Your Guide To Adult Vaccines
Turning 50? Go Get a Shingles Vaccine
It’s extremely effective, preventing a super-unpleasant infection. So why don’t more adults get it?
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.
“Our body gets it under control, but it never fully goes away and lives in our nerves,” says Ian Neel, M.D., assistant professor and director of geriatric medicine at University of California San Diego Health. “But as we age, our immune system wanes, and it puts us at higher risk of this virus breaking out of its cage and reactivating.”
In the U.S., 1 in 3 people will get shingles, usually after age 50, with the risk of complications climbing sharply after age 60. Since the risk rises with age, half of those who live to 85 will experience at least one episode.
Shingles’ most common symptom is an angry, blistering rash. And about 10 to 18 percent of people who develop that rash will also experience a complication known as postherpetic neuralgia, 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, Tennessee, “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: The two-dose course of 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 in people 70-plus for four years after they get 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 shingles can be incapacitating, causing severe pain that can really limit people’s functioning.”
What’s more, difficulty in getting the vaccine may have discouraged those who sought it out early on. The company that makes the vaccine couldn’t keep up with the initial demand, resulting in long waiting lists at pharmacies. (It’s more widely available now.)
Also, 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 founder 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.” In fact, he notes, “I couldn’t be more insistent and enthusiastic about any vaccine more than the shingles vaccine.”
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. The shot is more than 90 percent effective after you’ve had both shots.
Why you need it: One 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.
An important note: Beginning Jan. 1, 2023, Medicare enrollees with Part D won’t have any out-of-pocket costs for vaccines that the CDC Advisory Committee on Immunization Practices recommends for adults, including the shingles vaccine, under the Inflation Reduction Act of 2022.
A COVID connection?
A large observational study, published in the journal Open Forum Infectious Diseases, makes clear how important it is for older adults to get both the COVID-19 vaccine and the shingles vaccine.
Researchers analyzed medical data from nearly 400,000 older adults who contracted COVID-19 and more than 1.5 million who were never diagnosed. (Anyone vaccinated against either shingles or COVID-19 was excluded.) What they discovered: Adults age 50 and older, infected with COVID-19, were 15 percent more likely to develop shingles within six months of their COVID-19 diagnosis, compared to people who weren’t infected with the coronavirus.
The risk shoots up to 21 percent if you’ve been hospitalized with COVID-19. Health care experts surmise that the uptick could be related to the strain of the pandemic.
“Anything that is physically stressing to our body is going to potentially keep our immune system so busy that it forgets to protect against shingles for a while, and it give it a chance to come out,” Neel says. “And COVID is a very stressful event on our body and our immune system.” Indeed, surveys show a “major increase” in the number of adults who reported stress, anxiety, depression and insomnia during the pandemic, according to the Mayo Clinic.
Conversely, another large retrospective study published in The Journal of Infectious Diseases suggests that the Shingrix vaccine may offer a reduction in COVID-19 risk of diagnosis or hospitalization.
Researchers studied data from the electronic health records of Kaiser Permanente Southern California members age 50 and older, between March 1 and Dec. 31, 2020. One analysis compared COVID-19 diagnoses and hospitalizations between people who had received at least one dose of the shingles vaccine and those who had not. The other analysis examined shingles vaccination status among people who tested positive for COVID and people whose tests were negative.
What they found: Individuals who received at least one dose of the Shingrix vaccine were 16 percent less likely to be diagnosed with COVID-19. Shingles vaccine recipients were also 32 percent less likely to be hospitalized during the trial period.
Researchers think the vaccine may train the body to react more efficiently to any pathogen it encounters, including the coronavirus. “Our thought was that the shingles vaccine could potentially ramp up the immune system in a way that would also protect against COVID-19,” Bradley Ackerson, M.D., one of the lead authors of the study, said in a news release.
However, the researchers stress that people should not use these results as an excuse not to get COVID-19 shots.
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.