Shingles activates when your immunity is low, usually with advancing age. But not everyone who is a candidate for the shingles vaccine should take it.
Shingles is a disease that usually presents with a painful rash that affects one in three people in their lifetime. It is caused by the same virus that causes chickenpox — the herpes virus varicella-zoster. More than 99% of people born before 1980 have had chickenpox and have this virus dormant in the brain or spinal cord.
Shingles activates when your immunity is low, usually with advancing age. The currently used recombinant zoster vaccine (RZV) is safe and effective. But not everyone who is a candidate for the shingles vaccine should take it. Like all vaccines, the shingles vaccine has benefits and harms. You should know about both and make an informed decision about taking it.
What is shingles?
The chickenpox virus can lie dormant in your spinal or brain nerves for years or decades. It becomes active when age, some disorder, some medicines, or stress weaken your immunity. Shingles appears when the chickenpox virus in your body activates.
The illness starts with some tingling, itching, or pain, usually on the trunk. The rash appears a few days later and is reddish, and is patchy at first. It develops into clusters of fluid-filled small boils. It is common on the trunk but can happen on the head, face, limbs, or genitals. It is always on one side of the body. Other symptoms you may have with shingles:
About 10% to 18% of people who get shingles develop postherpetic neuralgia (PHN). This nerve pain can last from months to years and is often severe enough to interfere with daily living. Older people with shingles are more likely to get PHN. They're also likely to have severe and long-lasting pain. Other serious complications are blindness, pneumonia, hearing loss, hepatitis, and encephalitis (brain inflammation).
People with weakened immune systems have more frequent and severe complications of shingles. The rash is likely to be longer-lasting, and the infection may spread.
Though a virus causes shingles, you can't get shingles from another person. You have shingles only when the virus already in your nerve cells is activated. If you have shingles, susceptible people coming in contact with you might get chickenpox. People who have never had chickenpox or the varicella vaccine are susceptible.
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Who is a candidate for the shingles vaccine?
Adults 50 years and older. Immunocompetent adults 50 years and older should get two doses of Shingrix, 2 to 6 months apart.
Adults 19 years and older with weakened immunity. Immunity could be reduced by diseases like HIV, leukemia, or lymphoma. The immunosuppressive medicines given with organ transplants, and chemotherapy for cancer, also weaken immunity. The vaccine is safe and effective in people with multiple myeloma and other blood cancers, solid organ cancer, people with HIV, and renal transplant recipients.
People who have had shingles. Unlike chickenpox, shingles can happen again. The shingles vaccine works well if you've had shingles before. You will have stronger immunity against further attacks of shingles.
People who took Zostavax. This shingles vaccine is no longer in use in the US. People who took it should take two doses of RZV.
Do your age or health situation make you eligible for the vaccine? Weighing the benefits and potential dangers will let you make the best decision for yourself.
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Recombinant zoster vaccine (RZV)
The RZV provides effective protection against shingles and its complications. Most people who take this vaccine won't get shingles. If you have shingles after the vaccine, it will be mild. Taking the vaccine protects you against PHN and other complications of shingles as well.
Two doses of RZV are required. The second dose is given 2 to 6 months after the first. If your physician knows you will be immune-suppressed shortly, they may give the second dose as early as one month after the first. This could happen if you are about to start chemotherapy or have an organ transplant.
Vaccine adverse effects
RZV is a safe vaccine. But you may have some vaccine adverse effects:
- Pain at the injection site. You may have swelling and redness, too
- Muscle pain is a frequent side effect
- Headache
- Tiredness
- Stomach pain and vomiting
- Dizziness, difficulty seeing, or ringing in the ears
- Shivering and fever
Most of these side effects last for 2 or 3 days and don't need treatment. You should take the second dose even if you have any of these. Rarely, the vaccine can cause a severe allergic reaction or death. A severe allergic reaction is considered an absolute contraindication — you should never have further doses.
Why you shouldn’t get the shingles vaccine
If you've never had chickenpox. Almost everyone born after 1980 has had chickenpox at some time in their lives. A blood test can check immunity to chickenpox. If this test shows you've never had chickenpox, you shouldn't get the shingles vaccine. You need the varicella (chickenpox) vaccine instead.
If you're under 50. The risk of shingles is low when you're young. The most troublesome complication of shingles, postherpetic neuralgia (PHN), almost never happens under 40. Young people have little benefit from this vaccine.
If you're pregnant. The earlier shingles vaccine, Zostavax, was a live virus vaccine. Live virus vaccines are not recommended for pregnant women because the virus may cross the placenta and infect the baby. This vaccine is not available in the US since November 2020.
The vaccine available in the US now is the recombinant zoster vaccine (RZV, brand name Shingrix). This is a laboratory-made vaccine based on a glycoprotein of the varicella-zoster virus. It is not a live vaccine and should be safe. But safety in pregnant women has not been proven yet, and so it is not recommended during pregnancy.
Severe reaction to an earlier dose. If you had a severe allergic reaction after the first dose of RZV, you shouldn't have the second dose. Be careful also if you have had allergic reactions to other vaccines. Some components might be the same.
If you have shingles. You shouldn't take the vaccine when you have active shingles. Your physician will ask you to wait a few weeks or months. The vaccine is given when the illness has resolved.
If you're ill. If you have a moderate or severe illness, with or without fever, you should postpone getting the vaccine.
One person in three has shingles in their lifetime. Two people out of three never have it, but there isn’t a way to know if you’re among the lucky ones. Unlike other diseases, there are no precautions you can take to avoid the infection. The virus is probably already within you. Consider your age and other factors carefully while deciding whether to get this vaccine.