Understanding Shingles: How the Shingles Vaccine Can Help Prevent Lingering Pain and Provide Relief

Shingles, or herpes zoster, is more than just a rash – it's a painful reminder of the varicella-zoster virus that can linger long after the blisters fade. In this Q&A with Dr. Erika Blank, learn how the new shingles vaccine offers robust protection against this discomfort and its lasting effects

What is shingles?

Shingles, or herpes zoster, is a painful, itchy, vesicular rash caused by the same virus that causes chickenpox: varicella zoster. Once infected with varicella zoster during an episode of chickenpox, their body contains the virus in a dorsal nerve root or a cranial nerve ganglia. As the immune system wanes with age, illness or medications that affect the immune system, such as chemotherapy, the virus starts to replicate and appears again as a rash in the exact area of the particular nerve that was affected. This is why shingles often occur in a band. Both “shingles” (French and Latin) and “zoster” (Greek) translate to the English word “belt,” which describes the appearance of the rash.

What are some of the symptoms of Shingles?

Symptoms of shingles include pain, itching and a rash that usually appears on one side of the body and is often in a band or stripe pattern.

Who is at risk for shingles?

In the US, about one in three people will get shingles in their lifetime, with the incidence increasing above age 60. About 10 to 18% of people who develop shingles will also experience a complication known as postherpetic neuralgia. This painful condition affects the nerve fibers and skin, causing burning and sometimes incapacitating pain that can last months or even years after the rash disappears.

Postherpetic neuralgia becomes more common with increasing age, prodromal pain, more severe acute pain, ophthalmic involvement, and skin lesions involving large surface areas. Other serious complications include vision and hearing impairments and various neurologic complications.

How is shingles diagnosed?

Shingles diagnosis often relies on observing the rash's appearance and associated symptoms. Laboratory tests may be performed in some cases.

What is the shingles vaccine?

The good news is that we now have a vaccine that effectively prevents both shingles and postherpetic neuralgia. Unlike the prior shingles vaccine, Zostavax, which is no longer available in the US, the new shingles vaccine, Shingrix, is extremely effective. Shingrix is a recombinant vaccine. This means it contains a protein from a killed virus that helps create an immune response. It does not have a live virus.

It also includes an “adjuvant,” which helps boost the immune response. Most of the uncomfortable side effects of the vaccine are due to the adjuvant, which comes from an immune-boosting substance isolated from the surface of bacteria and a natural compound extracted from the Chilean soapbark tree. Shingrix is not egg-based and does not contain thimerosal, a mercury-containing preservative.

How effective is the shingles vaccine?

A large trial of 15,411 people over the age of 50 found the two-dose Shingrix vaccine to be:

• 97.2% effective at preventing shingles
• 91.2% effective at preventing postherpetic neuralgia.

Another large trial looking at 13,900 people over the age of 70 showed the vaccine to be:

• 91.3% effective at preventing shingles
• 88.8% effective at preventing postherpetic neuralgia in this older population.

Shingrix immunity remained high in people 70 years and older who had healthy immune systems for seven years following vaccination.

What are the Shingrix side effects?

The shingles vaccine has some side effects, but these do not compare to the pain one can experience from the infection or the persistent pain from postherpetic neuralgia. Side effects include injection site reactions and systemic reactions.

The most common side effect is pain at the injection site, affecting 78% percent of people. Reactions that prevented normal activities (pain, redness, and swelling) occurred in 9.4% of vaccine recipients. The most common systemic effects in the trials were muscle aches (44.7%), fatigue (44.5%), headache (37.7%), shivering (26.8%), fever (20.5%) and gastrointestinal symptoms (17.3%). Systemic effects that prevented normal activities were reported by 10.8% of vaccine recipients versus 2.4% of those who received a placebo. Most side effects improved in two to three days. Side effects were more common in younger people.

I never had chickenpox. Do I still need a vaccine?

You can get Shingrix whether or not you remember having chickenpox in the past. More than 99% of Americans born before 1980 have had chickenpox, even if they don’t remember having the disease. Antibodies to the virus are currently found in 97.3% of persons aged 20-39 and more than 99.2% of those older than 40 years.

When can I get shingles vaccines?

The CDC recommends two doses of recombinant shingles vaccine (Shingrix) to prevent shingles and related complications in adults 50 years of age or older. Shingrix is also recommended for adults 19 years or older who have weakened immune systems because of disease or therapy. Doses are given 2 to 6 months apart, but people with a weakened immune system can get the second dose 1 to 2 months after the first.

I already had shingles; do I still need the vaccine?

Having an episode of Shingles will boost your immunity to a recurrence, but the vaccine is still recommended. Shingrix can help prevent future occurrences of the disease. There is no specific length of time you need to wait after having shingles before you can receive Shingrix, but generally, you should make sure the shingles rash has gone away before getting vaccinated.

I already received the old shingles vaccine, Zostavax; should I still get Shingrix?

Yes.

Are there any contraindications to Shingrix?

You should not get Shingrix if you have had a severe allergic reaction to any component of the vaccine, you currently have shingles or are currently pregnant. If you have a minor illness, such as a cold, you may get Shingrix. But if you have a moderate or severe illness, with or without fever, you should usually wait until you recover before getting the vaccine. Shingrix should also not be administered to people with a history of Guillain-Barre syndrome.

Are shingles contagious?

You cannot get shingles from someone who has shingles. However, a person with active shingles can spread the virus to someone who has never had chickenpox or has never received the chickenpox vaccine. In this case, the person exposed to the virus might develop chicken pox. The virus can spread through direct contact with the fluid from the blisters of the shingles rash. The virus can no longer spread once the shingles blisters have developed crusts.

Does insurance pay for the vaccine?

Starting in 2023, people with Medicare Part D coverage pay nothing out-of-pocket for the Shingrix vaccine. Most commercial insurances also cover the Shingrix vaccine but check with your plan to make sure.

Dr. Erika Blank is a concierge primary care provider at MUSC Accel Health. She is board-certified in Internal Medicine and Lifestyle Medicine. Learn more about Accel Health's approach to primary care. Sign up to join the waitlist or call 843-876-9360.