Whether to vaccinate or not has become a discussion that creates a great deal of disagreement, and on websites, this conversation often leads to a heated debate. One of the latest controversies has been the new shingles vaccine, Shingrix. I’ve had multiple patients in my clinic ask me about this vaccine over the last month.

Who Is At Risk for Shingles?

Anyone who had the chicken pox (a varicella virus infection with body wide blisters) is at risk to get shingles later in life. Chickenpox (varicella) is a viral infection with small, fluid filled blisters that itch and  occur body wide. Prior to routine chickenpox vaccinations in the 1990s, nearly everyone became infected before they reached adulthood.

If you’ve had chickenpox, you are at risk later in life to develop shingles, caused by the varicella-zoster virus. The varicella-zoster virus can remain dormant in your nerve cells for multiple decades, waiting for a future date to reappear. Not surprisingly, when you are stressed or ill, you are more likely to suffer from an outbreak of the varicella-zoster virus along that nerve.

Shingles typically involves one nerve root and appears as a horizontal stripe of painful blisters over the course of that nerve. It can occur around your left or right trunk, on your face, extend into the eye, or even into your genitals. Shingles can be awful with painful blisters that last up to one month.

Even worse, up to 10% of people who get shingles develop permanent, severe nerve pain that continues after the infection itself resolves, a condition called post herpetic neuralgia. This dreadful condition can last a lifetime.

Without a shingles vaccine, 95-99% of people are at risk to get shingles, and about one-third of the US population will have it during their lifetime. Since 10% will have a serious complication, that means 3% of us are at risk for debilitating long term pain from post herpetic neuralgia. Unfortunately, I don’t know of any foods, supplements, or activities that will prevent a person from getting shingles.

Having seen my own patients in the past suffer from a shingles outbreak that caused them debilitating pain for decades, and how awful that can be, I don’t want any of my patients, or for you, to develop shingles.

Nearly 12 years ago, the first shingles vaccine, Zostavax, was released to protect people from getting shingles. It was shown to be relatively safe and fairly effective in the short term, but sadly, after five years the vaccine effectiveness dropped far more than was originally predicted. I had the Zostavax vaccine when I turned 60, but now I realize that it won’t be highly effective long term.

The good news is that there is this new, better shingles vaccine called Shingrix. As of January 25, 2018, the CDC has started recommending it to people over age 50, including those who got Zostavax previously.

Shingrix is more effective and lasts longer (10-15 times more effective in preventing shingles) than the prior vaccine, Zostavax, but requires two vaccines given 2-6 months apart. There is an annoying downside with the production of this vaccine, as there is more demand than there is vaccine, and most of my patients who want it are on a waiting list to receive it.

What About Vaccine Side Effects?

Like any vaccine, the Shingrix vaccine has side effects, in fact higher side effects than occurred with Zostavax. With the first shot, at least 25% of people will have fever, chills, and muscle aches for a few days, so best is to receive it when you have a few days without major responsibilities, such as on a Friday when you have the weekend off.

With several vaccines, including the influenza vaccine, there is also the very rare risk of a neurological condition, such as Guillain Barré Syndrome, causing muscle weakness and partial paralysis that can last for weeks to months. This is reported to occur with various vaccinations in about 1/500,000 to 1/1,00,000 subjects who receive them. They have not identified that Shingrix can cause Guillain Barré Syndrome, but it would be prudent to assume it might have the same rare risk associated with it.

Your challenge is to compare the benefit with the real risk. If you don’t get vaccinated, there is a 33% chance you will develop shingles in your lifetime, and a 3% chance you’ll develop permanent, potentially debilitating nerve pain related to it. Compare that with a 25% chance of a short term viral like syndrome that lasts 2-3 days, and a very rare risk (1 per million) of something more complicated. Which problem sounds greater?

How to Minimize Your Risk with Any Vaccine:

All vaccines have risk, but there are things you can do to minimize your risk when you receive them:

  • Avoid vaccines that use mercury as a preservative in multi-dose vials. Mercury is a neurological toxin. I think it is stupid to save a few dollars and receive a vaccine from a multi-dose vial with mercury (typically 20 doses per vial), when single dose vials that are free of mercury are available. This tip applies for the influenza (flu) vaccine as well.
  • Don’t receive a vaccine when you are sick with a cold or other infection. When you are sick, you are already inflamed. Don’t increase your risk for a reaction to the vaccine when you can avoid it.
  • Likewise, don’t have multiple vaccines at the same time. If you need more than one vaccination, better is to space them out so they are given weekly or monthly, even if that means the inconvenience of going back for a second trip. Multiple vaccines at the same time increase your total inflammatory reaction and increase your risk for a side effect. This doesn’t apply to just adults, but to children as well.

Summary

I believe that there is both a risk and a benefit with any vaccine, yet with the Shingrix shingles vaccine, I think the benefit is greater. Because there is so much bias, I think it is important to share the facts and let you decide what is best for you. I feel that if you have the right information, you’ll be able to make the best choice for you.

For my clinic patients with a history of having had chicken pox, I have started offering the Shingrix vaccine when they are between 50-60 years of age, and it is available for older adults as well. If people had the Zostavax previously, then I’m suggesting that they still get the Shingrix vaccine as a precaution. I wish you the best of health!

Steven Masley, MD, FAHA, FACN, FAAFP, CNS