Shingles is a disease that most people have heard of, but many people can't easily say what it is. We sat down with Dr. Mark Petrizzi from our Richmond office for a shingles Q&A, including whether you should get the new shingles vaccine.
Q: What is shingles?
A: Shingles (herpes zoster) is caused by the same virus that causes chickenpox: the varicella zoster virus. If you've had the chickenpox, then the virus is already in your body. It can reactivate later in life as shingles, a painful skin rash. If you get shingles on a sensitive area of the body, like the face or by the eye, it can be particularly disabling.
A common shingles complication is postherpetic neuralgia (PHN), a chronic, persistent pain in the body at the site of the shingles outbreak—this can hurt for a long, long time.
I'd like to stress that the key with shingles is getting immediate treatment. You want to seek treatment within the first 48 hours of seeing the rash. That's one of the benefits of more personalized medicine. You can talk to a doctor 24/7 through PartnerMD and get seen sooner rather than later.
Q: If a person has never had chickenpox, are they in the clear?
A: Technically, yes, but I've encountered people who claim to have never had the chickenpox, yet they test positive for antibodies. (Note: The CDC says, "Studies show that more than 99% of Americans 40 years and older have had chickenpox, even if they don't remember having the disease.")
Q: What about if a person has had the chickenpox vaccine?
A: While the chickenpox vaccine contains a weakened version of the chickenpox virus, which could theoretically reactivate as shingles later in life, that's considered incredibly rare (though not impossible).
So to answer the question: if you've had the chickenpox vaccine, you shouldn't get shingles later in life.
Q: Is shingles contagious?
A: No. You can't pass shingles from one person to another.
Q: Is shingles fatal?
A: Shingles can make you miserable to the point where you might feel as if you want to die, but shingles itself—the painful rash—won't kill you. In rare cases—and I want to stress the word "rare"—it could lead to complications, such as brain inflammation (encephalitis), that can lead to death. Again, that's rare.
Q: While it's not impossible for someone under 50 to develop shingles, it's more common in older populations. Why?
A: If you get a vaccine as a kid or as a young adult or even as an adult—or you get exposed to an infection as a kid or young adult—you have certain immune cells called B-cells that remember the infection. So if you get re-exposed to it later, they go, "Ah, I know that. And I'll go attack it." The problem is those B-cells die off after a while, maybe 20 years, maybe less. We don't know. That's why we vaccinate: to boost your immunity.
Q: Perfect segue. Let's talk about the shingles vaccines.
A: In 2006, the first vaccine—Zostavax—came out from Merck. In 2017, the FDA licensed a new shingles vaccine called Shingrix from GlaxoSmithKline.
The CDC says: "[We] recommend that healthy adults 50 years and older get two doses of Shingrix, 2 to 6 months apart. Shingrix provides strong protection against shingles and PHN. Shingrix is the preferred vaccine, over Zostavax."
Q: Why the endorsement of one vaccine over the other?
A: It comes down to effectiveness. The Pharmacy Times notes: "Zostavax was shown to reduce the risk of developing shingles by 51% and post-herpetic neuralgia by 67%." On the other hand, "Shingrix has been shown to reduce the risk of developing shingles by 97% in patients 50-69 years old and 91% in patients ages 70 and up. Shingrix was shown to prevent post-herpetic neuralgia by 90%."
In addition, Shingrix is not a live vaccine; Zostavax is a live vaccine, which means certain populations shouldn't take it.
In light of this, at PartnerMD, we recommend Shingrix. Click here to find out more about Shingrix and common side effects in this related article from Dr. Virginia Kladder.
Q: Who should get Shingrix?
A: If you're a healthy adult over 50, you should consider getting the vaccine—even if you'd had shingles in the past, even if you had the Zostavax vaccine, and even if you're not sure you had chickenpox.
Q: Who shouldn't get Shingrix?
A: As the CDC website indicates, you shouldn't get it if you've had an allergic reaction to any component of the vaccine or the first dose, you have an active case of shingles, you've tested negative for the varicella zoster virus (in which case, you should get the chickenpox vaccine instead), or you're pregnant or breastfeeding.
For further reading on Shingrix, the new shingles vaccine, check out these resources:
- The CDC website
- Pharmacy Times
- No Excuses, People: Get the New Shingles Vaccine – article from The New York Times
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