Available vaccines: Shingrix and Zostavax
ShinglesShingles (herpes zoster) will affect almost one in three individuals in the United States with an estimated 1 million cases per year in the U.S.
Shingles is caused by the varicella zoster virus, which is dormant in the body after chickenpox. Years later, for unknown reasons, the virus becomes reactivated and causes shingles. Shingles is a painful rash of blisters that occur in stripes around one side of the body or face, but individuals with a weakened immune system are at risk for a more widespread rash. There are instances where shingles can extend towards the eye area and cause blindness.
Although shingles itself is not contagious, the fluid in the blisters may transmit chickenpox to someone who has never had or been vaccinated against chicken pox, and until the blisters scab (typically within 5 days), the patient is infectious. During this time, the rash should be covered, and individuals should be careful to avoid itching or touching it.
Individuals should wash their hands often to reduce the spread, and they should avoid contact with pregnant women who have never had chickenpox or never received the chickenpox vaccine, premature or low-birth-weight infants, and those with weakened immune systems until the rash crusts.
Prior to developing the rash, some individuals have noted pain, itching, or tingling in the area where the rash will develop. Other symptoms may include fever, headache, chills, and upset stomach. It may take up to 2 to 4 weeks for the shingles rash to clear, but afterwards many individuals may develop postherpetic neuralgia (PHN), pain in the areas of the rash even after the rash clears up. It may take weeks or months for PHN to subside, and there are some instances of PHN taking years to resolve.
Risk of being diagnosed with shingles includes anyone who has recovered from chickenpox (even those who have had the chicken pox vaccine), age (although even children and teenagers may be diagnosed with shingles), and those with conditions affecting their immune system (diagnosis or leukemia, human immunodeficiency virus, etc.) or receiving immunosuppressive drugs. Most of the time, patients may only experience one outbreak of shingles; however, it is possible for a second or even third case.
Shingles VaccineThe only way to reduce the risk of getting shingles is to receive the vaccine. Otherwise, currently available antiviral medicines are available to shorten the length and severity of the illness.
Efficacy of the shingles vaccine has been noted to reduce the risk of shingles by 51% and PHN by 67%. Even if a patient has had shingles in the past, the vaccine may help prevent a future reoccurrence; there is no designated time to wait before receiving the vaccine after having shingles, but the rash should no longer be present before receiving the vaccine.
Who Should Get the Vaccine?Shingles and PHN risk increases as one ages, and the CDC recommends that individuals aged 60 years and older and the FDA and the Advisory Committee on Immunization Practices recommend individuals aged 50 years and older receive the shingles vaccine to prevent it. Currently, there is no maximum age to receive the shingles vaccine, but it has been noted that the vaccine is most effective in individuals aged 60 to 69 years.
Who Should NOT Get the Shingles Vaccine?Those who have a moderate or severe illness, allergies to ingredients of the vaccine, allergies to gelatin or neomycin, have a weakened immune system (immune deficiency, leukemia, lymphoma, or HIV/AIDS), are undergoing cancer treatment such as chemotherapy or radiation, take high doses of steroids, or are pregnant/planning to become pregnant.
Side EffectsCommon side effects from receiving the shingles vaccine include injection-site reactions (redness, soreness, swelling, or itching; approximately 1 in 3 people) and headache (approximately 1 in 70 people). There are no documented cases of a person contracting chickenpox from someone who has received the shingles vaccine; however, if an individual who received the shingles vaccine develops a chickenpox-like rash near the injection site, the rash should be covered until it resolves.
Insurance CoverageMedicare Part D plans cover the vaccine; however, a copay may be present or the patient may need to pay in full prior to being reimbursed; Medicare Part B does not cover the vaccine.
Medicaid plans may or may not cover the vaccine.
Most private health insurances cover the vaccine for those aged 60 years or older, and some plans cover the vaccine for those ages 50 to 59 years.