Shingles vaccine: live vs recombinant, what's the difference and what does it cost?
The two shingles vaccines compared: effectiveness, number of doses, who can and cannot have each, side effects and the clinic's prices, to help you choose for your parents or yourself.
People over 50 fear shingles because of the nerve pain, which can last months or years after the rash has gone. There are now two vaccines, and they differ in how they work, how well they protect and what they cost. Below they are compared point by point, with advice on who should choose which.
Key takeaways
- The recombinant (non-live, Shingrix) vaccine: 2 doses 2–6 months apart, over 90% protection that lasts, and the one current guidelines recommend first.
- The live vaccine (Zostavax): a single dose, about 50% protection that wanes, and not for anyone immunocompromised.
- Both are for age 50 and over; the recombinant vaccine is also licensed from age 18 for people with weakened immunity.
- Prices at the clinic: live 5,000 baht/dose · recombinant 6,900 baht/dose (2-dose package 13,000 baht)
What shingles is and why prevent it
Shingles is caused by the same virus as chickenpox. After childhood chickenpox the virus hides in nerve ganglia for life and reactivates when immunity weakens with age, stress or illness. About 1 in 3 people who have had chickenpox will get shingles at some point, and the risk rises sharply after 50.
The worst of it is post-herpetic neuralgia, nerve pain that persists after the rash heals. It affects 10–18% of patients, more with age. The burning or electric-shock pain can last months to years and disrupts sleep, and there are few good treatments for it, so prevention makes more sense than treatment.
The two vaccines compared
| Live attenuated | Recombinant (non-live) | |
|---|---|---|
| Brand | Zostavax | Shingrix |
| How it works | Weakened virus, provokes immunity like natural infection | Viral protein plus an adjuvant; contains no live virus |
| Doses | 1 dose | 2 doses, 2–6 months apart |
| Protection against shingles | About 51% (falling to about 35% at 70+) | Over 90% at every age, including 70+ |
| Protection against post-herpetic neuralgia | About 67% | About 90% |
| Durability | Wanes clearly after 5–8 years | Still over 80% at 10 years |
| Age | 50 and over | 50 and over, or 18 and over if immunocompromised |
| Not for | Immunocompromised, on immunosuppressants, pregnant | Severe allergy to a component (can be used when immunocompromised) |
| Typical side effects | Injection-site pain, redness, itch, headache; fairly mild | Quite sore arm, tiredness, aches, fever for 1–3 days |
| Price at the clinic | 5,000 baht/dose | 6,900 baht/dose · 2-dose package 13,000 baht |
Which to choose
Given the choice, guidelines in the United States and many other countries recommend the recombinant vaccine first, because it protects far better and for longer, especially past 70, where the live vaccine loses much of its effect. It is also the only one usable in people with weakened immunity, such as those on immunosuppressants, on cancer treatment or after a transplant.
The live vaccine remains an option for someone who wants a single dose, has a limited budget and has normal immunity. Anyone who had the live vaccine earlier is advised to have the recombinant vaccine as well, at least 8 weeks later, because protection from the live vaccine fades over time.
Good to know: If you have already had shingles you should still be vaccinated, because it can recur. Wait until the rash has healed and symptoms have settled, typically about a year, or as your doctor advises.
What to expect after the recombinant vaccine
- About 8 in 10 people get a sore arm, and about 1 in 6 has whole-body effects (tiredness, muscle aches, headache or fever) that interfere with normal activity for 1–3 days
- These are signs of the immune system responding, not an infection; paracetamol and rest are fine
- Pick a day when the next day is free of important plans, and expect the second dose to feel much like the first
- Serious reactions are very rare; the clinic keeps you for observation after the injection
Booking, and combining with other vaccines
Both shingles vaccines can be given on the same day as the flu and pneumococcal vaccines, in different arms, which is convenient for an older adult making one visit. Read the overview in Which vaccines should adults over 60 have?. See vaccine details at shingles vaccine, recombinant and shingles vaccine, live. Message us on LINE with age and medical conditions and the team will check stock and plan the doses.
Frequently asked questions
At Mongkhondee Clinic the live vaccine is 5,000 baht/dose (single dose) and the recombinant vaccine 6,900 baht/dose, or 2-dose package 13,000 baht, including doctor and nursing fees.
Related services
Related vaccines
Related articles
Sources
- Shingles Vaccination: What Everyone Should Know U.S. Centers for Disease Control and Prevention
- Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines U.S. Centers for Disease Control and Prevention (MMWR)
- คำแนะนำการให้วัคซีนป้องกันโรคสำหรับผู้ใหญ่และผู้สูงอายุ สมาคมโรคติดเชื้อแห่งประเทศไทย
This content is general information and does not replace an examination, diagnosis or personal advice from a doctor. Published 20 September 2026
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