Mayo Clinic Q And A: New Shingles Vaccine Recommended For Most Adults Over Age 50
DEAR MAYO CLINIC: How effective is the shingles vaccine? Who should get it? Is it recommended even for those who have already had shingles?
ANSWER: A new vaccine, called Shingrix, is now available thats very effective in preventing shingles. The Centers for Disease Control and Prevention recommends that everyone age 50 and older with a healthy immune system receive this vaccine, whether youve had shingles before or not.
Unlike the other vaccine thats been available for shingles since 2006, called Zostavax, this new vaccine is inactivated. That means it does not contain a live virus. Because of that, it is safe in people who have weakened immune systems. However, the CDC has not yet made recommendations for Shingrix vaccination in these individuals. If you have a weakened immune system, talk to your health care provider about your vaccination options for shingles.
Shingles is caused by a virus called varicella-zoster. When youre first infected with this virus, it causes the itchy rash known as chickenpox. Although chickenpox is uncomfortable, most people recover from it without any lasting problems. But after the rash of chickenpox goes away, the virus does not. Instead, the varicella-zoster virus goes into hiding in your bodys nerve cells.
Why Older Adults Have A Higher Risk
Since a weakened immune system is more susceptible to a trigger, shingles is generally more common and more severe in people over age 50. Thats why the shingles vaccine is recommended at age 50because your immune system weakens as you age. That said, people of all ages can have weakened immune systems, such as from chronic diseases like AIDS.
Older adults also have a higher risk of lasting pain from shingles, which is called postherpetic neuralgia , and a higher risk of hospitalization from shingles. About 10 to 18 percent of people who get shingles have potentially debilitating PHN, according to the Centers for Disease Control and Prevention.
Thats why young adults need to pay attention to their bodies, their overall physical and mental wellness, their social calendars, and their stress management. This is good advice for overall health, but it can also help prevent shingles and catch it early.
What If Ive Had The Vaccine For Chickenpox
Many young adults have had the vaccine for VZV, the virus that causes chickenpox. Although uncommon, its still possible to develop shingles if youve had the vaccine.
People whove received the VZV vaccine are at a lower risk for developing shingles. For example, a 2019 study in children found that the incidence of shingles was
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What Are The Benefits Of The Shingles Vaccine
The shingles vaccines are the best way to protect you from getting shingles. The vaccines have been shown to reduce the risk of getting shingles by 50% for Zostavax® II, and to more than 90% for Shingrix®.
For those who still get shingles after being immunized, the vaccines can reduce pain, including the type of pain that lasts after shingles.
Which Vaccines Do Older Adults Need
As you get older, a health care provider may recommend vaccinations, also known as shots or immunizations, to help prevent certain illnesses.
Talk with a doctor or pharmacist about which of the following vaccines you need. Make sure to protect yourself as much as possible by keeping your vaccinations up to date.
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Why Can’t You Get The Shingles Vaccine Before 50
Shingles is a painful belt-like patterned rash caused by varicella-zoster virus . Shingles is more common in adults over 50 years of age and in people with conditions that weaken the immune system.
The varicella-zoster virus is a type of herpesvirus. Other herpesviruses include the herpes simplex virus, which causes cold sores and genital herpes.
The shingles vaccine is available for adults 50 years and older to reduce the chance of developing shingles. Shingrix requires two doses administered two to six months apart. The two doses of Shingrix are more than 90% effective at preventing shingles and postherpetic neuralgia. Protection from the Shingrix shingles vaccine stays above 85% for at least four years after vaccination.
The Shingrix shingles vaccine is not approved by the Food and Drug Administration for use in people under 50 years of age. However, adults 19 years and older with weakened immune systems may also get two doses of shingles vaccine, due to a higher risk of getting shingles and related complications.
The vaccine has only been tested in adults 50 years and older and The Advisory Committee on Immunization Practices , a committee that is part of the Centers for Disease Control , does not recommend zoster vaccination for people younger than age 50 years regardless of their history of shingles.
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 . 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 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.
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When Should You Get Immunised Against Shingles
Anyone aged 60 years and over who wants to protect themselves against shingles can talk to their doctor about getting immunised.
Shingles immunisation is recommended for:
- adults aged 60 years and over who have not previously received zoster vaccine
- adults aged 70 years to 79 years, for free under the National Immunisation Program
- adults aged 50 or over who live in the same household as someone who has a weakened immune system.
Whos Most At Risk Of Shingles
People tend to get shingles more often as they get older, especially over the age of 70. And the older you are, the worse it can be. The shingles rash can be extremely painful, such that sufferers cannot even bear the feeling of their clothes touching the affected skin.
The pain of shingles can also linger long after the rash has disappeared, even for many years. This lingering pain is called post-herpetic neuralgia .
