NCHS Data Brief ■ No. 370 ■ July 2020

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Shingles Vaccination Among Adults Aged 60 

and Over: United States, 2018

Emily P. Terlizzi, M.P.H., and Lindsey I. Black, M.P.H.

Key findings

Data from the National 

Health Interview Survey

● Shingles vaccination among 

adults aged 60 and over 

increased from 6.7% in 2008 to 

34.5% in 2018.

● In 2018, women (35.4%) 

were equally as likely as men 

(33.5%) to have ever received a 

shingles vaccine.

● Non-Hispanic white adults 

(38.6%) were approximately 

twice as likely as non-Hispanic 

black (18.8%) and Hispanic 

(19.5%) adults to have ever 

received a shingles vaccine.

● Vaccination coverage was 

highest for those who were not 

poor and those who had more 

than a high school education.

● The percentage of adults 

aged 60 and over who ever had 

a shingles vaccination ranged 

from 26.3% in the East South 

Central region to 42.8% in the 

West North Central region of 

the United States.

Shingles is a painful rash caused by the varicella zoster virus (1). Persons of all 

ages are at risk for shingles. However, this risk and the risk of complications 

increase with age (1,2). Vaccines have been developed to prevent shingles, 

and beginning in 2017, the Advisory Committee on Immunization Practices 

(ACIP) recommended that all adults aged 50 and over be vaccinated (3). 

Prior to this change, ACIP had recommended that only adults aged 60 and 

over receive a shingles vaccine (3). This report describes trends in shingles 

vaccination as well as variation by demographic, socioeconomic, and 

geographic characteristics among adults aged 60 and over.

From 2008 through 2018, the percentage of adults aged 

60 and over who had ever received a shingles vaccine 

increased for all age groups examined.

50

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Percent

Survey year

Figure 1. Percentage of adults aged 60 and over who had ever received a shingles vaccine, by 

age group and year: United States, 2008–2018

1Significant quadratic increase from 2008 through 2018 (p < 0.05). 2Except for 2010, all percentage differences between adults aged 60–69 and adults aged 70 or over by year are statistically 

significant (p < 0.05). 

NOTES: Receipt of shingles vaccine is based on self-report. Each survey year, analysis excludes approximately 2%–3% of adults 

aged 60 and over with unknown shingles vaccination status. Estimates are based on household interviews of a sample of the 

civilian noninstitutionalized population. Access data table for Figure 1 at: https://www.cdc.gov/nchs/data/databriefs/

db370-tables-508.pdf#1. 

SOURCE: NCHS, National Health Interview Survey, 2008–2018. 

NCHS reports can be downloaded from: https://www.cdc.gov/nchs/products/index.htm.
NCHS Data Brief ■  No. 370  ■  July 2020

■  2  ■

● Among adults aged 60 and over, the percentage who had ever received a shingles vaccine 

increased from 6.7% in 2008 to 33.4% in 2016, and then remained constant through 2018 

(34.5%) (Figure 1).

● Among adults aged 60–69, the percentage who had ever received a shingles vaccine 

increased from 5.7% in 2008 to 29.6% in 2016, and then remained constant through 2018 

(28.8%).

● Among adults aged 70 and over, the percentage who had ever received a shingles vaccine 

increased from 7.8% in 2008 to 37.8% in 2016, and then remained constant through 2018 

(41.0%).

● For each year during 2008–2018, except for 2010, adults aged 70 and over were more likely 

than those aged 60–69 to have ever received a shingles vaccine.

Among adults aged 60 and over, receipt of shingles vaccination varied by 

race and Hispanic origin, but not sex.

● Among adults aged 60 and over, women (35.4%) were equally as likely as men (33.5%) to 

have ever received a shingles vaccine (Figure 2).

● Non-Hispanic white adults (38.6%) were more likely to have ever received a shingles 

vaccine than both Hispanic (19.5%) and non-Hispanic black (18.8%) adults.

Figure 2. Percentage of adults aged 60 and over who had ever received a shingles vaccine, by sex and race and 

Hispanic origin: United States, 2018

1Significantly different from non-Hispanic white adults (p < 0.05).

