What is shingles?
Shingles, also called herpes zoster, is a painful rash forming along the path of one spinal or brain nerve. The Centers for Disease Control and Prevention recommends that people over 50 receive two doses of the recombinant zoster vaccine (RZV).
Shingles, also called herpes zoster, is a painful rash forming along the path of one spinal or brain nerve. It can affect your trunk, limbs, or face. The disease itself is agonizing and can be contracted more than once.
Thankfully, safe and effective vaccines are available, but there's some confusion about who is a candidate for the shingles vaccine. Currently, only one vaccine is available in the USA: the recombinant zoster vaccine (RZV). This vaccine is sold under the brand name Shingrix and is typically recommended for people over 50 years old.
Shingles is a late-stage complication of chickenpox. It starts with some tingling in one part of the body that later becomes painful. You may have a headache and feel unwell. A rash may appear a few days later. It is most often located on the trunk but may also affect the limbs, genitals, or head.
The shingles rash is almost always on one side of the body. A rash that crosses the midline of the body is not likely to be shingles.
The rash starts as a series of red patches and later becomes a cluster of small blisters. It can be intensely painful.
The rash typically crusts and disappears in 2 to 4 weeks. The pain also gradually subsides. Pain that persists for more than 90 days is considered postherpetic neuralgia (PHN), a complication of shingles that affects one in five people. This pain can be severe and last months to years.
Almost everyone above a certain age is at risk of contracting shingles. More than 99% of Americans born before 1980 have had chickenpox, though they may not remember it. That means they have the virus alive inside their body, persisting within the nervous system.
Conditions that reduce your immunity and could wake the virus, subsequently causing shingles, include:
- Old age. Immunity weakens with age. Shingles occurs most frequently in people over 70.
- Stress (physical or emotional). Chronic stress can impact your immune system.
- HIV and AIDS. These diseases suppress the immune system.
- Chemotherapy. Many of the medicines used in chemo suppress the immune system.
Who is a candidate for the shingles vaccine?
The Centers for Disease Control and Prevention recommends that people over 50 receive two doses of the recombinant zoster vaccine (RZV). People over 19 with a weakened immune system should also get it.
Some conditions that weaken the immune system include:
- Cancer. Leukemia and lymphoma are especially dangerous
- Bone marrow or organ transplants. Recipients of these have to take immunosuppressive medicines for a long time.
- Treatment with immunosuppressive medicines like steroids and chemotherapy.
You should have this vaccine even if:
- You have had shingles before
- You received the earlier shingles vaccine, Zostavax
- You received the chickenpox (varicella) vaccine
There is no upper age limit for this vaccine.
You should not get this vaccine if you:
- Have shingles right now. You can take it once you're better.
- Are pregnant. RZV is not a live vaccine, but safety for use in pregnancy has not yet been fully tested.
- Had a severe allergic reaction to an earlier dose.
How often do you need the shingles vaccine?
Two doses of RZV are required. Once you take the first dose, your physician will call you for the second dose after 2 to 6 months. The vaccine is an injection and will be injected intramuscularly into your shoulder. You must take two doses even if you have received the varicella vaccine or Zostavax (the other shingles vaccine), or have had chickenpox before.
If you have weakened immunity, you are at risk for shingles at younger ages. Your physician may give you the second dose of shingles vaccine a month after the first dose to build your protection faster. They may also do this if you are going to be immune-suppressed because of chemotherapy or an organ transplant.
The earlier vaccine, Zostavax, was a live virus vaccine, and you only needed one dose. That vaccine has not been available in the USA since November 2020.
Shingles vaccine efficacy
The recombinant zoster vaccine, Shingrix, is highly effective. It provides 90% protection against shingles to people 50 years and older who have healthy immune systems. This protection remains for at least 7 years.
People with weakened immune systems are also protected. The vaccine is 68% to 91% effective at preventing shingles in those cases. This protection is valuable since people with weakened immunity are likely to have more severe shingles.
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Risks of the shingles vaccine
The currently used vaccine, Shingrix, is generally a safe product. Possible adverse effects, though, include pain, redness, and swelling at the injection site. Others include body aches, tiredness, headache, shivering, and fever.
Why only get the shingles vaccine over age 50?
Shingles is uncommon in young people with a healthy immune system. The risk of shingles and its complications increase sharply after age 50, though. Older adults are more likely to have PHN and other complications necessitating hospitalization. Some serious complications of shingles include pneumonia, encephalitis (brain inflammation), and eye involvement that may cause blindness.
Since people over 50 are the most frequently affected, the vaccine trials were performed on this group. It is estimated that one case of shingles can be prevented by vaccinating 11 to 17 people over 50. For people younger than 50, the benefits from this vaccine are much lesser. The vaccine has excellent efficacy at this age, though, and will prevent shingles in midlife and beyond.
Conclusion
RZV (Shingrix) is a safe and effective vaccine for the prevention of shingles. People who have had chickenpox can also get shingles (that includes almost everyone born before 1980). If you are over 50, you should get this vaccine to keep yourself safe from shingles and its complications. People below 50 should only get this vaccine if they have weakened immunity that puts them at a higher risk of getting shingles at a younger age.