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How Can I Get The Shingles Vaccine
You can buy the shingles vaccine at most pharmacies and travel clinics. Shingrix® is given as a series of 2 doses, 2 to 6 months apart, and costs about $150/dose. Zostavax® II is given as 1 dose and costs about $200. Some health insurance plans may cover the cost of the vaccine check with your provider.
If you buy the vaccine at a travel clinic, a doctor or nurse on site will be able to immunize you. Most pharmacists in B.C. are also able to immunize.
If you want to be immunized by your doctor, find out if they have a supply of the shingles vaccine.
How Do I Get The Shingles Vaccination
Once you become eligible for the shingles vaccination, a GP or practice nurse will offer you the vaccine when you attend the surgery for general reasons.
You can have a shingles vaccine at the same time as most other vaccines. But try to leave 7 days between the shingles vaccine and a coronavirus vaccine, so that if you have any side effects you’ll know which vaccine they were from.
If you are worried that you may miss out on the shingles vaccination, contact your GP surgery to arrange an appointment to have the vaccine.
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How Does The Shingles Vaccine Work
The vaccine recommended for most people is a live vaccine called Zostavax. It contains a weakened chickenpox virus . Itâs similar, but not identical, to the chickenpox vaccine.
People with a weakened immune system cannot have live vaccines. They will be offered a non-live vaccine called Shingrix. It activates the immune system but also contains an ingredient called an adjuvant, which helps to boost the response to the vaccine.
Very occasionally, people develop chickenpox following shingles vaccination . Talk to a GP if this happens to you.
Is The Shingles Vaccine Safe
As with any vaccine, its possible to have some side effects after receiving it. In clinical studies, the side effects linked to this vaccine usually lasted only 2 to 3 days, and the most common ones were:
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Pain and redness at the injection site
Most people report at least some arm pain after the injection. Some people reported that their side effects kept them from doing their usual daily activities. For this reason, its a good idea to plan to not do anything right after receiving your injection, just in case.
Severe allergic reaction to this vaccine is very rare. Symptoms of such a reaction include:
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Shingles Vaccine For Older Adults
Shingles is caused by the same virus as chickenpox. If you had chickenpox, the virus is still in your body. As you get older, the virus could become active again and cause shingles.
Shingles affects the nerves. Common symptoms include burning, shooting pain, tingling, and/or itching, as well as a rash with fluid-filled blisters. Even when the rash disappears, the pain can remain. This is called post-herpetic neuralgia, or PHN.
The shingles vaccine is safe, and it may keep you from getting shingles and PHN. Healthy adults age 50 and older should get vaccinated with the shingles vaccine, Shingrix, which is given in two doses.
You should get a shingles vaccine even if youve already had chickenpox or the chickenpox vaccine, or if you don’t remember whether you had chickenpox. You should also get the shingles vaccine if you’ve already had shingles or received Zostavax. However, you should not get a vaccine if you currently have shingles, are sick or have a fever, have a weakened immune system, or have had an allergic reaction to Shingrix. Check with a health care provider if you are not sure what to do.
You can get the shingles vaccine at a doctors office and at some pharmacies. Medicare Part D and private health insurance plans may pay some or all of the cost. Check with Medicare or your health plan to find out if it is covered.
Who Should Not Get The Shingles Vaccine
Some people shouldnt get the shingles vaccine. These people include those:
- Who currently have shingles.
- Who have had a severe allergic reaction to the shingles vaccine in the past.
- Who have tested negative for immunity to the varicella-zoster virus, meaning youve never had chickenpox. If youve never had chickenpox, you should get the chickenpox vaccine.
- Who are ill. You should wait until your illness has passed before receiving the shingles vaccine.
- Who are pregnant or breastfeeding.
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What Are Your Chances Of Getting Shingles
Only people who have had chickenpox can get shingles.
Out of 100 people, about 30 may get shingles sometime in their lives.footnote 2 And the risk is higher for people age 50 and older. Older people are also more likely to have severe pain with shingles.
Most people who get shingles will not get it again. But some people get shingles more than once.
Why Is The Shingles Vaccine Important
Shingles causes a painful rash and blisters and it can lead to serious complications. The most common complication is post-herpetic neuralgia , a condition that causes burning pain that can last long after the shingles rash and blisters go away. The older you are when you get shingles, the more likely you are to develop PHN.
Getting vaccinated is the best way to prevent shingles and PHN.
Shingles is caused by the same virus that causes chickenpox. After you have chickenpox, the chickenpox virus stays dormant in your body. The virus can activate years later and cause shingles.
