Should I Get The Shingles Vaccine?

Celeste Robb-Nicholson, MD

Harvard Health

Q: I'm 79 and had chickenpox as a child. Should I get the shingles vaccine? What are the risks?

A: The U.S. Advisory Committee on Immunization Practices (ACIP) recommends the shingles vaccine for most people ages 60 and over, regardless of whether they recall having had the chickenpox or not. (Studies show that 99 percent of people over age 40 have had chickenpox.)

Shingles, also called herpes zoster, or zoster, is a painful blistering rash caused by the same virus that causes chickenpox -- the varicella zoster virus (VZV). After you recover from chickenpox, VZV retreats to nerve cells near the spine, where it lies dormant until it comes to life again as shingles. About one in three people will develop shingles during her or his lifetime.

When VZV is reactivated, it moves away from the spine and travels along nerve pathways that provide the sensory network for specific skin areas called dermatomes, which are arranged in a band-like pattern radiating from the spine. The shingles rash -- small fluid-filled blisters resembling chickenpox -- breaks out along dermatome lines on one side of the face or body. It can range from simply itchy and uncomfortable to extremely painful. In about 20 percent of cases, the pain lingers after the rash has disappeared; this sometimes debilitating condition is called postherpetic neuralgia.

The shingles vaccine (called Zostavax) reduces the risk of shingles by 50 percent. Even if you do get shingles, your risk of postherpetic neuralgia is much less. The most common side effects were redness, soreness, and some swelling at the injection site.

The vaccine's maker, Merck, is still collecting data about its safety and effectiveness, and the results have not changed. The only new finding is that the effectiveness of Zostavax is reduced if it is given at the same time as the pneumonia vaccine.

If you currently have shingles or any illness causing a fever of 101° F or higher, wait until you have recovered before getting the vaccine.

You should not get the shingles vaccine if you:

- are allergic to a component of the vaccine, including neomycin or gelatin

- have leukemia, lymphoma, or cancer that affects the bone marrow or lymphatic system

- have an immunodeficiency disease, including HIV and AIDS

- are receiving immunosuppressive treatments such as chemotherapy, steroids, or radiation.

It's always a good idea to talk to your doctor about your possible risks and benefits of getting the vaccine.

Celeste Robb-Nicholson, M.D. is an Assistant Professor of Medicine at Harvard Medical School, Associate Physician and Associate Chief of the General Internal Medicine Unit at Massachusetts General Hospital.

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