NOTES: Receipt of shingles vaccine is based on self-report. This analysis excludes approximately 3% of adults aged 60 and over with unknown shingles 

vaccination status. Adults categorized as Hispanic may be of any race or combination of races. Adults categorized as non-Hispanic white and non-Hispanic 

black indicated one race only. Estimates for non-Hispanic adults of races other than white only or black only, or of multiple races, are not included in this 

analysis. Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. Access data table for Figure 2 at: 

https://www.cdc.gov/nchs/data/databriefs/db370-tables-508.pdf#2. 

SOURCE: NCHS, National Health Interview Survey, 2018.

118.8

38.6

119.5

35.4

33.5

0 10 20 30 40

Non-Hispanic black

Non-Hispanic white

Hispanic

Women

Men

Percent
NCHS Data Brief ■  No. 370  ■  July 2020

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Receipt of shingles vaccination varied by poverty status and educational 

attainment among adults aged 60 and over.

● Receipt of shingles vaccination increased with family income, from 20.4% among poor 

adults to 38.4% among not-poor adults (Figure 3).

● Receipt of shingles vaccination increased with educational attainment, from 21.2% among 

adults with less than a high school diploma to 39.9% among adults with more than a high 

school diploma or GED.

1Significant linear trend by poverty status (p < 0.05). 2Significant linear trend by educational attainment (p < 0.05).

NOTES: Receipt of shingles vaccine is based on self-report. This analysis excludes approximately 3% of adults aged 60 and over with unknown shingles 

vaccination status. “Poor” adults are defined as having family incomes below the federal poverty level (FPL). “Near poor” adults are defined as having family 

incomes that are 100% to less than 200% of the FPL. “Not poor” adults are defined as having family incomes that are 200% or greater than the FPL. Estimates are 

based on household interviews of a sample of the civilian noninstitutionalized population. Access data table for Figure 3 at: https://www.cdc.gov/nchs/data/

databriefs/db370-tables-508.pdf#3. 

SOURCE: NCHS, National Health Interview Survey, 2018. 

Figure 3. Percentage of adults aged 60 and over who had ever received a shingles vaccine, by poverty status and 

educational attainment: United States, 2018

39.9

29.4

221.2

38.4

25.9

120.4

More than a high school 

diploma or GED

High school diploma or GED

Less than a high school diploma

Not poor

Near poor

Poor
NCHS Data Brief ■  No. 370  ■  July 2020

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Among adults aged 60 and over, the percentage who had ever received a 

shingles vaccine ranged from 26.3% in the East South Central region to 

42.8% in the West North Central region.

● The percentage of adults aged 60 and over who had ever received a shingles vaccine was 

significantly lower in the South Atlantic (32.0%) and East South Central (26.3%) regions 

compared with the national average (34.5%) (Figure 4).

● The percentage of adults aged 60 and over who had ever received a shingles vaccine 

was significantly higher in the West North Central (42.8%) and Pacific (38.2%) regions 

compared with the national average.

● The percentage of adults aged 60 and over who had ever received a shingles vaccine in 

the Mountain (38.1%), West South Central (31.5%), East North Central (35.6%), Middle 

Atlantic (31.5%), and New England (38.8%) regions was not significantly different from the 

national average.

Figure 4. Percentage of adults aged 60 and over who had ever received a shingles vaccine, by region: 

United States, 2018

NOTES: Receipt of shingles vaccine is based on self-report. This analysis excludes approximately 3% of adults aged 60 and over with unknown shingles 

vaccination status. The New England region includes CT, MA, ME, NH, RI, and VT. The Middle Atlantic region includes DC, DE, MD, NJ, NY, and PA. The East 

North Central region includes IL, IN, MI, OH, and WI. The West North Central region includes IA, KS, MN, MO, ND, NE, and SD. The South Atlantic region includes 

FL, GA, NC, SC, VA, and WV. The East South Central region includes AL, KY, MS, and TN. The West South Central region includes AR, LA, OK, and TX. The 

Mountain region includes AZ, CO, ID, MT, NM, NV, UT, and WY. The Pacific region includes AK, CA, HI, OR, and WA. Estimates are based on household 

interviews of a sample of the civilian noninstitutionalized population. Access data table for Figure 4 at: https://www.cdc.gov/nchs/data/databriefs/

db370-tables-508.pdf#4. 

