Lingering Questions And Answers About The Shingles Vaccine

Shingles (Wikimedia Commons)

A case of shingles (Wikimedia Commons)

In case you missed our earlier post and Radio Boston segment on the shingles vaccine, here’s the CliffsNotes version:

Whether to get the shingles vaccine is a complex personal decision, and here are some points to consider as you make it: Your risk of shingles  – a painful, blistery rash – rises dramatically as you age. The vaccine, Zostavax, is about 51% effective at preventing shingles but far more effective at preventing a potentially life-ruining complication, a chronic pain condition called postherpetic neuralgia. The vaccine is approved for age 50 and up, and it is generally covered by health insurance if you’re over 60, but coverage for younger people gets spotty, and Zostavax is not cheap, costing up to $200 or so. And preliminary studies suggest that the vaccine’s protection wears off somewhat after a few years.

Left scratching your head? Join the club. I’ve decided to get the vaccine out of sheer terror — I’ve just heard too many horror stories, and the post brought more in the comments section. But because shingles is not generally contagious, your decision does not affect others, so you’ll hear no preaching from me about whether you should get it. I do, however, want to add a few points of information in response to readers’ very good questions:

Q: What about children who have had the chicken pox vaccine? Will they be able to contract shingles in the future? I’ve asked a couple of physicians, and they did not know the answer. 

A: According to the CDC: The short answer is yes, but the risk is a small fraction of the risk following chickenpox itself. In case you wish to know more, chickenpox can be mild and unrecognized during infancy or in utero, or following vaccination (the vaccine does not prevent all infections). So kids may get the vaccine and also (often unknowingly) be infected with the natural virus. Also, the weakened virus used to formulate the varicella vaccine can in fact cause shingles. But the risk for all of these seems low and rates of shingles in children and adolescents seem to be declining.

Q: What are the risks for someone who never got chicken pox as a child?  Should I get the chicken pox vaccine (in my mid thirties) or wait and get the shingles one?

A: Also according to the CDC, well over 99% of adults have been infected with the chickenpox virus, including persons who do not recall the illness, and if you were born before 1980 you need not get the chickenpox vaccine but can instead wait to get the shingles vaccine (exception: guidelines for health care workers are more stringent). Persons who wish to be reassured can ask their physician about lab testing to confirm that they have evidence of chickenpox infection. It’s all more complex than this, but that may be more than you want to read.

A couple of somewhat biting comments also raise good points. (Sigh. Must you pollute your good thoughts with trollishness?)

One begins “Unbelievably naive reporting on the efficacy of said vaccine. Wow:).” Gee, thanks, friend, I didn’t know it was naive to quote the country’s premier government health authority on efficacy. But you do make a good point, which is that early data suggest that the vaccine’s protection drops very significantly with time. Here is the site for Zostavax on the European Medicines Agency website, and if you go to page 21 of the product information here you’ll find this early data suggesting that the protection drops, very roughly, by half: (HZ refers to herpes zoster, or shingles; PHN is postherpetic neuralgia, the longer lasting complication; and BOI is “Burden of Illness.”)

The Long-term Persistence Substudy (LTPS): Following completion of the STPS, the LTPS evaluated the duration of protection against HZ, PHN and HZ BOI in a total of 6,867 subjects previously vaccinated with ZOSTAVAX in the SPS. The mean age at enrollment into the LTPS was 74.5 years. A concurrent placebo control was not available in the LTPS; data from prior placebo recipients were used to estimate vaccine efficacy.

The LTPS analyses for vaccine efficacy are based on data collected primarily from Year 7 through Year 10 following vaccination in the SPS. The median follow-up during the LTPS was ~3.9 years (range is one week to 4.75 years). There were 263 evaluable HZ cases reported among 261 patients [10.3/1000 person- years] during the LTPS. The estimated vaccine efficacy during the LTPS follow-up period was 21% (95% CI: [11 to 30%]) for HZ incidence, 35% (95% CI: [9 to 56%]) for PHN incidence and 37% (95% CI: [27 to 46%]) for HZ BOI.

And finally, a commenter who called me simplistic (Hey, have you been talking to my husband?) writes: “What’s scary is that we MAY be turning a simple childhood illness into an epidemic of adult onset of shingles.” The comment links to a 2006 journal article connecting the rise in shingles to the drop in cases of childhood chicken pox thanks to the vaccine.

Indeed, when I spoke to Dr. Anne Louise Oaklander of Massachusetts General Hospital, she confirmed that the near-universal chickenpox vaccine is thought to be contributing to a rise in shingles. Part of the impetus for developing the shingles vaccine, she said, came from projections of a spike in shingles because of the childhood vaccine. The thinking: When children have chicken pox and adults are exposed to them, the exposure boosts the adults’ immunity to the virus that causes both. Now, with the vast majority of children immunized, the adults get much less exposure, and less of a boost.

“Epidemiologists long ago made the observation that women on average come down with shingles several years after men,” she said, “and it was figured out that the likeliest reason was that the majority of people looking after kids with chicken pox were women. And when adults are exposed to kids with chicken pox, or grandparents with shingles, it reboosts their immunity.”

 

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  • LisaBNM

    I am 48. I had my first minor case at 40. Had it 8 more times in the next 6 years, 4 of those cases occurred within 12 months. I insisted on the shot as each episode got worse. I got a very mild case 2 weeks after the vaccine but seemed to be in the clear after that. Until today 2 years later. I woke up with new sores and not in the same place as usual. I’m terrified that they will continue to get worse.

  • Lucy Carr

    i agree with Dorene that maybe the shingles vaccine might bring on the shingles disease…can a doctor respond to my statement? Please?

