Over 50? You Need a Shingles Vaccine

I spent a recent Sunday languishing on the sofa, reading, napping, and binge-watching a ridiculous amount of Netflix. It was all for a good cause: avoiding the varicella-zoster virus, which causes shingles and chickenpox. I’d just been vaccinated with the shingles vaccine known as Shingrix and wasn’t feeling great. 

“The majority of patients who get shingles are more than 50 years old, which is why this is the main group for whom Shingrix is approved,” says Scott Elman, M.D., a dermatologist with the University of Miami Health System.

Although I easily qualify as “more than 50 years old,” I’d shied away from Shingrix due to a bad reaction to a tetanus vaccine years ago. That experience didn’t stop me from racing to the nearest pharmacy for the COVID-19 vaccine, however. The COVID shot left me listless and flu-like for a couple of days, but I gladly returned for my boosters. 

So why was Shingrix any different?

Unlike COVID, I wondered if shingles was really serious enough to put up with the potential side effects. I’m not alone in trying to rationalize my way out of the shot. 

“I hear patients not wanting to get the vaccine because the vaccination can be painful,” Dr. Elman says. “While it is true that vaccination can lead to soreness for one to three days on average, the pain from the vaccine is significantly less than the pain of shingles. Another common misconception I hear is that if you had shingles once, you can’t get it again.

Previous (shingles) infection does not prevent a future infection.

Dr. Scott Elman

“As such, I recommend that even those who have had shingles previously receive the Shingrix vaccine. The vaccine is effective at preventing shingles as well as its dreaded, painful complication of post-herpetic neuralgia.”

While symptoms of shingles are not life-threatening, its tingling or burning blisters can be intensely painful. Some people experience common side effects of fever, headache, fatigue, and sensitivity to light.

The virus also has a knack for striking in the most inconvenient places.

One friend developed an angry red rash on her armpits and under her breasts. The pain was so severe, she walked around like Frankenstein with her arms extended and had to go braless for days.

Another friend got shingles in his throat. Several years later, he still suffers occasional attacks of dry coughing he claims were caused by shingles.

A third friend spent hours in a lukewarm bath, seeking relief from the itching, open sores blistering her right hip. Even worse, the painful rash can occur around the eye; left untreated, it can permanently damage your vision. When the pain of shingles precedes the rash, doctors may think it stems from sources besides shingles and may evaluate it accordingly. 

I finally stopped procrastinating and took the plunge. The injection was uncomfortable, but even for this sensitive soul, the side effects were minimal: pain at the injection site (easily alleviated with ice), all-over achiness, fatigue, and a few waves of nausea. 

For one day.

What causes shingles?

The varicella-zoster virus belongs to a group of herpes viruses, which is why shingles is also known as herpes zoster. (This group includes viruses that cause cold sores and genital herpes, but shingles and chickenpox are not caused by the same viruses. Genital herpes is a sexually transmitted infection.) 

 “After you have chickenpox, the varicella virus can live dormant in your nerves,” says Dr. Elman. 

In some people, the virus reactivates later in life and travels along the nerve pathways to the skin, causing shingles. This happens more often in older individuals and those with weak immune systems.” 

Most people born before the chickenpox vaccine was introduced in 1995 (or at least those born before 1980) have had chickenpox, even if they do not remember having it. This is the most important point and why I recommend Shingrix for individuals over age 50 AND adults 19 years or older who have weakened immune systems as a result of a disease or therapy.

Dr. Scott Elman

Currently, Dr. Elman says that “the FDA has not approved Shingrix for adults less than 50 who have a normal immune system, regardless of their prior history of shingles.” 

Stress can also trigger a shingles outbreak. “The virus’ wakes up’ and can emerge as shingles after a stressful event. The stress can be physical or emotional,” Dr. Elman says.

On a positive note, Dr. Elman says that since the chickenpox vaccine was introduced, cases of shingles in children have decreased. 

“My expectation is that as the young group who received the chickenpox vaccine gets older, there will be less shingles (since you need to have had chickenpox to develop shingles) but it is still too soon to know the full effect of chickenpox vaccination on adult-developed shingles.”

Is the shingles virus contagious?

The short answer is yes. 

Anyone with open shingles blisters should avoid physical contact with people who have not had chickenpox or the chickenpox vaccine, especially pregnant women, infants, and immunocompromised individuals. In people who haven’t had chickenpox or been vaccinated for it, the varicella-zoster virus causes chickenpox, not shingles.

While Shingrix contains a virus component, it is a nonliving vaccine. 

It is given in two shots, two to six months apart. Some people experience redness, pain, and swelling at the injection site. Some also feel fatigued; others get a headache. 

The Centers for Disease Control and Prevention (CDC) recommends that people aged 50 and older get the Shingrix vaccine. If you’re eligible for Shingrix, don’t procrastinate like I did. 

Research shows that the vaccine not only helps prevent shingles in older adults, it also lowers your chance of complications if you do have an outbreak. In fact, Shingrix is considered more than 90% effective in preventing shingles and post-herpetic neuralgia.

And there’s more good news. “The vaccine lasts with good durability for four to seven years. 

At present, the CDC does not recommend a ‘booster’ dose of Shingrix,” says Dr. Elman.

You can still get vaccinated if:

• You’ve had shingles in the past.
• You had the Zostavax shingles vaccine that is no longer used in the U.S.
• You don’t know whether you have had chickenpox.

In some instances, Shingrix is not recommended. 

“You should avoid getting Shingrix if you have ever had a reaction to a component of the vaccine, you currently have shingles or are currently pregnant. If you are unsure if your underlying medical conditions place you at increased risk, you should speak with your doctor,” Dr. Elman says. 

Does a case of shingles require a doctor’s visit?

Timely medical treatment can reduce pain, complications, and the duration of an outbreak, so it’s wise to see a doctor. You may be prescribed an antiviral drug; if so, avoid drinking alcohol while taking the medication.  

There are times when a shingles rash requires immediate medical attention, such as:  

• You are 50 or older – the risk of complications increases with age
• Blisters occur near your eye. Left untreated, the infection could damage your vision permanently
• The rash is painful and covers a wide area
• Your immune system is compromised from a chronic illness, steroid use, radiation, or chemotherapy therapy
• You are in regular, close contact with someone at high risk for contracting shingles

Shingrix cannot treat an active outbreak, so it makes sense to get vaccinated. Not only will you be more than 90% protected against shingles and its complications, you’ll also have a good excuse to relax on the sofa. 

Nancy Moreland is a regular contributor to the UHealth Collective. 

She has written for several major health care systems and the CDC. Her writing also appears in the Chicago Tribune and U.S. News & World Report.

Tags: complications of shingles, Dr. Scott Elman, painful blister, people with shingles, shingles include, skin reaction