SOURCE: NCHS, National Health Interview Survey, 2018. 

Mountain

38.1%

New England

38.8%

Middle

Atlantic

31.5%

South

Atlantic

32.0%

East South

Central

26.3%

West South

Central

31.5%

Pacific

38.2%

West North 

Central 42.8%

East North 

Central 35.6%

Not significantly different from U.S. average

Significantly lower than U.S. average

Significantly higher than U.S. average

U.S. average is 34.5%

OR

CA

AZ

AK

HI

NM

TX LA

MS AL GA

OH

FL

AR

MO

TN

KY

NE

OK

KS

NV

UT

CO

WA

ID

MT ND

WY

SD WI

MI

ME

CT MA

RI

NJ

DE

VT

NY

PA

WV

VA MD

NC

IL IN

MN

IA

DC

SC

NH
NCHS Data Brief ■  No. 370  ■  July 2020

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Summary

Shingles vaccination among adults aged 60 and over increased from 6.7% in 2008 to 34.5% in 

2018. Vaccination increased among both adults aged 60–69 and adults aged 70 and over. While 

there has been a shingles vaccine available since 2006, a new vaccine was introduced in late 

2017, and uptake in the market may have occurred differentially in 2018. The discontinuation 

of Zostavax®, the shingles vaccine singly available prior to 2018, starting in 2020 may further 

alter shingles vaccination patterns (4). Also in 2017, ACIP expanded their recommendation 

for shingles vaccination to adults aged 50 and over (3). Prior to this change (starting in 2008), 

shingles vaccination was only recommended for those aged 60 and over.

Shingles vaccination did not differ by sex, but non-Hispanic white adults were more likely to 

have ever received this vaccine compared with Hispanic and non-Hispanic black adults. Shingles 

vaccination increased with educational attainment, as well as with increasing family income. 

Additionally, regional differences were observed in receipt of shingles vaccination. This report’s 

findings are consistent with previous research regarding disparities in shingles vaccination by 

demographic and geographic characteristics (5,6). However, this report uses more recent data 

from a large, nationally representative data source to update these estimates and describe these 

disparities.

Definitions

Poverty status: Categories were calculated using National Health Interview Survey (NHIS) 

imputed income files and were based on family income and family size, using the U.S. Census 

Bureau’s poverty thresholds. “Poor” persons are defined as those with incomes below the federal 

poverty level (FPL); “near poor” persons have incomes of 100% to less than 200% of the FPL; 

and “not poor” persons have incomes of 200% of the FPL or greater.

Race and Hispanic origin: Adults categorized as Hispanic may be of any race or combination of 

races. Adults categorized as non-Hispanic white and non-Hispanic black indicated one race only. 

Estimates for non-Hispanic adults of races other than white only or black only, or of multiple 

races, are not included in this analysis.

Regions: Categories were slightly modified from the nine U.S. Census Bureau-designated 

divisions by moving Delaware, the District of Columbia, and Maryland into the Middle Atlantic 

region (7). Divisions include: New England—Connecticut, Maine, Massachusetts, New 

Hampshire, Rhode Island, Vermont; Middle Atlantic—Delaware, District of Columbia, Maryland, 

New Jersey, New York, Pennsylvania; East North Central—Illinois, Indiana, Michigan, Ohio, 

Wisconsin; West North Central—Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, 

South Dakota; South Atlantic—Florida, Georgia, North Carolina, South Carolina, Virginia, West 

Virginia; East South Central—Alabama, Kentucky, Mississippi, Tennessee; West South Central— 

Arkansas, Louisiana, Oklahoma, Texas; Mountain—Arizona, Colorado, Idaho, Montana, Nevada, 

New Mexico, Utah, Wyoming; and Pacific—Alaska, California, Hawaii, Oregon, Washington.

