By Mark A. Kelley, MD |1/11/17
Founder, HealthWeb Navigator
I have seen more and more friends and patients who have suffered with shingles. For no apparent reason, a very painful rash appears, most often on the chest or abdomen. The rash eventually disappears but the pain can last for weeks.
Fortunately, this condition can be prevented.
What Causes Shingles?
Shingles can’t be “caught,” and you can’t get shingles if you’ve never had chickenpox. Both chickenpox and shingles are caused by the varicella zoster virus.
In chickenpox, the virus spreads through the body because the patient has no immunity to it. Once immunity develops and controls the virus, the patient recovers.
However, some of the virus hibernates in our nerve cells, locked away by our immune system. As we age, our immune system is not as effective in keeping the virus in check.
For some folks, the zoster virus emerges and spreads along the nerve cells, causing them to become painfully inflamed. The result is a localized rash that resembles chickenpox. Weeping fluid from the rash contains live zoster virus and can cause chickenpox in anyone who has never been exposed to zoster, such as infants.
With shingles, the body usually fights off the virus successfully. However, it takes a long time for the inflamed nerves to settle down and for the pain to subside. Ask anyone who has had shingles and you will be impressed with how disabling the pain can be.
Roughly 1 in 4 adults will develop shingles at some point during their lifetime. Those odds increase with age.
In a healthy person, shingles is usually not life-threatening, but it can lead to chronic pain or, if it affects the eye, can cause blindness. More serious complications, including death, can occur in patients whose immune systems are weakened by anti-inflammatory drugs, chemotherapy, or chronic disease.
What Are My Options?
Currently there are two injectable vaccines that can prevent shingles.
Zostavax is a single injection that delivers a weak form of varicella zoster. That exposure awakens the immune system to quickly fight off the virus. This vaccine prevents shingles in about 50% of patients, but that protection is only good for about 5 years. However, for immunized patients who develop shingles, the vaccine reduces the severity of the symptoms.
Shingrix is a new vaccine that was engineered to look like the zoster virus to our immune system. Since it is not a real virus, it cannot cause any infection. The vaccine requires two separate shots and may be more effective than Zostavax. In numerous trials, the Shingrix vaccine has protected over 90% of elderly patients from shingles for about 8 years. Zostavax, on the other hand, has protected only half of similarly aged patients. Shingrix is approved by the FDA but will not be available until later this year.
Is the Shingles Vaccine Right for Me?
The CDC’s current recommendation is that every adult over the age of 60 should be immunized with Zostavax, whether or not they have had chickenpox. The reason is that most American adults have antibodies to varicella, suggesting they were once infected with the virus. There has been no consensus on whether to recommend periodic booster shots. Younger patients with immune systems weakened by disease or treatments may also be considered for the vaccine.
These recommendations may change to favor the newer vaccine Shingrix, because it appears to be more protective. No formal policy has yet been published, although one is expected later this year.
The retail price for both vaccines is about the same. The single shot of Zostavax costs about $220, and the two shots of Shingrix together are estimated to cost about $240. Insurance or discount coupons may cover some or all of this cost. It pays to check with your insurance company and shop around.
I think the shingles vaccine makes sense for most patients over the age of 60. It substantially reduces the risk of developing a very painful condition that can last weeks. We now have one—and soon two—safe, effective vaccines.
Consult your physician to see if and when the shingles immunization is right for you.