Every day I am asked if I recommend the shingles vaccination. According to epidemiologists, 1 in 4 people will develop shingles during their lifetime. The CDC (center for disease control) has urged the vaccine to anyone over 50. It was previously 60. Although I’m not anti-vaccine, I know enough to make informed decisions before I purchase any vaccines.

Let’s first look at shingles, and the reasons vaccines were developed.

Shingles, also known as herpes zoster or chickenpox, result from a previous varicella zoster (or prior chickenpox) infection. It belongs to the herpes family. The virus can remain dormant for years in your body and become active as shingles. Shingles are characterized by a cluster or line of small blisters on one side only. Herpes can affect the nerves and give them a distinct appearance. Some people experience pain and itching, while others develop blisters. Shingles can have long-lasting side effects, particularly in the area where the blisters form. This is called post-herpetic neuralgia (nerve pain). The third most common reason for chronic neuropathic pain is post-herpetic neuralgia. This pain can last for months or years and can be highly debilitating. Shingles can also lead to other side effects (remember, it’s a herpesvirus so you might see some of the Epstein-Barr virus symptoms here). It can also cause flu-like symptoms, headaches, and fever. About 1-4% of those affected by shingles might end up in the hospital. According to a study, 96 people die each year from shingles. This is mainly due to older adults and those with impaired immune systems.

There are many reasons why someone gets shingles. When I was in medical school, shingles could be a severe condition. We only treated people with deficient immunocompromised status. However, this is no longer the case. It is fantastic to see how many young people have shingles. Although a decreased immune system can certainly contribute, there may be something else. Because there are fewer chickenpox cases, the mandatory vaccine does not boost the immune system. The CDC disagrees and claims that the rise in shingles began before the mandatory vaccine was made. However, epidemiologists believe this to be an essential link and are concerned by the increase in shingles among the recipients of the chickenpox vaccination. (The newsletter for the chickenpox vaccine must be completely different)

A shingles vaccine has been developed by two companies and is currently available on the market. Before you purchase this vaccine, there are essential things to remember. READ ON to find out what questions to ask and what considerations…

Zostavax, a Merck & Co vaccine, was first introduced in 2006. It is a live virus, so it is essential to know. Live virus vaccines can cause virus shedding, infection, and transmission. It can also cause shingles. Some side effects may be minor, such as pain, swelling, and redness at injection sites. Others may be more serious, such as fever, shock, joint or muscle pains, swollen and painful glands, respiratory symptoms, and severe eye infections, which can lead to blindness, death, and even blindness.

Current recommendations for Zostavax are to give the vaccine to healthy people over 60 years old. The vaccine’s effectiveness in reducing the actual rash is 51%, and the 67% in lowering post-herpetic pain (neuralgia) associated with shingles is 67%. Studies have shown that the vaccine’s effectiveness in preventing post-herpetic pain has declined from 67% to 31% in the first three years. Zostavax was most effective at reducing shingles in the 60-69 age group (64%), while it was only 41% for those aged 70-79 and 18% if you are 80 or older. Despite its declining effectiveness, the CDC has stopped recommending it. However, it is still available.

There were 42,604 shingles complaints as of May 31, 2018, with 128 cases of vaccine-related deaths and 660 related disabilities. Merck has more than 60 lawsuits regarding the side effects of this vaccine.

GlaxoSmithKline released Shingrix, a new vaccine against shingles, in October 2017. Shingrix, a recombinant vaccine against zoster (not live), is available in TWO doses between 2-6 months. This vaccine is recommended for people over 50 years of age. It is recommended for people over 50 who are healthy. The vaccine’s effectiveness for preventing a skin rash is between 90% and 90% in all age groups. Shingrix studies have shown that the vaccine protects against 85% of inflammation for at least four years (compared with 31% for Zostavax). For more than four years, efficacy has yet to be proven.

