Understanding the immunology of the Zostavax shingles vaccine

•Zostavax is a safe vaccine to prevent shingles/postherpetic neuralgia.•Zostavax is a weak stimulator of innate immune responses.•Zostavax changes several metabolomic pathways which are correlated with immune outcome.•Zostavax elicits polyfunctional VZV-specific CD4+ T cells and low CD8+ T cell responses.•Zostavax boosts antibody responses which are strongly influenced by pre-existing antibody levels.