Why You Should Get the Shingles Vaccine Soon

If you're a healthy adult age 50 or above, you should get vaccinated against shingles, medical experts say. The vaccine is Shingrix, which is highly effective at preventing shingles and its serious and painful complications.

Here's why older and not-so-old adults get the Shingrix vaccine -- despite reports of injection discomfort -- and why experts strongly recommend taking this step to protect yourself from shingles.

[See: Ways to Boost Your Immune System.]

Shingles Symptoms

Nearly one in three people in the U.S. develops shingles at some point, according to the Centers for Disease Control and Prevention, with an estimated 1 million people diagnosed with shingles yearly. Pain, rash, itching and first fluid-filled, then eventually crusting blisters, are hallmark shingles symptoms. Some people become hypersensitive to touch or light, and experience headaches and fevers.

Shingles pain tends to come first, ranging from mild to intense. Pain is usually most severe in the first one or two weeks, sometimes making it difficult to work, sleep and perform daily tasks. People may need prescription pain medicine when shingles is at its worst.

The shingles rash of reddish-purple clusters tends to show up on one side of the back, chest or abdomen. Typically, shingles looks like stripes across the skin. This pattern corresponds to areas known as dermatomes. A dermatome is an isolated skin section that receives sensation from a single nerve. Shingles usually affects one or a few adjacent dermatomes.

The appearance of shingles can be distressing to those who have it, particularly when a bright rash or crusting lesions occur on one side of the forehead or surrounding an eye. Shingles can lead to permanent scarring.

Availability

To prevent shingles, healthy adults ages 50 and older should get two doses of Shingrix, spaced two to six months apart, according to the CDC.

The Food and Drug Administration approved Shingrix in late 2017. At first, it was one of two shingles vaccine options. However, the older vaccine, called Zostavax, is no longer available in the U.S., as multiple studies confirmed that Shingrix is far more effective.

Initially, Shingrix was in short supply as people were extremely eager to gain its protection. Shingrix is now widely available.

"With COVID, people are so far behind getting their (shingles) vaccines because they haven't been aggressive about getting them while not wanting to go out," says Stephan Foster, a pharmacist and liaison member of the Advisory Committee on Immunization Practices, or ACIP. "There is enough supply. There are a lot of people that need to get it right now."

Whether you're in your 50s or a frailer older adult in your 70s, shingles vaccination is safe and effective, according to a study published Nov. 16, 2020, in the Journal of the American Geriatrics Society. In the large, multicenter study of about 27,000 people vaccinated with Shingrix or a placebo, effectiveness ranged from about 90% in frail participants to nearly 96% in non-frail participants. The study was supported by GlaxoSmithKline, the maker of Shingrix.

Safety

Like all vaccines, Shingrix is continually assessed for safety, Foster says. "The monitoring of vaccines is incredible," he says, with several different systems in place, including these:

-- The Vaccine Adverse Event Reporting System detects possible safety problems in U.S.-licensed vaccines early on. VAERS is co-managed by the Centers for Disease Control and Prevention and the Food and Drug Administration.

-- The Vaccine Safety Datalink, a project run by CDC's Immunization Safety Office, incorporates data from participating health care organizations to monitor vaccine safety and conduct studies on rare and serious events following immunization.

Shingrix is a non-live, recombinant vaccine that is manufactured using only a specific piece of protein from the shingles-related virus.

In terms of effectiveness, Foster says the probable reason that Shingrix worked better than Zostavax, is that Shingrix is an adjuvant vaccine. "An adjuvant is an ingredient of the vaccine that makes our bodies react more to it -- get a better response to it," he explains. "It's an immune enhancer."

Last week the FDA required that a warning about Guillain-Barré syndrome be included in safety labeling information for Shingrix. After evaluation data from a post-marketing study, the FDA determined that "the results of the observational study show an association of GBS with Shingrix, but that available information is insufficient to establish a causal relationship," according to a March 24 agency statement.

The small but increased risk of GBS -- a rare autoimmune disease affecting nerve cells that's sometimes triggered by vaccines -- was observed in the first six weeks following the first dose of Shingrix for adults ages 65 and older, with more incidences of GBS compared to historical data for Zostavax, the previous shingles vaccine. No increased risk was observed after the second dose.

The risk is still very small, Foster emphasizes. "Personally, I would not let it change the decision" to go ahead with shingles vaccination, he says.

Paying for Shingrix

Your private health insurance may cover Shingrix. However, coverage might not apply for plan enrollees younger than 60. Check for individual coverage details.

Medicare Part D covers commercially available vaccines like shingles shots, according to Medicare.gov. People who haven't met their deductible may have to pay some or all of the roughly $325 cost to receive both shots.

COVID-19 vs. Shingles Priorities

As COVID-19 vaccination takes place across the county -- with seniors among priority groups -- it adds a new wrinkle when planning shingles vaccination. "I would say it's more important that they get the COVID vaccine now," Foster says. "And there needs to be a two-week window between them."

