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
I did get the new shingrix vaccine, 2 dosages and do not regret it, even though I am very holistic minded since the consequences of getting shingles is to great. I already have poor vision because of Macular degeneration and dont want to loose the rest of my eyesight in case the shingles goes into my eyes. Thank you for confirming my decision.
I think that Dr Thomas Levy has excellent advice with Vit C ag. shingles etc
Thank you for this very clear article from a trusted physician—you!
I am thinking this new shingles vaccine also has mercury in it? And what are your thoughts on flu vaccines. Thank you so much for all you do.
Here are the extra ingredients in the vaccine: dipotassium phosphate, polysorbate 80, sodium dihydrogen phosphate dihydrate, and sucrose. No mercury. Steven Masley, MD
I have had shingles once already — can I get it again? Should I still get the vaccine? I did get the Zostavax vaccine.
Yes you can get shingles more than once. The Zostavax vaccine was less effective than previously thought. You likely have some protection from having had the shingles once and from having had the Zostavax vaccine. Your benefit with the vaccine is likely greater than your risk, yet you are less likely than the average person to get shingles. There is no right or wrong decision; in your case if it was me, I’d likely get the vaccine, but it is your call. Steven Masley, MD
I did not get the original first Zostovac. I came down with nasty case of shingles on my right shoulder, chest and back 2 years ago. I’m 76 years old, diabetic 49 years, atypical celiac disease and resently diagnosed hypothyroidism. I have the postherpatic neuralgia with burning pain sometimes worse than others.
Do you think the new Shingrex vaccine would be helpful to quiet down the postherpatic neuralgia?
Thank you for your time.
David Liddell, DVM
I do not know if it would help post herpetic neuralgia pain. But I doubt it. It would help prevent you from getting shingles again. Steven Masley, MD
Can this be passed down from your parents? Don’t remember my parents having this. Maybe my grandmother had it…
If you had chicken pox, there is a 30% chance that you have the virus in your nervous system and that you will get shingles. You can catch chicken pox from another person if you never had it before, but you can’t catch shingles from another person. Steven Masley, md
Thank you for your important information. My wife has never had the chicken pox. If I get the Shingrix vaccine, will I run the risk of exposing her to the virus? I previously got the Zostavax vaccine and she was fine. Thank you!
You won’t put her at risk for shingles or chicken pox. If you did have a shingles outbreak, she would be very likely to get chicken pox, which as an adult is a very dangerous infection. She should talk to her doctor about testing to see if she has been exposed or not, and consider the chicken pox vaccine (not the Shingrix vaccine) if she was never exposed. Steven Masley, MD
Thank You = Thank You Dr Masley – you save us so much time in investigating current new information.
Thanks Doc…that’s comforting to hear you say this. I’m 57 and recently had my second dose of the Shingrix vaccine. I did get the symptoms. Hopefully I won’t ever get the shingles.
What do you recommend for people that had the original vaccination and later developed shingles?
Yes you can get shingles more than once. The Zostavax vaccine was less effective than previously thought. You likely have some protection from having had the shingles once and also from having had the Zostavax vaccine. Your benefit with the vaccine is likely greater than your risk, yet you are less likely than the average person to get shingles. There is no right or wrong decision; in your case if it was me, I’d likely get the vaccine, but it is your call. Steven Masley, MD
Dr. Masley – if you had the Zostavax shot when you turned 60, instead of the new vaccine, would it be beneficial to have another Zostavax injection?
If you had the Zostavax vaccine, the effectiveness wears off over time. I would wait at least six months, and then get the new vaccine. I would not repeat the Zostavax vaccine. Repeating it has not been studied and I don’t know what the side effects from repeating it might be. Steven Masley, MD
I had shingles when I was 50, then again (a very light case this time) at about 62, then I got the Zostavax vaccine maybe a couple of years after that. I am now 72. Wondering if I should get the Shingrix vaccine now. Zostavax would not be good by now, but I was never sure even when I got it that I should have, having already had shingles. ???