Shingles vaccination: From 2008 through 2017, this information was collected based on the 

survey question, “Shingles is an outbreak of a rash or blisters on the skin that may be associated 

with severe pain. The pain is generally on one side of the body or face. Shingles is caused by the 

chicken pox virus. A vaccine for shingles has been available since May 2006. Have you ever had 
NCHS Data Brief ■  No. 370  ■  July 2020

■  6  ■

the Zoster or Shingles vaccine, also called Zostavax®?” In 2018, the wording of this question 

was changed to, “Shingles is an illness that results in a rash or blisters on the skin and is usually 

painful. There are two vaccines now available for shingles; Zostavax®, which requires 1 shot, 

and Shingrix®, a new vaccine which requires 2 shots. Have you had a vaccine for shingles?” 

Receipt of a shingles vaccination was based on a positive response to these questions.

Data source and methods

Data from the 2008–2018 NHIS were used for this analysis. NHIS is a nationally representative 

household survey of the civilian noninstitutionalized U.S. population. It is conducted 

continuously throughout the year by the National Center for Health Statistics (NCHS). Interviews 

are conducted in respondents’ homes, but follow-ups to complete interviews may be conducted 

over the telephone. For more information about NHIS, visit: https://www.cdc.gov/nchs/nhis.htm.

Point estimates and the corresponding confidence intervals for this analysis were calculated using 

SUDAAN software (8) to account for the complex sample design of NHIS. Differences between 

percentages were evaluated using two-sided significance tests at the 0.05 level. Trends by age 

group were evaluated using JoinPoint software and confirmed using orthogonal polynomials in 

logistic regression. Trends by poverty status and educational attainment were evaluated using 

orthogonal polynomials in logistic regression. All estimates in this report meet NCHS data 

presentation standards for proportions (9).

About the authors

Emily P. Terlizzi and Lindsey I. Black are with the National Center for Health Statistics, Division 

of Health Interview Statistics.
NCHS Data Brief ■  No. 370  ■  July 2020

■ 7  ■

References

1. National Center for Immunization and Respiratory Diseases. Shingles (herpes zoster).

Available from: https://www.cdc.gov/shingles/index.html.

2. National Center for Immunization and Respiratory Diseases. Complications of

shingles. Available from: https://www.cdc.gov/shingles/about/complications.html.

3. Dooling KL, Guo A, Patel M, Lee GM, Moore K, Belongia EA, Harpaz R.

Recommendations of the Advisory Committee on Immunization Practices for use of

herpes zoster vaccines. MMWR Morb Mortal Wkly Rep 67(3):103–8. 2018.

4. National Center for Immunization and Respiratory Diseases. Shingles (herpes zoster). 

Available from: https://www.cdc.gov/shingles/vaccination.html.

5. National Center for Immunization and Respiratory Diseases. Vaccination coverage

among adults in the United States, National Health Interview Survey, 2016. Available

from: https://www.cdc.gov/vaccines/imz-managers/coverage/adultvaxview/

pubs-resources/NHIS-2016.html#ref03.

6. Lu P, O’Halloran A, Williams WW, Harpaz R. National and state-specific shingles

vaccination among adults aged ≥ 60 years. AM J Prev Med 52(3): 362–72. 2017.

7. Holahan J, Buettgens M, Carroll C, Dorn S. The cost and coverage implications of the

ACA Medicaid expansion: National and state-by-state analysis. Kaiser Commission on

Medicaid and the Uninsured. 2012.

8. RTI International. SUDAAN (Release 11.0.3) [computer software]. 2018.

9. Parker JD, Talih M, Malec DJ, Beresovsky V, Carroll M, Gonzalez Jr. JF, et al.

National Center for Health Statistics data presentation standards for proportions. National

Center for Health Statistics. Vital Health Stat 2(175). 2017. 
NCHS Data Brief ■  No. 370  ■  July 2020

Keywords: herpes zoster • vaccine • prevention • National Health Interview 

Survey

Suggested citation

Terlizzi EP, Black LI. Shingles vaccination 

among adults aged 60 and over: United 

States, 2018. NCHS Data Brief, no 370. 

Hyattsville, MD: National Center for Health 

Statistics. 2020.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Brian C. Moyer, Ph.D., Director

Amy M. Branum, Ph.D., Acting Associate 

Director for Science

Division of Health Interview Statistics

Stephen J. Blumberg, Ph.D., Director

Anjel Vahratian, Ph.D., M.P.H., Associate 

Director for Science

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