Shingles Herpes Zoster
Shingles, also known as herpes zoster (HZ), is a painful skin rash caused by the reactivation of the varicella-zoster virus, which also causes chickenpox, according to the US CDC. If you've had chickenpox, you are at risk for shingles.
Shingrix Vaccine News
July 17, 2025 - Brigid Groves, Vice President of Professional Affairs at the American Pharmacists Association, said, "The prefilled syringe presentation of GSK's shingles vaccine is good news, providing a convenient method of administration."
July 1, 2025 - Adults who received the recombinant shingles vaccine Shingrix or the respiratory syncytial virus (RSV) vaccine Arexvy — both of which contain the AS01 adjuvant — had a lower risk for dementia in the 18 months after vaccination.
July 25, 2024 - Dr. Maxime Taquet, NIHR Academic Clinical Lecturer in the Department of Psychiatry at Oxford, said: 'The size and nature of this study make these findings convincing and should motivate further research. They support the hypothesis that vaccination against shingles might prevent dementia. If validated in clinical trials, these findings could have significant implications for older adults, health services, and public health.'
April 17, 2024 - Phil Dormitzer, GSK Senior Vice President and head of Vaccines R&D, said: "These data go far beyond the typical long-term follow-up period for a trial, tracking the efficacy of vaccination for some participants as they aged into their 70s, 80s, and 90s..... these data add to the body of evidence on the extended long-term protection against shingles and provide further confidence to inform public immunization strategies."
January 31, 2024—Emma Walmsley, CEO of GSK, stated in a press release, "GSK delivered excellent performance in 2023, with clear highlights being the exceptional launch of Arexvy and continued progress in our pipeline. We plan for at least 12 major launches from 2025, with new Vaccines and Specialty Medicines for infectious diseases, HIV, respiratory, and oncology."
October 9, 2023 - GSK announced today that it has reached an exclusive agreement with Chongqing Zhifei Biological Products, Ltd. to co-promote GSK's shingles vaccine, Shingrix, in China for an initial three-year period, with the potential to extend the partnership should all parties agree.
April 24, 2023 - GlaxoSmithKline Pharmaceuticals Ltd announced the launch of Shingrix in India.
Shingrix Clinical Trials
ZOSTER-049 is an open-label, long-term follow-up study from two pivotal phase III randomized clinical trials (ZOE-50, ZOE-70).
The long-term results from ZOSTER-049 include 79.7% VE in adults aged ≥50 cumulatively within the period from year six to year 11 after vaccination; 82% VE in adults ≥50 at year 11, showing VE remains high in each year after vaccination; 73.1% VE in adults aged ≥70 cumulatively from six to 11 years after immunization showing high VE rates across all age groups.
In the interim analysis conducted over four>4 years of long-term follow-up, representing up to 10 years since immunization (mean: from 5.6 (±0.3) to 9.6 (±0.3) years post-vaccination), vaccine efficacy was 81.6%. From 1 month post-second dose in those initial studies up to ten years post-vaccination (mean: 9.6 (±0.3) years post-vaccination), vaccine efficacy was 89.0%. The safety profile observed in this extension study is consistent with the established safety profile of the vaccine. No new safety concerns were identified. The incidence of serious adverse events was consistent with the age of the study population. No deaths or other Safety Adverse Events related to vaccination were reported. Five HZ-related complications (PHN - 3 cases and HZ disseminated disease - 2 cases) were reported. A total of 7,413 participants were enrolled in the study's safety cohort. The participants were 60.7% female. Participants were 76% White-Caucasian/European heritage, 18.7% Asian, and 5.3% from Other Ethnic Backgrounds.
