Dr. Jacqueline Gerhart: Shingles Vaccine Recommended For 60 and Up
Madison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that appears Tuesdays on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.
Dear Dr. Gerhart: I got shingles this year. Should I get the vaccine to prevent further outbreaks? What is the likelihood after getting it once that I will get it again?
Dear Reader: I'm sorry to hear that you got shingles. It can be very painful, and can last longer than most people assume. While some cases of shingles go away within a couple of weeks, other cases can cause symptoms for six months or more. Luckily, once you have your first episode, it is unlikely that you will get a second. However, some people can get second and third cases in certain situations. And, in those situations it is helpful to get the shingles vaccine. Let me explain.
Shingles is caused by the varicella zoster virus. This is the same virus that causes chicken pox. After your body is exposed to chicken pox or to the varicella vaccine, the virus stays dormant in your nerves in an inactive state. For reasons we don't understand, this virus can then reactivate in the form of herpes zoster, causing shingles. When the virus reactivates, people often describe a burning or tingling feeling in a small area of their skin. As it progresses, this pain can get more severe and spread to a larger area, and then a rash can develop. This rash usually occurs on the trunk and is along a dermatome line - which means it is in one area, on one side of the body, and doesn't cross the midline to the other side of your body.
Only people who have been exposed to the varicella virus are at risk of getting shingles. In other words, if you didn't have chicken pox as a kid you may not need the shingles vaccine. However, the CDC estimates that 99.5 percent of people born in the U.S. over the age of 40 have had the chicken pox. Nowadays (since 1995 when the vaccine was licensed) most kids get the varicella vaccine - and therefore do not get chicken pox. We routinely recommend the two-dose varicella vaccine for children - the first dose is given between 12 and 15 months and the second dose is given between 4 and 6 years of age. Getting the vaccine prevents them from getting chicken pox, but does not protect them from the risk of getting shingles in the future. However, early data shows that children with the vaccine are less likely to develop shingles than children who've had chicken pox.
In the U.S. about 1 in 3 people will get shingles in their lifetime and there are 1 million cases of shingles annually. Over half of the cases of shingles are in patients over the age of 60, but even at age 50, your risk starts to rise. Getting a second case is uncommon.
There are no major clinical trials that have studied how well the vaccine works in preventing a second episode. With that being said, the CDC recommends vaccination for patients age 60 and over - regardless of whether you have had shingles in the past. In 2011, the FDA licensed and approved the vaccine to be given to patients aged 50 and older. However, the CDC committee on vaccinations has not yet made a statement regarding the benefit in people aged 50-60. Also, keep in mind that if you are under age 60, your insurance may not cover the shingles vaccine. Medicare part D covers it; Medicare part B does not.
There are some patients who should not get the shingles shot, including those who are pregnant or who have an immune disorder, such as HIV/AIDS. Some patients on immune suppressing medications may also need to forgo the shot.
This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.
Date Published: 02/19/2014