Do I need the Shingles Vaccine?

Shingles certainly won’t kill you, but they could result in a trip to the doctor or urgent care for some adults. In 2017, a new shingles vaccine called Shingrix became available for people 50 and over.  Should you consider vaccination to avoid shingles as an adult?

What is chickenpox, exactly? It’s an infection caused by the varicella-zoster virus. In children, it’s usually a mild disease that runs its course in five to 10 days and requires no medical intervention. But in those who develop chickenpox as teens or adults, there’s a risk of complications, including pneumonia, skin infections, and brain swelling.

What’s the difference between chickenpox and shingles? Adults can develop shingles if they’ve already had chickenpox. Also called herpes zoster, shingles is a reactivation of the virus that causes chickenpox. After you recover from chickenpox, the virus doesn’t entirely disappear — it lies dormant in nerve tissue near your spinal cord and brain. When it springs into action again as a painful skin rash, that’s shingles.

Shingles (Disease), Herpes zoster, varicella-zoster virus. skin rash and blisters on body

What if I’ve never had chickenpox? Almost everyone born before 1980 tests positive for exposure to varicella. That’s why the federal Advisory Committee on Immunization Practices considers people born before 1980 immune to the varicella virus. Even if you never broke out in the classic rash, if you’re 38 years old or older, you almost certainly have the virus lying dormant in your system.

So should I get the chickenpox vaccine or the shingles vaccine? For most healthy people, if you’re between 30 and 50 years old, there’s no need for either vaccine. However, there are some exceptions, including health care workers, pregnant women, teachers, and those who are HIV-positive. If you’re an adult who hasn’t received the vaccine or you think you’ve never been exposed to chickenpox, you can ask your primary care doctor to run a blood test called varicella titers. It shows your level of chickenpox immunity. 

But if you’re 50 or older, you can and should get the new shingles vaccine, Shingrix, whether or not you remember getting chickenpox in childhood. It’s given as a shot in two doses, two to six months apart.

Is Shingrix better than the older shingles vaccine Zostavax?

Yes. Shingrix is 97% effective at preventing herpes zoster (shingles) in folks over 50, whereas the Zostavax shot was 50-64% effective in preventing shingles and even lower for those over 70. Shingrix stays effective for longer.

Tell me more about the Shingrix vaccine.

Shingrix is not a live virus; it contains a single protein that causes the immune system to recognize the varicella-zoster virus. However, Shingrix causes fatigue, headache, and muscle pain in about 15% of people the following day, so plan your Shingrix vaccine when you have 24 hours of downtime.

If I’ve had the Zostavax, the older vaccine, when should I get Shingrix? 

About five years later. Studies examined the safety of Shingrix vaccination five or more years after the Zostavax vaccination.

What should I do if I’ve already had one outbreak of shingles? Still get Shingrix.

Should I give my children the chickenpox vaccine? Vaccine conversations are tricky, but there is no benefit to letting your kids get chickenpox over the vaccination. Adult medicine doctors are often asked if getting the chickenpox vaccine makes one more susceptible to getting shingles later in life. There’s no evidence that one route — vaccine versus infection — is more or less likely to lead to shingles.

What is post-herpetic neuralgia?

This what we worry about as primary care doctors because we’ve seen our patients suffer. Postherpetic neuralgia (PHN) is the most common complication of shingles. It occurs in about a fifth of all people who get shingles. PHN is pain that lasts after your shingles heal due to nerve fibers getting damaged during a shingles outbreak. The pain can last for months to years and be very severe, affecting sleep and interfering with normal recreational activities. In addition, studies have found that the risk for PHN increases with age. The chances of having post-shingles pain are  5% in patients younger than age 60,  10% for people aged 60 to 69, and 20% for people aged 80 years or older.

Dr. O.