The availability of the vaccine against shingles, known as Shingrix, has transformed the approach to preventing this common and often debilitating disease. This recombinant zoster vaccine is designed to prevent the reactivation of the virus that causes chickenpox, protecting against shingles and its most severe long-term complication. Deciding whether to get this two-dose vaccine involves understanding the disease, recognizing health recommendations, and weighing the vaccine’s performance against its safety profile.
Understanding the Shingles Virus and Disease
Shingles, or herpes zoster, is caused by the reactivation of the varicella zoster virus (VZV), the same virus that causes chickenpox. After recovery from chickenpox, VZV remains dormant within nerve cells in the central nervous system. The virus can reactivate years later, often due to a decline in immune system strength caused by age, illness, or stress, traveling along nerve fibers to the skin.
The primary symptom of a shingles outbreak is a painful, blistering rash that typically appears in a single stripe on one side of the body or face. This pain can be severe, described as burning, sharp, or deep aching, and often occurs before the rash becomes visible. While the acute rash usually resolves within a few weeks, the most concerning complication is postherpetic neuralgia (PHN).
PHN is a persistent nerve pain syndrome that continues for months or years after the shingles rash has healed. This chronic pain results from damage to the nerve fibers caused by the reactivated virus. The affected area can become extremely sensitive, where even a light touch causes pain. Approximately one in three people will develop shingles, and the risk of PHN increases significantly with age, affecting about 20% of those over 50 who contract shingles.
Official Vaccine Recommendations and Eligibility
The Centers for Disease Control and Prevention (CDC) recommends the vaccine for all healthy adults aged 50 years and older. This recommendation exists because the risk of shingles and its complications rises sharply after age 50. There is no upper age limit for receiving the vaccine.
The vaccine is also recommended for individuals who have previously had an episode of shingles, as recurrence is possible. If a person has recently had shingles, vaccination should be administered after acute symptoms resolve, typically waiting at least 12 months. Screening for a history of chickenpox is unnecessary, as nearly all adults aged 50 and older have had the virus and are at risk.
Special Eligibility Groups
Adults aged 19 years and older who are or will be immunocompromised due to disease or therapy should also receive Shingrix. These individuals are at a higher risk for shingles and its complications. Shingrix is also recommended for those who previously received the older Zostavax vaccine, which is no longer available in the United States. If Zostavax was received, a person should wait at least eight weeks before starting the Shingrix series.
Efficacy Rates and Safety Profile
The recombinant zoster vaccine is effective at preventing both shingles and postherpetic neuralgia (PHN) across different age groups. Two doses of the vaccine are approximately 97% effective in preventing shingles for adults aged 50 to 69 years. Efficacy remains high in older populations, reported at about 91% for adults aged 70 years and older.
Protection against PHN is also high, with an efficacy of 91% in adults aged 50 and older, and 89% for those aged 70 and older. Data suggests that the protection offered by the two-dose series remains strong, often exceeding 85%, for at least the first four years following vaccination.
Most side effects are temporary and expected, representing the body’s immune response. The most common reactions are local, occurring at the injection site, and include pain, redness, and swelling. Systemic side effects are frequent and may include muscle pain, fatigue, headache, shivering, and fever. These symptoms are generally mild to moderate, resolve within two to three days, and can often be managed with over-the-counter pain relievers. Individuals with a history of a severe allergic reaction to a previous dose or any component of the vaccine should not receive it.
Practical Steps for Receiving the Vaccine
The vaccine is administered as a two-dose series. For healthy adults, the second dose is typically given two to six months after the first dose. Immunocompromised individuals may receive a shorter interval of one to two months between doses to provide protection sooner.
Receiving both doses is necessary to achieve the high efficacy rates demonstrated in clinical trials. If the second dose is delayed beyond the recommended six-month window, the series does not need to be restarted. The vaccine is given as an intramuscular injection, usually into the deltoid muscle of the upper arm. Administration is widely available at a doctor’s office or through many local pharmacies.
Coverage and Contraindications
The cost of the vaccine is generally covered by most private insurance plans and Medicare Part D for eligible beneficiaries. Patients should check with their insurance provider to confirm coverage details and potential out-of-pocket costs. The main contraindication is a documented history of a severe allergic reaction to a previous dose or any of its components. The vaccine is also not recommended during pregnancy and should be delayed until after delivery.