National Shingles Vaccination Program
One in three people will develop shingles in their lifetime, with the risk of complications increasing with age. Herpes zoster vaccination is recommended and has been funded from 1 November 2016 for eligible people under theNational Immunisation Program. Shingles immunisation can significantly reduce the risk of developing shingles and the associated ongoing persistent pain known as postherpetic neuralgia .
Who Should Not Get Shingrix
You should not get Shingrix if you:
- Have ever had a severe allergic reaction to any component of the vaccine or after a dose of Shingrix.
- Currently have shingles.
- Currently are pregnant. Women who are pregnant should wait to get Shingrix.
If you have a minor illness, such as a cold, you may get Shingrix. But if you have a moderate or severe illness, with or without fever, you should usually wait until you recover before getting the vaccine.
What Are The Risks Of Shingles
About one in five people who get shingles will have severe pain after the rash goes away. This pain can last months or even years. This pain is known as post-herpetic neuralgia.
Rare complications of shingles include scarring, pneumonia, loss of hearing or vision, swelling of the brain and bacterial superinfections of the rash.
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What Matters Most To You
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to get a shingles vaccine
Reasons not to get a vaccine
I want to lower my chances of getting shingles.
I would rather take my chances without getting a vaccine.
I’m afraid of the pain that shingles can cause.
I’m not afraid of shingles pain.
Getting shots doesn’t bother me.
I don’t like getting shots.
Does Medicare Cover Shingles Vaccines In 2022
Shingles is a viral infection caused by the varicella-zoster virus . It produces a painful rash with fluid-filled blisters and typically shows up on one side of the body. The same virus that causes chickenpox causes shingles. Anyone who has had chickenpox in the past is at risk of getting shingles.
Shingles is a painful rash that occurs along the distribution of a nerve, called a dermatome, says Erum N. Ilyas, MD, a fellow of the American Academy of Dermatology and founder of AmberNoon. The virus lays dormant in the nervous system. Immunity likely plays a role in preventing the virus from reactivating. When immunity is low, the virus replicates and spreads down the nerve causing pain, inflammation, and blistering.
The Centers for Disease Control and Prevention recommends that adults older than 50 get the shingles vaccine. Shingles can cause long-term nerve pain and nerve damage. Getting two shingles vaccine doses two to six months apart has proven to be very effective at preventing shingles.
Shingrix is a brand-name shingles vaccine and is currently the only shingles vaccine available in the United States. Zostavax, a previous zoster vaccine, wasdiscontinued in 2020.
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Know Your Shingles Risk
You can get shingles at any age if youve had chickenpox.
But older adults and those who are immunocompromised get it most often. Two-thirds of shingles cases in Canada happen to people over 50 years old. The severity of shingles and its complications also increase with age.
Age is the most important risk factor.
Traditional Medicare Part B Does Not Cover Some Recommended Vaccines Including Shingles Shots Prescription Drug Plans Include Commercially Available Vaccinations But Are Likely To Require Some Payments From Beneficiaries
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If youre about to make a move to Medicare from your private insurance, you might want to make sure youve had all your shots – especially your vaccination for shingles. Thats because coverage of recommended vaccines under Medicare is more complex than under private health insurance.
Under the Affordable Care Act, private insurers are required to cover all recommended vaccines as preventive care with no out-of-pocket costs to beneficiaries. But under Medicare, different vaccines are covered under different parts of Medicare with inconsistent out-of-pocket costs for beneficiaries.
In short, the shingles vaccine is not covered by Medicare unless you have a Part D prescription drug plan or an Advantage plan with prescription drug coverage even then, youre likely to have out-of-pocket costs.
Medicare Part B covers certain vaccines, including flu and pneumonia, but not others, including shingles. Vaccines covered under Part B are provided to beneficiaries at no cost to them.
If you have a prescription drug plan, Medicare Part D, it will cover other commonly available vaccines, including those for shingles. But even then, Part D is not required to provide cost-free coverage of preventive treatments. What this means is medications and vaccines covered by Part D plans will likely be subject to deductibles and copays, resulting in out-of-pocket costs.
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Key Points To Remember
- Shingles can be very painful.