The study that compared the two vaccines found Shingrix to be 85% more effective at reducing shingles cases than Zostavax. Still, it has a 30% higher number of vaccine-related side effects. Shingrix side effects can be severe and may worsen if the vaccine is not administered correctly. It is possible to have a local reaction if the injection is not distributed in the muscle but just below the skin. According to Shingrix’s original study, 85% of people who received the vaccine experienced local or systemic reactions. These included pain, swelling, redness, fatigue, and headaches. 17% of those with more severe reactions prevented them from engaging in everyday activities. Optic neuropathy, gout, and other severe reactions were also reported. The 50-59 age group wrote the following:

88% felt pain at the injection site

57% of those surveyed had suffered from muscle aches and fatigue.

51% of those surveyed had headaches

39% had redness

34% of people shiver

30% of the population had experienced swelling

After just eight months, 3.2 Million Shingrix doses were distributed. According to VAERS (vaccine adverse events reporting system), 4381 adverse reactions had been reported as of June 30, 2018. 3.3% of the cases were considered severe.

These are the most important questions you should ask your doctor:

  1. Which vaccine is it? Shingrix or Zostavax? The CDC recommends the Shingrix vaccine over Zostavax.
  2. What side effects are they experiencing? Shingrix can cause pain and redness at injection sites in most people. Many people experience muscle aches and fatigue for up to two days. This should be disclosed.
  3. How should they administer the vaccine to their patients? It should be administered intramuscularly (not SubQ, which is subcutaneous).
  4. What should you do if your immune system reacts to the vaccine? What to do if you have swelling or redness after receiving the Shingrix vaccine.

Who should not get the shingles vaccine?

  1. If you have ever experienced a severe allergic reaction to vaccines
  2. You may have shingles. You can get rid of shingles once the episode is over.
  3. If you’re pregnant or nursing
  4. A severe illness, especially during injections
  5. Antiviral drugs such as valacyclovir, famciclovir, or acyclovir must be stopped 24 hours before vaccination. They should also be taken for less than 14 days. This must be done under the supervision of the physician who administered the vaccine.

Notable: The CDC recommends that Shingrix be given to anyone who has had the Zostavax vaccine before.

The tricky question is now. Do you need the vaccine?

It isn’t easy to know what to do. I will start by asking you about your chances of getting shingles. Then, ask yourself what your risk is of developing post-herpetic neural pain. There are many risk factors.

  1. A chart that shows the age-related incidence of shingles was found on my site. Although this chart is from GlaskoSmithKline, it is consistent with other data. Notably, over 50% of cases are found in people 60 and older. The lifetime risk of developing shingles is 1 in 4, with 80-year-olds having a greater chance of developing post-herpetic neuralgia. Refer to the chart below.
  2. Prevalence of other medical conditions: This increases your risk for post-herpetic neural pain by 5% to 20%. This risk is increased by diabetes, lupus, and recent trauma.

If I do not get the vaccine, can shingles be treated?

Current recommendations suggest starting antiviral treatment as soon as possible to avoid the pain and complications of post-herpetic. Although it may reduce the severity of the shingles, the medication does not cure them. The risk of developing post-herpetic neural pain is greater if you experience pain or abnormal sensations before the onset of the rash. Many medications can be used to relieve the pain.

Here are my quick points about this vaccine, which I derived and would consider before receiving the vaccine.

Side effects can occur, so do not get the vaccine before you have an essential event.

Shingles are more common in older people.

Are there any risk factors that could increase your chances of getting shingles?

My concern is… Is the effectiveness of the vaccine decreasing every year? Then, the highest chance of getting shingles is when you are 60 …. If we have no other risk factors, what are we gaining by getting the vaccine in our 50s? Hmmm. It doesn’t matter if you’re in the 50-year-old age bracket, but it does mean you won’t get the vaccine.

My thoughts about “new” things are that I prefer to see a track record before jumping in. Shingrix was published in October 2017. However, it had a median follow-up of 4 years before its release in their studies. You can see the product’s potential when you do things on a larger scale. While I don’t recommend against taking the vaccine, I suggest you think about these before jumping into any new product.