Yes you can get shingles more than once. The Zostavax vaccine was less effective than previously thought. You likely have some protection from having had the shingles once and from having had the Zostavax vaccine. Your benefit with the vaccine is likely greater than your risk, yet you are less likely than the average person to get shingles. There is no right or wrong decision; in your case if it was me, I’d likely get the vaccine, but it is your call. Steven Masley, MD
Thank You Doctor for this information.
Thank you for a very informative article. You didn’t mention what the adjuvants are in this new vaccine. What adjuvants does it contain? Thanks!
The ingredients are dipotassium phosphate, polysorbate 80, sodium dihydrogen phosphate dihydrate, and sucrose. They sound fairly benign to me.There is likely some remote risk to anything that gets injected, yet to me the 30% risk of getting shingles and the 10% chance of getting post herpetic neuralgia for decades is worse than that risk. There is no right or wrong decision here. You have to make the best decision for yourself.
Steven Masley, MD
Thank you for addressing this problem. I have been battling making a decision for years. Now I find myself in stage 3 diastolic heart failure and no one can tell me if there is an increased risk. Also diabetic with mild neuropathy in both feet. I hope they are working on the statistics so we patients just don’t role the dice. But I do love the fact that you have taken such an active part in your patients care. Like everyone else I wish you were my doctor. I am enjoying thrive. Have a wonderful holiday season. God Bless you and all who support your good works. Linda Pruss
Thank you for this valuable needed information.
I have not been able to find out what the adjuvants in the new Shingles vacination are. You imply that there is a no mercury version- what about aluminum? Is this safe for individuals with significant risk of auto-immune diseases?
The ingredients are dipotassium phosphate, polysorbate 80, sodium dihydrogen phosphate dihydrate, and sucrose. No mercury or aluminum listed. They sound fairly benign to me.There is likely some remote risk to anything that gets injected, yet to me the 30% risk of getting shingles and the 10% chance of getting post herpetic neuralgia for decades is worse than that risk. I suspect that someone with an auto-immune disease has a slightly greater risk for a vaccine reaction, but that likely has not been studied, and my best guess is that it is far less than 3%. There is no right or wrong decision here. You have to make the best decision for yourself.
Steven Masley, MD
Can you get Shingles more than once??
Is it good to get the Shingrix vaccine
Even if you have had The Shingles virus several years ago?
Most people who get shingles only get it once. I’ve searched for the percentage of people who get it more than once, but good data is hard to find. My experience is that far too many people get it more than once. The problem is that it occurs at the worst of times. Your immune system is down because you are stressed and/or sick, and boom you get hit with shingles when you are already sick.
If you have had a shingles outbreak, even if you have had the Zostavax vaccine, I personally would still get the vaccine to avoid getting it again, especially at a time when I have been ill from another cause. You have to weigh the benefits and risks and go with a choice that works best for you.
Steven Masley, MD
Dr. Masley, Thank You. As usual you have issued extremely valuable information. 37 years ago, I got some very painful blisters on my right hip/buttock. I went to my Doctor when my leg sort of went numb. After examination, he informed me that it was •herpes zoster•. He treated me as a child for chickenpox. I was 31 when the blisters struck. He treated with •prednisone• 5 day course. I am 68 now. Over the years, this site now has what looks like a small nipple and the skin around it resembles an areola, approximately 2 inch diameter. weird!. I cover it with a large bandaid. If I don’t, it becomes irritated. When I change it, I wipe down the area with 91% alcohol. Does not irritate in any way. However, if I lay or sleep on my right side for more than a couple of hours, my leg goes a painful numb. Sounds odd, I know. In any event, the area does ache sometimes. Would the vaccine help in any way, or is this something that will bother me from now on? Thank You for your Awesome andTruly Dedicated Work. I have been fortunate enough to have three (3) fine Physicians. You Are the Famous and last one. As Drs. Greenberg, and Mahoney are no longer with us. I have unofficially been one of your patients since your KQED. San Francisco: Heart Health Series about 8 years ago. I highly value your knowledge and information and Recipe Saturday. THANK YOU VERY, VERY MUCH. SINCERELY JESSE B MITCHELL II FIREMAN -(ret.RFD)
Jesse,
You need to have a physician look at the skin changes you describe. I don’t know if the vaccine will help your skin issue or not (likely not), but the vaccine would help prevent you from getting shingles again. Steven Masley, MD
Thanks for the information, I have a friend who had shingles and now has the long term pain associated with it ……..something to definitely avoid! Get the Shingrix vaccine!
