Shingles and the Shingrix Vaccine

My friend Barbara had shingles and told me it was the most painful experience she ever had, including childbirth. Having gone through labor with my three now-adult children, I was motivated to look into Shingrix, the newest vaccine for shingles, approved in October 2017. I had previously received the older, but less effective vaccine, Zostavax, approved in 2006.

Let’s explore shingles, the vaccines, and clear up some common questions and misconceptions to help prevent this difficult disease.

What is shingles?

Shingles is an infection caused by the varicella zoster virus (VZV), the same virus that causes chickenpox. The virus can hide in nerves along the spinal column of those who previously had chickenpox. It’s thought that a breakdown in the immune system, as well as getting older, enables the virus to “re-activate” and cause shingles.

The Centers for Disease Control estimates that about 95 percent of adults over 40 in the United States have had chickenpox. Among those not vaccinated against shingles, about one in three will contract it. Many adults are uncertain if they had chickenpox as a child, but you can get a blood test which tests for antibodies against the virus to find out. As an aside, a chickenpox vaccine has been available in the United States since 1995. Those who receive this vaccination have a 99 percent chance of being “safe” from shingles, but that won’t protect most of us reading this article since most of us have had chickenpox and the virus is already inside us. Symptoms of shingles frequently include a red rash that follows several days of pain, burning, tingling, itching, sensitivity to touch, and/or numbness. The rash produces fluid-filled blisters that break open and crust over. The rash is often, but not always, in a band on one side of the waist; “shingles” is named for the Latin and French names for “girdle” and “belt”, which describes this rash that frequently appears around the abdomen.

Can you “catch” shingles?

You cannot “catch” shingles from someone with shingles, but if you haven’t been vaccinated against chickenpox or if you do not have antibodies against the virus from having had chickenpox yourself, you can get chickenpox from someone who has shingles with the active rash blisters. And, of course, you could then possibly later develop shingles yourself, not a happy thought.

Although unlikely, it is possible to get shingles a second time. The chance of a recurrence is five percent. And, although rare, you can conceivably get shingles a third time. However, a bigger issue after shingles is potentially getting a pain syndrome called PHN (postherpetic neuralgia). Sometimes PHN occurs after the shingles rash has disappeared and can last for more than a month. PHN is the result of damaged nerve fibers from the shingles virus and occurs in about 10 to 15 percent of shingles cases. Anti-seizure medication can help calm the electrical activity in the damaged nerves, and other medicines, such antidepressants and anti-viral agents, may also be given for PHN.

Other, less common side effects of shingles can include blindness and, very rarely, hearing problems, pneumonia, encephalitis (brain inflammation), or death.

How effective are the vaccines?

The Shingrix vaccine, recommended for people age 50 and over, is a two-dose vaccine: you get the second shot two to six months following the first vaccination. According to the Centers for Disease Control, 97 percent of those adults 50 to 69 years old who received the two doses of Shingrix were protected from shingles, and 91 percent were protected from PHN. Among adults 70 years and older, Shingrix (again, two shots) was 91 percent effective

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The older vaccine, Zostavax, reduced the risk of shingles by 51 percent for people age 60 years or older, and there was a 39 percent lower incidence of PHN than those who were not vaccinated. So, Zostavax is certainly better than nothing, but Shingrix is far superior (and no, I have no connection with the makers of any of these vaccines!). Even if you had the older Zostavax vaccine, you should still get the Shingrix vaccine, since this newer vaccine is much more effective. I am one of those people who have had both Zostavax and Shingrix vaccines. When first launched, there were severe shortages of the Shingrix vaccine—people put their names on waiting lists, there were limited supplies and deliveries of the vaccine, and waits for the shots are long. The shortage has eased up.

What side effects should you expect?

The most common side effects include a sore arm at the injection site (about 70 percent describe the shot as “painful”), as well as redness and swelling. About one in six people experience side effects such as headaches, shivering, pain in the muscles or stomach, and/or feeling nauseous or experiencing flu-like symptoms.

Side effects can last a day or two. My arm was sore after the shot, but that was the extent of it, so I felt lucky. And, it seemed a good tradeoff for avoiding the pain of recurring shingles or of PHN, which can last for months or years.

How much does the Shingrix shot cost?

I’ll be honest with you—the Shingrix vaccine is not cheap. If you self-pay, it’s about $170 per shot, and remember that you need two of them. With Medicare Part D coverage, I paid about $60/shot (but be sure to call your insurance company to find out your cost). Is it worth it? I think so. So does my friend Barbara.

Jan Cullinane is an award-winning retirement author, speaker, and consultant. Her current book is The Single Woman’s Guide to Retirement (AARP/Wiley).

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