Shingles Vaccine: What You Should Know

Shingles Vaccine: What You Should Know

If you’re 50 or older and healthy, there are two things experts think you should know: You’re almost certainly as risk of getting shingles, and you should get vaccinated.

“Shingles is not just an annoying rash that lasts for a week or two,” says Christine E. Kistler, MD, associate professor of family medicine and geriatric medicine at the University of North Carolina at Chapel Hill. “The rash itself is often very painful. Once it’s gone, a significant percentage of people go on to have severe nerve pain in the area where the rash was, a complication called postherpetic neuralgia [PHN].”

The vaccine, called Shingrix, is more than 90% effective at protecting you from this painful rash illness and the serious, long-term complications it can cause.

“Anyone who has ever had chickenpox is at risk. That’s pretty much everybody older than 50,” Kistler says. The CDC reports that 99.5% of people born before 1980 have had chickenpox, even though many don’t remember it.

The vaccine doesn’t prevent shingles in every person, Kistler says. “If you do get it, however, you’ll have a much milder case and a much lower risk of complications. And that’s what we want: to prevent all the bad things that can happen because of shingles.”

Shingles is caused by the varicella zoster virus (VZV), the same virus that causes chickenpox. Once you recover from chickenpox, the virus remains in your body, lying dormant, or inactive, in nerve tissues in your spinal cord. There, the virus can stay quiet for decades. Later in life, it can reactivate as shingles.

The blistery rash of shingles most often appears one side of the body, usually in a single band around the right or left side of the torso. Along with pain, it can cause itching, tingling, or burning. The rash can also appear on the face and around the eyes. If it affects the eyes, it can cause vision loss.

In some people, most often those with issues that affect their immune system, the rash can spread widely over the body. In rare cases, it can cause pneumonia, hearing problems, brain inflammation, or death.

“These complications are very rare, but they are real things that do happen because of this virus,” says Kistler. “The nerve pain of postherpetic neuralgia, which can last for months or years, is by far the most common complication, and it can be disabling.”

The CDC recommends it for healthy adults over the age of 50, but the FDA has approved Shingrix for people 18 and older who are or who will be at increased risk of shingles due to immunodeficiency or immunosuppression caused by known disease or therapy. This includes those who have already had shingles, which you can have more than once. Vaccination lowers the chances of a second round of the painful rash and of a serious outbreak and complications, Kistler says.

That’s why Duncan Isley, who had shingles at 45, recently got vaccinated. The outbreak he had was “fairly mild” compared with the stories he’s heard from others. But it’s something he doesn’t want to repeat.

“I had the classic torso rash and back pain. It was a very painful experience to be sure, and I still have some lingering, minor nerve sensations from time to time,” says Isley, who is now 53 and lives in Durham, NC. “I tell my close friends they should get vaccinated.”

You should also get vaccinated with Shingrix if you got an older shingles vaccine called Zostavax, which was withdrawn from the market in 2020. Zostavax’s protection wears off with time, says Kathleen Dooling, MD, MPH, a medical officer and shingles disease expert at the CDC.

In the first year after vaccination, Zostavax prevented shingles about 60% of the time. “That decreases in subsequent years, so that after a number of years it’s not clear that the vaccine is providing any protection,” she says.

Have you been vaccinated but aren’t sure whether you got Shingrix or Zostavax? The timing of your vaccination may hold the answer. The FDA approved Shingrix in October 2017, so if you were vaccinated before then, you got Zostavax. If you’re still not sure, check with your doctor.Shingrix is the only VZV vaccine currently available in the US.

There are a few situations in which shingles vaccination may not be right for you. You should not get Shingrix if you’ve ever had a severe reaction to a vaccine. This means you had trouble breathing or swelling in your mouth or airway, a life-threatening condition called anaphylaxis.

