Your Guide To Adult Vaccines
En español | Shingles is sneaky. It’s caused by the same virus as chickenpox — varicella-zoster, which lays dormant for decades in the body, ready to pounce when your immune system is weakened by stress, certain medications (for example, long-term steroids) or disease. Those with rheumatoid arthritis, for instance, are twice as likely to develop shingles as healthy older adults.
In the U.S., 1 in 3 people will get shingles, usually after age 50. Since the risk rises with age, half of those who live to be 85 will experience at least one episode. Shingles’ most common symptom is an angry, blistering rash. About 10 to 18 percent of people who develop that rash will also experience a complication known as postherpetic neuralgia (PHN), a condition that affects the nerve fibers and skin, causing burning, and sometimes incapacitating, pain that can last for months (or even years) after the rash disappears. “Shingles rarely kills you,” says William Schaffner, M.D., a professor of preventive medicine and infectious diseases at the Vanderbilt University Medical Center in Nashville, “but it can make you wish you were dead.”
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Enter Shingrix, a vaccine approved by the U.S. Food and Drug Administration (FDA) in 2017. Unlike Zostavax, its predecessor, Shingrix is, in the words of Schaffner, “spectacularly effective.” The numbers support his claim: Shingrix is 97 percent successful at preventing shingles in people in their 50s and 60s, and 91 percent for those in their 70s and older. (That protection stays at over 85 percent for four years in people 70-plus after getting the vaccination.) What’s more, studies suggest the vaccine may also lower the risk of shingles-related strokes in older adults.
Why more adults aren’t getting the super-effective vaccine
Despite such impressive results, only about 35 percent of adults 60 and older reported receiving the shingles vaccine in 2018. What’s behind the hesitation? A couple of things. First, says Kristin Christensen, M.D., an internal medicine specialist affiliated with Penn Medicine, in Radnor, Pennsylvania, some of us don’t take shingles as seriously as we should: “People think, ‘If it’s not going to kill me I don’t need it,’ without realizing that singles can be incapacitating, causing severe pain that can really limit peoples’ functioning.”
What’s more, difficulty in getting the vaccine may have discouraged those who sought out the vaccine earlier on. The company that makes the vaccine couldn’t keep up with the initial demand, resulting in long waiting lists at pharmacies that dispensed the vaccines. (It’s more widely available now.)
Then there’s the hit to your wallet. Shingrix costs on average about $195 per injection, and two injections are required. But unlike the flu and pneumonia vaccines, which are fully covered as preventive services under Medicare Part B, the shingles shot falls under the prescription drug plan under Medicare Part D. Depending on your plan, even after you’ve met your annual deductible you’ll likely end up shelling out money for it. “If you’re between the ages of 50 and 65, and covered by a private health insurance, ask your doctor about getting your vaccine now, while you’ve got good coverage,” Schaffner suggests.
Finally, there’s the ouch factor: not the needle, but the way the body initially responds to the vaccine itself. “This is a moderately reactogenic vaccine, meaning 20 to 30 percent of people may get a fever, along with pain and swelling at the injection site,” says Gregory Poland, M.D., an infectious disease expert and director of the Mayo Clinic’s Vaccine Research Group. However, Poland notes, the second dose tends to cause less of a reaction so people do better with it. Besides, Schaffner reasons, “Having your arm hurt for a day or so is a small price to pay to avoid this infection.”
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.
What to know about the shingles vaccine
Who needs it? The CDC recommends that everyone 50 and older get Shingrix, even if they had the earlier recommended vaccine Zostavax, or if they’ve already had a bout of shingles. Older adults should also get this vaccine, whether or not they remember having had chickenpox as a child. Why? More than 99 percent of Americans over the age of 40 have been exposed to the varicella-zoster virus, even if they don’t recall getting chickenpox.
How often? The CDC recommends that older adults, as described above, get this vaccine, which is given in two doses spaced two to six months apart. But it remains to be seen if the agency will recommend that older adults get it again, say, after its effectiveness starts to wane four years after their first inoculation.
Why you need it: 1 in 3 people will get painful, occasionally debilitating shingles, usually after age 50, and the risk increases with age. By age 85, half of adults will have experienced at least one outbreak.
A COVID connection?
A small number of people have experienced an outbreak of shingles after getting vaccinated for COVID-19. Most notably, doctors in Israel reported this year that six women with autoimmune disorders developed the rash days after receiving a first or second dose of Pfizer’s COVID-19 vaccine.
Infectious disease specialists, however, have found no evidence of a link, pointing out that many Americans who have gotten their COVID-19 vaccine are older — and the risk of getting shingles goes up with age.
“We need to distinguish between coincidence and causation,” Schaffner says. “If you got shingles six days after getting a COVID vaccine, you would have gotten it anyway.” What’s more, he notes, the stress of the pandemic may very well trigger an episode of shingles. The bottom line, says the CDC: “Shingles vaccination should not be delayed or discontinued because of the COVID-19 pandemic, unless a patient is suspected or confirmed to have COVID-19.”
One thing that shingles and COVID-19 vaccinations do share are many of the same side effects. “The shingles vaccine can give you a sore arm, and yes, you can feel rather puny and not up to snuff for a day or two afterward — with aches, pains and headaches — but that’s not COVID,” says Schaffner. “If it happens within the 48 to 72 hours after receiving the shingles shot, you can rather securely attribute those side effects to the shingles vaccine.” To avoid post-vaccine panic, be sure to ask your health care provider about potential reactions before getting jabbed.
Barbara Stepko is a longtime health and lifestyle writer, and former editor at Women’s Health and InStyle. Her work has appeared in The Wall Street Journal, Parade and other national magazines.
Editor’s note: This story, originally published on Oct. 20, 2020, has been updated with new information.
Correction: An earlier version of this article pictured a shingle vaccine that is no longer used.