Thank you, Dr. Masley
It is good to see the benefits and drawbacks of the vaccine.
if i have already had shingles, can i get it again?
You can.
Can you get shingles more than once in your adult years?
You can.
I had the Zostavax vaccine and 5 years later developed ophthalmic shingles (on face, in the eye quadrant). It occurred after Hurricane Harvey and, at the same time, the death of a close friend – so I think stress is a contributing factor. I was told after I’d healed to drink lemon balm tea, that it may help keep the virus in the spinal cord where it resides. (I haven’t verified that information.) I know I can get shingles again, so I’m torn about the new vaccine.
If you had the Zostavax vaccine and shingles, then you are less likely to get shingles again than the average person. yet you could still get shingles a second or third time. The benefit is likely higher than the risk, but you have to make that call. There is no right or wrong decision. Steven Masley, MD
Dr. Masley,
Really liked your common sense approach to this. Not sure what all they add to the mix, but thank you for this informative article. Really enjoyed it!
Thank you for this good advice! My dear mother got shingles at age 88 and suffered terribly. Her health had been good, but we feel she died of exhaustion for the unrelenting terrible pain. She suffered for
Four years and it ruined the rest of her life. She was such a beautiful lady. I got the new shots as soon as possible.
I’m surprised Dr Masley you are so comfortable with this vaccine since it is so new to market I have had Shingles 6 years ago when I was overwhelmed and had no idea about self care. Now, my Vitamin D level to over 80 and learned how to support my immune system and maximize overall self care. And educated myself also about suppressed Vaccine Injury data. I do not want to put anything in my body that may risk Guillian Barre Syndrome or the host of other side effects that are much more common than we are led to believe!! Immune support is the way to go in my opinion!! It’s a win-win👍🧘♀️🥑🙋
There is no right or wrong. There are risks and benefits with any approach. My goal is to give you the information for you to make the best decision for yourself. Steven Masley, MD
You recommend giving children single vaccines at a time because of inflammatory response this directly contradicts the academy of pediatrics cdc who and other organizations. Is this practical
You are correct that I recommend a more cautious approach. It isn’t less effective to spread out the vaccination schedule. The down side is that it is more inconvenient, and the positive is that you have less of an inflammatory response. I suspect many public health officials would be concerned that if you required more visits, you would skip them and not get vaccinated. I am not suggesting that you skip them, but that you spread them out. Steven Masley, MD
I’m 68 and have already had shingles sometime during my 50’s. It wasn’t fun, but I survived and the lingering nerve pain lessened and finally disappeared over the next year.
Since I’ve already had shingles, don’t I already have the antibodies in my system that a shingles vaccine would be adding? Is my thinking right on that?
Yes, you did get a short term boost in antibodies from having had shingles. But the reality is that you can get shingles more than once. I suspect that if you know first hand how nasty this can be that you will want to take steps to ensure that you don’t give it again. Steven Masley, MD
How soon after an episode of shingles do you recommend one getting the Shingrix vaccine?
Esther, That is a good question. There is not an answer that has been studied with clinical trials. In my clinic, I recommend that my patients wait for six months after having shingles to get the vaccine, but I honestly do not have studies to support that suggestion. Ask your physician who knows your personal medical history what they would recommend. Steven Masley, MD
I did have shingles, later took the zostavax shot; do I still need the new vaccine?
If one received the Zostavax vaccine in the past few years, is it safe to now get the Shingrix vaccine, within a 2-5 year span?
After you had the Zostavax vaccine, you should wait at least 2-3 months before getting the Shingrix vaccine. I typically have my own patients wait at least six months. By five years, the Zostavax vaccine becomes fairly ineffective. Steven Masley, MD
Thank you! I appreciate your
Recommend opinions.
what % of reduction of the chance to get the Shingles for a person who had the smallpox will this new vaccine provide. In other words how effective is it 50%, 75% ?????
Thanks
The vaccine decreases your risk for getting shingles by more than 90%. Te short term prevention rate was 97% reduction.