But once you're fully vaccinated for COVID-19 and that two-week period has elapsed, put shingles vaccination back on your priority list, Foster advises. "If anybody has ever had a case of shingles before, they're going to regret that they didn't just get it. Shingles is a bad disease. And if they can help prevent that, boy, is it worth it."

Since the pandemic began, there's been an uptick in shingles cases, says Dr. Ardeshir Hashmi, a geriatrician and the endowed chair for geriatrics innovation at Cleveland Clinic .

Early in the pandemic, patients weren't able to come in for vaccines or any sort of preventive care, Hashmi says. Fortunately, he adds, that's changing now.

"The other reason we saw a real uptick in the beginning was the stress of the pandemic," Hashmi says. "The anxiety and social isolation mediated that stress. Older adults have decreased immunity, anyway. So that combination -- stress superimposed on decreased immunity -- is a real fertile ground for shingles cases to spike."

[See: Questions Doctors Wish Their Patients Would Ask.]

Shingrix Side Effects

Shingrix, like many vaccines, has temporary side effects. Mostly, people are having local reactions to vaccination with pain, redness and swelling at the injection site, Hashmi says. Fewer patients have generalized symptoms such as muscle aches and pain, fatigue or headaches. Rarely, patient develop fever or gastrointestinal symptoms, he says.

It's easy to treat injection-site symptoms at home, Hashmi says. "Really, it's local application of ice and just monitoring that closely," he says. Patients are always cautioned to watch closely for any signs of infection. "We always want to monitor for any redness or warmth at the site which persists beyond seven days, or any increases in that area of redness," he says. "But most of the time it settles down within that first week." He recommends acetaminophen (Tylenol) if pain medication is needed.

What Causes Shingles?

The varicella-zoster virus causes chickenpox when it first infects the body, usually in childhood. Later, the virus lies dormant in the body, often for decades. If the virus is reactivated in adulthood, it causes herpes zoster, commonly known as shingles.

With the early, initial infection, the body's immune system launches a response to clear varicella-zoster virus from cells and prevent the virus from duplicating. This immunity lasts long after chickenpox is gone. Unfortunately, however, the body's immunity tends to wane as people age, which can pave the way for the virus to reactivate in the form of shingles. That's what makes vaccination so important.

Is shingles contagious? Not exactly. Someone with shingles in the blistering stages can spread the varicella-zoster virus to someone who has never had chickenpox or the chickenpox vaccine. That person might then get chickenpox -- not shingles. People with shingles should avoid direct contact with people with weakened immune systems, pregnant women and newborn babies.

Shingles Complications

Shingles pain can persist well after skin lesions have healed. Chronic, severe pain that lasts weeks, months or years after shingles is called postherpetic neuralgia. Up to 15% of people with shingles develop postherpetic neuralgia, according to the CDC, and the risk increases with age.

Pain is often described as aching, burning, stabbing or shooting. Discomfort may also involve excess sensitivity to temperature changes and touch, itching and numbness.

Inability to work, exercise or socialize because of continual pain takes a physical and emotional toll. People with postherpetic neuralgia may develop depression or other signs of mental distress.

With shingles involving the eye, vision loss is a possible complication. In rare cases, shingles can lead to blindness. Muscle weakness or paralysis are possible complications. Encephalitis, or inflammation of the brain, is a rare long-term complication.

[See: Different Types of Pain, Explained.]

Awareness

Hashmi says he still sees a fair number of people with shingles. Fortunately, the frequency is decreasing as more people are getting vaccinated against shingles. Also, patients who do have shingles tend to come in with milder cases than in the past.

"Most of the time there's awareness and it's being picked up early," Hashmi says. "We rarely see the complications. People don't leave it as long -- so that's encouraging. But the complications we do see can be, and are, at pretty times severe."

Postherpetic neuralgia is the primary longer-term complication in his patients. "There's not any great treatment for it, unfortunately, once it's already onset."

Eye involvement, or herpes zoster op hthalmicus, occurs in between 10% and 25% of shingles cases in older adults, Hashmi notes. Ear involvement with hearing loss is another serious shingles complication

One group of patients should not routinely receive the shingles vaccine, Hashmi says. "People who have autoimmune diseases, or cancer and depressed immune systems, or it could be HIV -- any sort of autoimmune entity -- the shingles vaccine, specifically, is not for them." For patients in that category who would like to have the vaccine, he says, the key is to have conversations with their doctors, particularly their specialists such as cancer doctors or hematologists. "There are protocols but we have to be extra-cautious."

Otherwise, for most people 50 and older, Hashmi's urges them to get the shingles vaccine: "Just like any vaccine, it's not 100%," he says. "So you can still get shingles infections even if you (are vaccinated) but it decreases your chances significantly. It has 90% efficacy, which is pretty high." That's true in older patients, he adds. "We see that efficacy in people who are 50-plus, but we also see it in patients who are 70-plus."

Moreover, "for people who've had the vaccine, their rate of complications is much lower -- specifically with herpetic neuralgia and the pain associated with it," Hashmi says. All this raises the importance of getting the vaccine, he says: "Prevention is better than cure."