Even If You've Had Shingles, Get the Zostavax Vaccine

Nearly one in three American adults will experience an outbreak of herpes zoster, also called shingles, at some point in their lives. 

Most will get the viral illness—which brings a blistery rash (often on the torso, and almost always only on one side of the body) and, sometimes, searing nerve pain—only once.

But unlike some viruses, such as measles, which you become immune to after you’ve had the illness, shingles can strike again. Studies suggest anywhere from 1 percent to 6 percent of people may have shingles more than once.

“Recurrences are not unusual,” says Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser. “I had one patient who had three verified attacks.”

How can you protect yourself from a recurrence—or reduce the chance of getting shingles in the first place? Here’s what the experts recommend.  

Shingles is caused by the varicella zoster virus, which also causes chicken pox.

If you’ve ever been exposed to chicken pox, that virus remains in your body forever—staying dormant in nerve cells.

But it can reactivate later in life as shingles, possibly as a result of an immune system that weakens with age, or medical conditions or medications that suppress immunity.

Shingles can cause burning, tingling pain, numbness, itchiness, fever, headache, chills, gastrointestinal distress, and an uncomfortable rash of fluid-filled blisters. The rash is most common around the midsection, or on an arm or leg, but can spread to almost any part of the body—including the eyes, which can cause permanent vision loss.

The rash usually clears up within three to five weeks, but about one in five people with shingles are left with nerve pain that can range from mild to severe—called postherpetic neuralgia, or PHN. About 20 percent of those with PHN still have pain three months after a shingles outbreak, and 15 percent report discomfort two years later.

Who Should Get the Vaccine?

A vaccine, called Zostavax, reduces the likelihood of developing shingles by 51 percent. And for those who get shingles anyway, the vaccine cuts the risk for lingering nerve pain by 67 percent. 

So who should get the Zostavax vaccine, and when? Currently, the government’s advice is for the vaccine to be given only once in a lifetime.

Because the shot’s effectiveness begins to wane after five years and the risks of shingles and PHN rise as we age, the Centers for Disease Control and Prevention advises that people have the shot at age 60 or older.

The wrinkle: Although the CDC doesn’t recommend use of the Zostavax vaccine in people age 50 to 59, it’s approved by the Food and Drug Administration for that group. That means doctors can administer it to people in that age range when they think it’s appropriate.  

Currently, it’s unclear exactly who would fall into that group. The CDC’s take on the matter: Healthcare providers who choose to give the vaccine to people between 50 and 59 might consider those who would have significant difficulty tolerating shingles and/or PHN.

This could, says the CDC, include people with chronic pain, severe depression, sensitivity to the medications used to treat shingles, or those whose jobs would make shingles or PHN especially challenging. In these cases, you and your doctor should discuss potential risks and benefits of the vaccine. Cost may be a factor, too.

What If You’ve Already Had Shingles?

If you’re age 60 or older and had shingles but not the Zostavax vaccine, the CDC says you can go ahead and have the shot “to help prevent future occurrences.”

What if you’re younger? Between the ages of 50 and 59, it’s reasonable to talk to your doctor about having the shot, says Lipman. After all, the vaccine has been evaluated for safety in that group. (But be aware that it may wear off before your risk for shingles is highest, at age 70 and beyond.)

Below the age of 50, says Lipman, wait at least until you hit the half-century mark to have that discussion. “Shingles is uncommon before 50, and if you have it that early, it would prompt me to see why and what’s going on with your immune system,” he says.

If you get the vaccine, don’t do so while you have an active rash. In fact, it’s best to wait 12 months after the rash has disappeared, according to William Schaffner, M.D., professor of preventive medicine and infectious diseases at Vanderbilt University School of Medicine.  

That’s because “having had shingles may actually act as a short-term immune booster,” he says, although “we don’t know for certain.”

Although the Zostavax vaccine is safe for most people, you’ll have to skip it if you are allergic to any of its components, are pregnant or could become pregnant within the next four weeks, have an illness that affects your immune system, or are on a medication that reduces immunity.

And if you are 60 or older and haven’t had shingles or the vaccine, get the shot, Schaffner says.  

“Shingles rates are rising in the United States, so vaccination is more important than ever,” he notes.  

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