Steven Masley, MD
Good info. Thank you!
Last year I had Shingles, the blisters and pain remained 6 months, I have been ok for eight months do you recommend the vaccine for people like me that already had shingles?
Thank you
That sounds dreadful. Yes I recommend the vaccine if you have had shingles.
Steven Masley, MD
Is it beneficial to get the vaccine if you have had the shingles. What is the percentage
of getting the shingles multiple times?
If you have had shingles, sadly you can get it again. I just saw a patient 2 weeks ago that has had shingles 3 times. I do recommend the vaccine for people who have had a shingles outbreak. Steven Masley, MD
I do not know if I had chicken pox as a kid. How do I find out if I’m at risk?
If you are not sure, ask your doctor to test you. A blood test can determine if you have been exposed or not. If you were never exposed, getting chicken pox as an adult is far worse than getting it as a children. There is a vaccine that will help prevent you from getting chicken pox. If you never had chicken pox, then you do not need the Shingix vaccine.
Hi Dr Masley,
Can you point to any studies on those who received the chicken pox vaccine and later incidence of shingles? In other words; if I had the shot for chicken pox, what are the odds that I could get shingles? Thank you!
Beth,
Good question! If you never had chickpox, and got the vaccine to prevent it, then you would not be at risk for getting shingles, and you would not benefit from the vaccine.
Steven Masley, MD
Could the shingix vaccine trigger a permanent autoimmune response (such as rheumatoid arthritis or lupus) in a person who already has some increased autoimmune antibioties (ANA, and at one time double stranded DNA) or would it be ok to take
Thanks in advance
All vaccines have the potential to raise inflammation levels short term. I think the risk of causing a flare of an auto-immune disease is possible, but that it is less than the risk of getting shingles, and for most people, there is more benefit than risk with the vaccine. Yet for people who are struggling to get into an auto-immune remission, I am sometimes more careful. Best would be to discuss with a medical provider who knows you and is well educated on this topic.
Steven Masley, MD
Do you know if the new vaccine would trigger an autoimmune disease in those with already raised antibodies (ANA and one time a high double stranded DNA)
Thank you
Patti,
All vaccines have the potential to raise inflammation levels short term. I think the risk of this is less than the risk of getting shingles and for most people, there is more benefit than risk. Yet for people who are struggling to get into an auto-immune remission, I am sometimes more careful. Best would be to discuss with a medical provider who knows you and is well educated on this topic.
Steven Masley, MD
Most youngsters received chicken pox vaccine since it came out in the 1990s, so does that mean shingles will be uncommon in years to come?
Diane, You are correct, although it will take decades before this happens, because most adults had chicken pow, not the vaccine. Steven Masley, MD
I am torn but value your advice. I had the first shingles vaccine some years ago, and within 6 to 8 months got shingles over my left eye. It caused corneal inflammation in that eye so a course of eye drops was used. The ophthalmologist told me that if I had not had the vaccine, I might have become blind in that eye. Now my conventional medical doctor says I should get Shingrix, but my functional medical doctor is against all vaccines. There has been a backlog of the vaccine so I have waited. Thank you for all your information. Perhaps my functional medical doctor will change her mind when she knows Shingrix does not contain mercury or aluminum. I certainly don’t want to get shingles again!
Hi, This past year November 1, 2018, I got my first outbreak of Shingles at age 41. I had the first dose of ShinglesX and am now due for the second. However, I have had one random water filled blister form on my ankle, knee, and back. Just one at a time, erupt, then crust over. Also, strange itchy skin on my torso. I’m kind of worried about getting the second shot, due to these side effects. What do you think about a woman in her 40’s and getting a vaccination that is recommended for 50 and older? Thanks!
Good question. Having shingles so young makes you an unusual. There is not an evidence based answer to your questions. I understand the temptation to get boosted in your 40s after having had shingles so young. I likely would have waited until age 50. Shingrex is not a live vaccine, so it shouldn’t be able to cause the blisters you mentioned. That may be a coincidence. Since you had the first vaccine, if it was me, I’d go ahead and get the second to complete the series, but always consult with your own physician as to what they advise for you. There is no right or wrong answer in this setting.
Steven Masley, MD