Symptoms of shingles include:
Shingles cant spread from person to person like chickenpox. But if you have shingles, you can spread the virus to someone who isnt immune to chickenpox meaning someone who hasnt had chickenpox and isnt vaccinated against it. If that happened, the person might get chickenpox but not shingles. Learn more about shingles.
- Adults age 50 and older
- Adults 19 years and older who have a weakened immune system because of disease or treatments
You need to get 2 doses of Shingrix. Youll need the second dose 2 to 6 months after the first dose. You need to get Shingrix even if you:
- Have already had shingles
- Have been vaccinated against shingles with Zostavax
- Are not sure if youve had chickenpox
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Know The Benefits And The Side Effects
Shingrix is more than 90% effective at preventing shingles and long-term nerve pain. You may experience some short-term side effects because Shingrix causes a strong response in your immune system.
After getting Shingrix:
- Most people had a sore arm.
- Many people had redness and swelling where they got the shot .
- Many felt tired, had muscle pain, a headache, shivering, fever, stomach pain, or nausea.
About 1 out of 6 people who got Shingrix experienced side effects that prevented them from doing regular activities like yardwork or swimming. Side effects usually go away after 2 to 3 days. Remember that the pain from shingles can last a lifetime, and these side effects should only last a few days.
Do I Need To Pay For Shingles Immunisation
Vaccines covered by the NIP are free for people who are eligible. See the NIP Schedule to find out which vaccines you or your family are eligible to receive.
Eligible people get the vaccine for free, but your health care provider may charge a consultation fee for the visit. You can check this when you make your appointment.
If you are not eligible for free vaccine, you may need to pay for it. The cost depends on the type of vaccine, the formula and where you buy it from. Your immunisation provider can give you more information.
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The Biology Behind That Blistering Rash
During the initial exposure to chickenpox, some of the virus particles settle into the nerve cells around the spinal cord and brain. When the virus reactivates sometimes decades later, as a result of things like stress it travels down those nerve fibers to the skin. As the virus multiplies, the telltale rash erupts.
Make A Plan To Get 2 Doses
- You can get Shingrix at your doctors office or pharmacy. Talk to your doctor or pharmacist about getting Shingrix.
- Plan to get your second dose of Shingrix 2 to 6 months after your first dose.
Five years later, I still take prescription medication for pain. My shingles rash quickly developed into open, oozing sores that in only a few days required me to be hospitalized. I could not eat, sleep, or perform even the most minor tasks. It was totally debilitating. The pain still limits my activity levels to this day.
A 63-year-old harpist who was unable to continue playing due to shingles
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Dr Roach: Must Son Wait Until Hes 50 To Get Shingles Vaccine
Dear Dr. Roach: In your recent column referring to the shingles vaccine, you do not mention younger adults. My son had a very bad case of chickenpox when he was only 6 months old. He is now 40 years old, and earlier this year had an attack of shingles that affected the area behind his ear. He wanted to get the shingles vaccine to hopefully avoid a repeat of this and was told he was too young and would have to wait until he is 50 to get it. Is he to remain susceptible to this for another 10 years? What is your opinion on this situation?
L.C.
Dear L.C.: The shingles vaccine has only been tested in adults over age 50, and thus is not indicated for younger ages by the Food and Drug Administration. The vaccine is particularly important in older people because shingles is more common and has a higher risk of complications in older people. People in their 40s are at low risk for complications. People who have already had shingles are still recommended for the vaccine once they are 50, but are at lower risk from shingles than those who havent had shingles.
Dear Dr. Roach: I am an 88-year-old woman. I have had excessive belching for nine months. I have tried many medications and home remedies, but nothing has helped. Have you heard of this problem? I have to ride three and a half hours to see a specialist doctor.
C.M.
Dear C.M.: I have seen this problem often.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.
What Are The Side Effects
The shingles vaccines are very safe.
Common side effects to the vaccines include headache as well as soreness, redness and swelling where the vaccine was given. Itching and a rash may also occur after getting Zostavax® II. Other reactions that may occur after getting Shingrix® include fever, muscle soreness, fatigue, shivering, nausea, vomiting and diarrhea.
It is important to stay in the clinic for 15 minutes after getting any vaccine because there is an extremely rare possibility of anaphylaxis, which is a life-threatening allergic reaction. This may include hives, difficulty breathing, or swelling of the throat, tongue, or lips. The chance of true anaphylaxis is about 1 in 1 million vaccine doses. Should this reaction occur, your health care provider is prepared to treat it. Emergency treatment includes administration of epinephrine and transfer by ambulance to the nearest emergency department. If symptoms develop after you leave the clinic, call 9-1-1 or the local emergency number. Learn more about anaphylaxis on our vaccine side effects page.
It is important to always report serious or unexpected reactions to your health care provider.
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