  • Shelley McD

    If the herpes zoster is anything like herpes simplex, then it does indeed remain dormant, and there is no building up immunity to the virus. A friend had shingles and continues to get little outbreaks, which she treats topically with a homeopathic anti-inflammatory gel. What brings on outbreaks of cold sores (herpes simplex on the lips) based on my experience is usually stress. The good news is there is a preventative measure – taking the amino acid L-Lysine (available in capsule form), which at least lessens the eruption of the blisters if it doesn’t prevent it altogether. L-Lysine has been studied for this and has been used for decades to minimize and prevent herpes. After reading this article and related posts, I am NOT going to get the vaccination. I will just be careful to take the L-Lysine, get plenty of rest and boost my immune system with better nutrition and natural supplements.

  • wilber deck

    Since varivax and zostavax (the chicken pox and shingles vaccines, respectively) are both live vaccines, it seems to me it shouldn’t matter what dose you get, whether it is one of the two varivax doses or the much higher zostavax dose. Has this been studied? Given the huge price difference between the two, I wouldn’t expect Merck to have studies or published anything about this, but is there any other evidence?

  • nefana

    Shingles itself isn’t contagious but the virus that causes it is! If a person with no prior cases of chicken pox or the chicken pox vaccination is exposed to someone with shingles and gets the varicella virus in their system, they get chicken pox. And what if that someone has a depressed immune system and the chicken pox causes major harm? The vaccine actually is helpful to not only the person who gets it but to one that isn’t able to get it as well. Do more research, because if you don’t people end up getting hurt.
    http://deadlymicrobes.com/what-causes-shingles#more-471

  • Robert Reuther

    Received the shingles vaccination on January 29, 2014. Began having shingles pain late on January 31, 2014. Rash started the next day (February 1). Still have rash (February 7). Went back to doctor. At first, doctor didn’t know whether shingles vaccine could cause shingles, but later confirmed that there are apparently known cases. He called the manufacturer, who stonewalled, but agreed to fax directions on obtaining a sample from a blister to send for analysis by the manufacturer (this was on February 3). His office is still waiting on the directions for obtaining and sending the sample for analysis. The “official” reason why they haven’t received the fax from the manufacturer is because the manufacturer’s office is having power issues.

    Apparently, the analysis can determine whether the vaccine was at fault for the shingles. I am beginning to suspect that they are stonewalling and hoping that my rash heals, which means that they won’t be able to obtain a useable sample for testing.

  • Dorene Ernst

    I am afraid to get the shingles vaccine because I keep hearing of people who get the shot and then get shingles. I don’t think that is a coincidence

  • jane

    How often should be get the vaccination? I got one when I turned 60

  • BILL

    IS ZOSTAVAX A LIVE VACCINE ??

  • Susie

    My husband and I both had the shingles shot three years ago and cost was $168.00 each. Neither of our insurances covered a dime (Medicare and United Health Care). WHY ?? Several people have since told me that their Medicare did cover charges for their shot.

  • vincent

    Do I need a Dr. Prescription for the shingle vacinne? I am 66 yrs old.

  • Supermom2

    I’ve had shingles but doctor says I actually ‘vaccinated’ myself by having shingles. Another doctor said I am prone to get shingles again and to get shingles vaccination! Below experiences regarding vaccine reactions, I will NOT be getting the vaccine shot since I already vaccinated myself.

    • Jennifer

      omg, you don’t “vaccinate yourself” by coming down with shingles. Once you have the varicella zoster virus, that virus stays dormant in your nerves until times of stress or compromised immunity. You CAN get the shingles virus more than once. Some people…wow.

      • Shelley McD

        omg. Some people can be so rude and condescending.

    • Shelley McD

      Since shingles is a form of herpes, you can’t really build up immunity to it. But there are ways to prevent an outbreak. The amino acid L-Lysine has been used for many years to minimize and prevent cold sore eruptions, which are usually brought on by stress. I would bet it works the same way for shingles. I keep Acyclovir on hand for cold sores, and will keep it refilled just in case!

  • CRichter

    I had shingles right after my diagnosis of breast cancer. Is there any point of getting the vaccine or is it NOT reccommended for people who have already had shingles????

  • Dottywhack

    I have had the shingles vaccine-two years ago. Is there a nneed to get the vaccine more than I time only?

    • capri44

      I had the shingles vaccine, as did my hubby, and two years later had a very serious breakout of shingles. (According to my dr. it’s only effective from 85-95% of patients.) Hubby didn’t get shingles, but our dr. suggested that we both get second shingles shots, which we did 2 days ago. Now, he has a red spot about the size of a plum where he received the injection, but I so far don’t have any reaction. Now it’s a wait and see game to watch if the red spot on his arm actually gets better or becomes infected.

    • jane

      That’s what I would like to know…..anyone out there have an answer?

  • Dave

    I developed shingles pain exactly 12 days after receiving the vaccine (diagnosed by a doctor). Two days later the shingles rash began. Clearly, the shingles vaccination caused shingles. I have reported this to the CDC.

    • Lin Maine

      I thought I was the only one who developed shingles within a few days of receiving the vaccine. I can’t find any info on this, and my doctor is stumped!

  • Momkat

    I and two of my friends developed shingles after taking the vaccine. But we didn’t report it. So perhaps there are thousands and thousands of unreported cases?

    • Bruce

      I got shingles 5 days after getting the vaccine.

      • Vanessa Michelle Johnston

        My mom just got shingles a week after vaccination. This seems like a very common problem

  • Shae

    I’m reading that since i was exposed chicken pox when my children were infected, my immunity to shingles is boosted