You should also skip Shingrix if:

  • You have allergies to any parts of the vaccine. These include gelatin and the antibiotic neomycin. If you have other allergies, tell your doctor or pharmacist about them before you get Shingrix.
  • You currently have shingles or another illness. You can get the vaccine when you’re well.
  • You are pregnant or breastfeeding. You should wait until you’ve stopped breastfeeding to get vaccinated.
  • You happened to test negative for VZV, the virus that causes chickenpox. If you’re older than 50, you probably had chickenpox even if you don’t remember it. The CDC does not recommend testing for this. However, if a blood test shows you’ve never had the childhood illness, you should get the chickenpox vaccine instead.

If you have a disease or take medications that affect your immune system, talk to your doctor about the pros and cons of Shingrix.

“It’s an individualized decision based on factors such as the specific medications and conditions of the person sitting in front of you,” Kistler says. She often consults with her patients’ specialist doctors to make decisions about Shingrix.

Dooling says that Medicare data show that people with immune system issues do get the vaccine. She says the CDC and its Advisory Committee on Immunization Practices have been looking at Shingrix vaccination in this group and hope to issue more advice soon.

Ready to get vaccinated? This is the essential info on how the shots are given, what to expect with side effects, and more.

You need two doses of Shingrix to get full protection from shingles. You should get your second dose 2 to 6 months after the first. Your doctor or pharmacist will inject the vaccine into the muscle of your upper arm, so wear clothes that give easy access to that area.

If it has been more than 6 months since you got your first dose, go ahead and get your second dose. You don’t need to start over, Dooling says.

Because Shingrix is so new, experts aren’t sure whether you’ll eventually need another shot, or a booster, years down the road.

“The CDC is actively following how protected people remain after the two-dose series,” she says. We know that after 4 years, protection remains above 85%. Only time will tell how durable that protection is.”

You do not have to wait between Shingrix and COVID-19 vaccination. The CDC has determined its safe to get the COVID-19 vaccine at the same time as Shingrex, but recommends they be given in different arms. You should not get eithe vaccine if you have COVID.

Side effects are fairly common. You may have heard that people sometimes have unpleasant side effects soon after they get the shingles vaccine.

“Shingrix tends to have has more side effects than some vaccines, like those for the seasonal flu,” says Kistler. The shingles vaccine may cause:

These side effects go away on their own after 2 to 3 days. About 1 in 6 people have side effects that keep them from their normal routine. That’s what happened to Martha Howard, 70, who lives in Strawberry Plains, TN.

“I didn’t have any side effects with my first shot. With the second, though, I had every single one on the list they gave me at the pharmacy. I felt pretty miserable, but after 3 days they were gone,” Howard says.

“Think of the side effects as short-term pain for long-term gain,” Dooling says. “They show the immune system has been called to action.”

Her advice? Once you’ve scheduled your shots, make a plan that allows you to rest and recover if you need to. Over-the-counter pain medication can make you more comfortable, she says.

Shingrix’s cost depends on your health insurance. The Affordable Care Act requires that private insurance cover Shingrix at no cost if it’s given by an in-network doctor or pharmacist, says Sean Clements, head of Vaccines Communications for GSK, the vaccine’s manufacturer.

Out-of-network costs are usually low, often around $5 a shot, and Shingrix is covered under Medicare Part D, the program’s prescription drug plan.

“For those with Medicare Part D, the out-of-pocket cost depends on the specific plan, but the average is about $50 per dose,” Clements says.

If you’re uninsured and have met your Medicare Part D out-of-pocket spending limit, you may be able to get Shingrix at no cost. It depends on your income. GSK’s patient assistance program, GSK For You, provides more details.

There is no Shingrix vaccine shortage. If you tried to get vaccinated for shingles sometime in 2018 or 2019, your doctor or pharmacist may have told you that they were out of the vaccine.

Supply has since increased, and you’re unlikely to encounter a shortage, Dooling says.

The bottom line, she says, is, “Shingrix is a safe and very powerful way to protect yourself from the pain and other even more debilitating complication of shingles. It’s a disease you really don’t want to go through. If you’re unsure about that, ask anybody who has ever had it.”


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