9 Questions to Ask Your Doc About the Shingles Vax
As of summer 2020, Shingrix is the only vaccine still in production to prevent shingles, a painful and potentially debilitating rash that can bring long-lasting neurological problems (people who complain about shingles really aren’t exaggerating). Here’s the skinny on your most pressing questions about this important shot–including who should get it, why they need it, and what to expect from it.
What Is Shingles?
Shingles (the technical term is “herpes zoster”) is caused by the varicella-zoster virus—the same one that causes chickenpox (varicella). Anyone who has had chickenpox or received the chickenpox vaccine is at risk for getting shingles, but it’s most common in people over 50. “Shingles can be extremely painful—the pain has been compared to childbirth or passing a kidney stone,” says Scott Kaiser, M.D., a geriatrician at Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, CA. “It lasts for months or even years after the rash improves, and results in other serious long-term complications.” In other words, shingles is something you want to avoid.
What Causes Shingles?
Shingles develops when that varicella virus, which has been hiding out in the body for decades, get reactivated. It occurs most commonly in people over 50 because the immune system begins to weaken, making it harder to keep the virus in check. “As you age, the immune system is slower to respond," says Richard Seidman, M.D., chief medical officer at L.A. Care Health Plan in California. And that slowdown can give the virus the opening it needs to reemerge. The Centers for Disease Control and Prevention (CDC) says half of people who reach age 85 have had or will get shingles.
What About the Old Shingles Vaccine?
There are currently two vaccine options in the United States. In 2006, the live zoster vaccine (Zostavax) became available. “Zostavax is 51% effective in preventing shingles,” says Nirmala Gopalan, M.D., medical director of the geriatrics clinic at Santa Clara Valley Medical Center in San Jose, CA. “It is recommended in healthy adults 60 years and older and is given as one dose.” Zostavax stopped being produced in the U.S. on July 1, 2020. However, pharmacies and clinics may continue to administer the vaccination, if it is in stock and not expired, before or by November 18, 2020.
Should I Get the Old Shingles Vaccine, or the New One?
The CDC currently recommends the recombinant zoster vaccine (Shingrix), which became available in 2017, as the preferred vaccination for shingles. Unlike Zostavax, which is a live vaccine, Shingrix is an inactivated vaccine (it contains killed virus). “Shingrix is over 90% effective in preventing shingles,” Dr. Gopalan says. Shingrix also has a lower age limit than Zostavax – the CDC recommends it for healthy adults 50 years and older. “Shingrix is given in two doses separated by at least two to six months, and you can get the Shingrix vaccine even if you’ve had the Zostavax vaccine in the past, or don’t remember having had chickenpox,” Dr. Gopalan says.
What Are the Benefits of Shingrix?
Along with preventing shingles, Shingrix is effective in preventing postherpetic neuralgia (PHN), the long-term nerve pain that is a common complication of shingles. “Studies show that in people age 50 to 69 who received two doses, Shingrix was 91% effective in preventing PHN; in people age 70 and older, it was 89% effective,” Dr. Kaiser says.
Researchers who monitored people in the years following vaccination found that the level of protection from Shingrix remained high. “As the risk of shingles—and PHN in those who develop shingles—increases with age, it is extremely important to have strong and lasting protection as you get older,” Dr. Kaiser says.
Who Shouldn't Get the Shingles Vaccine?
Like all vaccines, Shingrix isn’t suitable for everybody. If you have a history of severe allergic reaction (like anaphylaxis) to a vaccine or after a previous dose of Shingrix, you should avoid it. Shingrix hasn’t been studied in pregnant or breastfeeding women, so vaccination should be delayed until after birth and/or nursing. It’s fine to get the vaccine if you have a minor acute illness, like the common cold, but if you have a more severe illness and/or have a temperature of 101.3° F or higher, it’s best to wait until you’ve recovered.
When Should I Get Vaccinated?
You might think that you wouldn’t need a vaccine if you already had shingles, but shingles can strike twice, Dr. Seidman says. While there’s no set time that you must wait to get the vaccine after having a case of shingles, the CDC suggests making sure that the shingles rash has disappeared before getting the vaccine.
Because the effectiveness of the Zostavax vaccine drops significantly over time, your doctor may recommend vaccinating with Shingrix. If you previously got the Zostavax vaccine, the CDC recommends waiting at least eight weeks before getting Shingrix.
Are There Any Side Effects?
Minor, short-term side effects are possible with all vaccinations. “The shingles vaccine may cause muscle pain, redness at the injection site, or headache,” Dr. Gopalan says.
Because the Shingrix vaccine does cause a strong response in your immune system, it may cause some more short-term side effects that are more intense than with other vaccines, Dr. Kaiser adds. Some people may experience fatigue, headache, shivering, fever, stomach pain, or nausea—with about one out of six people reporting that these side effects prevented them from doing some of their regular activities for a short while following vaccination. However, most symptoms were gone within a few days.
- Prevalence of Shingles: Centers for Disease Control and Prevention. (2008). “CDC Recommends Shingles Vaccine.” cdc.gov/media/pressrel/2008/r080515.htm
- CDC Recommendation: Centers for Disease Control and Prevention. (2018). “Shingrix Recommendations.” cdc.gov/vaccines/vpd/shingles/hcp/shingrix/recommendations.html
- Shingrix Level of Protection: The New England Journal of Medicine. (2016). “Efficacy of the Herpes Zoster Subunit Vaccine in Adults 70 Years of Age or Older.” pubmed.ncbi.nlm.nih.gov/27626517
- Paying for Shingrix: GSK. (2020). “Coverage & Coding.” gskpro.com/en-us/products/shingrix/coverage