- Adults ages 50 and older and adults 19 and older who have a weakened immune system can get the vaccine. You need two doses, whether or not you’ve had shingles before.
- The vaccine greatly lowers your chances of getting shingles. If you get shingles anyway, you are less likely to have the long-term pain that can occur after shingles than if you hadn’t had the vaccine.
- If you’ve already had shingles, you are not likely to get it again. But some people do.
Reasons To Get The Shingles Vaccine
Once a person develops chickenpox after contracting the varicella-zoster virus, the virus never leaves the body. It remains dormant in the nerve roots and can reappear as shingles later in life.
The primary symptom of shingles is a painful rash on one side of the body, most often on the torso or face. People initially have pain or a burning sensation on the skin without a rash, and then painful blisters develop. The rash lasts approximately seven to 10 days and fully clears within two to four weeks.
The likelihood of developing shingles increases dramatically after age 50. Therefore, the Centers for Disease Control and Prevention recommends that all adults age 50 and over receive two doses of Shingrix to prevent shingles. The vaccine is recommended even if a person is unsure if they have ever had chickenpox.
People with weakened immune systems are at higher risk for shingles. Therefore, the Food and Drug Administration also recently approved Shingrix vaccination for adults age 18 and older who are at risk for shingles due to immunodeficiency or immunosuppression caused by an underlying disease or medication.
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How Effective Is The Shingles Vaccine In Preventing Shingles
The shingles vaccine can provide strong protection against shingles and postherpetic neuralgia , the most commonly occurring shingles complication.
The shingles vaccine is 97% effective in preventing shingles in people ages 50 to 69 years old. Its 91% effective in people ages 70 years and older.
In addition, the shingles vaccine is 91% effective in preventing PHN in people ages 50 to 69 years old. Its 89% effective in people ages 70 years and older.
Shingles is a viral infection. It presents with a rash followed by an episode of intense pain in the infected area. This is caused by the virus called varicella zoster. This virus also causes chickenpox. If a child has had chickenpox, the virus may not completely go away, lie dormant in the body and come back years later as shingles. Older individuals and immunocompromised individuals are more likely to develop shingles. The shingles vaccine is generally recommended for those older than 50 years of age and immunocompromised individuals .
Know Your Risk Of Getting Shingles And Complications
About 1 out of every 3 people in the United States will develop shingles during their lifetime.
If youve had chickenpox, you are at risk for shingles. More than 99% of Americans born before 1980 have had chickenpox, even if they dont remember it.
Your risk of getting shingles and having serious complications increases as you get older.
About 1 in 10 people who get shingles develop nerve pain that lasts for months or years after the rash goes away. This is called postherpetic neuralgia and is the most common complication of shingles.
Shingles may lead to other serious complications involving the eye, including blindness. Very rarely, it can also lead to pneumonia, hearing problems, brain inflammation or death.
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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.
Should I Get A Vaccine
Doctors say most healthy people over 50 should get Shingrix, as well as anyone 19 or older who are immunocompromised. Itâs available at pharmacies as well as doctorsâ offices. Most people have been exposed to the chickenpox even if they didnât actually develop symptoms.
You should get the Shingrix vaccine unless:
- You are allergic to any part of the vaccine
- Had a blood test that proves you never had chicken pox
- Have shingles now
- Are breastfeeding or nursing.
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Vaccine Effectiveness And Safety
The vaccine reduces your chance of getting the virus by more than 50%, depending on your age. Vaccine effectiveness is higher among seniors between 65 and 70 years old.
No vaccine is 100% effective. If you get vaccinated, you may still develop shingles. But the infection would likely be less severe and youd be better protected from complications.
The vaccine has been licenced by Health Canada, having met all requirements under the Food and Drugs Act.
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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.
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Where In The Body The Vaccination Is Given And How Many You Will Need
Like most vaccinations, the vaccine will be given in your upper arm. You will only have the vaccination once.
If you have the Zostavax vaccine, you will just need one injection. If you are not eligible for the live vaccine, you will need 2 doses of the Shingrix vaccine 2 months apart to give you the best protection. Once your course is completed, you will not need any more shingles vaccines.
