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Q

Need a Shingles Shot?

I had a case of shingles a few years back. One doctor said I should get the shingles vaccination while another said it isn't necessary. What is your opinion?

A
Answer (Published 1/19/2015)

Get the shot.

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Shingles is caused by the herpes zoster virus, which is also responsible for chicken pox. The virus can lie dormant in the body for many years after a bout of chicken pox and then reactivate for unknown reasons to stage a new attack in the form of shingles. If you’ve had chicken pox (which is quite likely – according to the CDC more than 99 percent of Americans ages 40 and older have had chickenpox, even if they don’t remember it), you have a 10 to 20 percent chance of someday developing shingles

 The risk of shingles increases with age: of the one million cases that occur in the United States every year, about half are in people over 60. The rate of shingles has been increasing in recent years, for reasons that aren’t clear.

Shingles is an unpleasant experience at best, as I learned when I developed a moderate case in 2006. An attack typically begins with an itch, a tingling sensation, or a stabbing pain, usually on the surface of the skin of the torso or the face. A few days later, a rash develops that runs along the course of a nerve root on one side of the body. The rash then turns into small, fluid-filled blisters that then dry out and crust. At its peak, the outbreak can cause intense pain. A few people get over shingles quickly, but a severe attack can last for three to five weeks and leave some unlucky individuals with residual pain that can linger for months or even years after the lesions disappear; this condition is called post-herpetic neuralgia.

The FDA approved the vaccine Zostavax® in 2006 to prevent shingles in people age 50 and older, but the vaccine is really aimed at those over 60 because they’re at highest risk. Zostavax isn’t perfect. It works about 51 percent of the time. But according to the CDC it prevented post-herpetic neuralgia in 67 percent of the people who participated in the drug trial to establish the vaccine’s effectiveness. The Zostavax seems to work best for people 60 to 69 years old but also provides some protection for older groups.

The CDC recommends having the vaccine even if you’ve had shingles in the past because it can help prevent future attacks. Just be certain that your shingles rash has disappeared before getting the shot.

You should not be vaccinated if you have ever had a life-threatening or severe allergic reaction to gelatin, the antibiotic neomycin, or any other component of shingles vaccine. Be sure to tell your doctor if you have any severe allergies. Others who should not have the vaccine are individuals with weakened immune systems due to HIV/AIDS or other diseases affecting the immune system; those being treated with steroids or chemotherapy; cancer patients and pregnant women.

Possible side effects are redness, soreness, swelling or itching at the injection site and (in one out of 70 people) headache. Medicare Part D (the drug plan) covers the cost, but depending on your specific plan you may have to make a co-payment. Most private health insurance covers the cost of the vaccine for people over the age of 60 and some also cover the cost for individuals age 50 through 59.

Bottom line: I definitely recommend getting the vaccine whether or not you’ve had a prior shingles attack.

Andrew Weil, M.D.

Sources:

http://www.cdc.gov/vaccines/vpd-Vac/shingles/vacc-need-know.htm
http://www.cdc.gov/vaccines/hcp/vis/vis-statements/shingles.html
http://www.cdc.gov/shingles/hcp/clinical-overview.html

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