Personal Stories About Considering A Shingles Vaccine
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I talked to my doctor about the shingles vaccine and I think I’m going to get it. My wife had shingles 2 years ago, and she was really in a lot of pain. If I can avoid that by getting a vaccine, it will really be worth it to me.
Abel, 65
I’m not going to get a vaccine, at least not right now. I don’t like to take medicines of any kind if I don’t have to.
Hattie, 50
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Does Medicare Cover Shingles Vaccines
Most health insurance companies cover shingles vaccines, and so does Medicare. However, Original Medicare coverage wont cover the vaccines. You must be enrolled in a Medicare Part D drug plan or a Medicare Advantage Plan that includes drug coverage in order to have prescription drug coverage that covers shingles vaccines. Medicare Part A or Medicare Part B , components of Original Medicare, wont cover shingles vaccines.
Other Medicare supplement plans, like Medigaps, dont cover shingles vaccines either.
You can enroll in a Medicare Part D prescription drug plan by itself, or enroll in a Medicare Advantage plan that includes Part A, B, and D coverage. Either of these options will usually cover the Shingrix vaccine.
Every Medicare Part D plan is different and copays or coinsurance may vary from plan to plan. Deductibles also may apply.
Different Medicare Part D plans classify medications and vaccinations into different tiers. What tier your plan puts shingles vaccinations into will determine your copay. The best way to determine the insurance plan thats best for you is to compare formularies to find the one that covers as many of your medications and vaccinations as possible or contact Medicare customer support.
How Do We Know The Vaccine Is Safe
All medicines are tested for safety and effectiveness by the Medicines and Healthcare Products Regulatory Agency . The shingles vaccine meets the high safety standards required for it to be used in the UK and other European countries. The vaccine has been given to millions of people worldwide.
Once they’re in use, the safety of vaccines continues to be monitored by the MHRA.
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Medicare Coverage For Shingles Vaccine
Shingrix is not the first shingles vaccine, but it is the only one currently on the market in the United States.Instead of using a live virus,the vaccine uses a protein from the virus to trigger an immune response. It is administered in two doses two to six months apart.
This shingles vaccine has been shown to decrease the risk for shingles by 97% for people between 50 and 69 years old and by 91% for people 70 and older. It reduces complications as well. The risk for post-herpetic neuralgia goes down by 91% and 89%, respectively, in those age groups.
Because the vaccine works well, it is important to know if and when Medicare covers it.
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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What Are The Possible Reactions After The Vaccine
The shingles vaccines are very safe. Common reactions 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, less than 1 in a million, of a life-threatening allergic reaction called anaphylaxis. This may include hives, difficulty breathing, or swelling of the throat, tongue or lips. 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.
It is important to always report serious or unexpected reactions to your health care provider.
The Affordable Care Act
If youre under age 65 and dont have health insurance, you may be eligible for low-cost coverage through Healthcare.gov or a state exchange established by the Affordable Care Act .
Under the ACA, routine vaccines are considered preventive care. This means they must be covered at no cost to you when given by a provider who is covered by your insurance. This is also true for most private health plans. Adult children are allowed to stay on their parents health plans until age 26.
You can apply for ACA coverage through the extended August 15 deadline on Healthcare.gov. If your state runs its own exchange, you can check the enrollment deadlines on Healthcare.gov as well.
Monthly premiums on ACA marketplace health plans are lower than usual, too. Due to the pandemic, the federal government has boosted financial assistance for people of all income levels.
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What Shingles Vaccines Are Available
According to the Centers for Disease Control and Prevention , there are 2 vaccines licensed and recommended to prevent shingles in the U.S.: Shingrix and Zostavax.2 The CDC recommends that healthy adults 50 years and older get 2 doses of Shingrix, separated by 2 to 6 months, to prevent shingles and the complications from the disease.3
Considerations For Patients Who Previously Received Zostavax
Studies have not examined the safety and immunogenicity of Shingrix administered less than 5 years following Zostavax vaccination. However, there are no data or theoretical concerns to indicate that Shingrix would be less safe or less effective when given at an interval shorter than 5 years following Zostavax. Since the risk of herpes zoster increases with age, providers should weigh a patients risk of herpes zoster with the age-specific protection expected from Zostavax to determine when to vaccinate with Shingrix.
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