What you should know about the Shingles Vaccine

Q. I have been seeing more and more information about the shingles vaccine in the news.  What is shingles?

A.  Shingles (or herpes zoster) is a painful skin rash that usually appears in a band, a strip, or a small area on one side of the face or body.

Q. What causes shingles? 

A.  Shingles occurs when the virus that causes chickenpox becomes active (reactivates) again in your body.  After you get better from chickenpox, the virus “sleeps” (is dormant) in your nerve roots.  In some people, it stays dormant forever.  In others, the virus “wakes up” when disease, stress, or aging weakens the immune system.  Some medicines may trigger the virus to wake up and cause a shingles rash.  It is not clear why this happens, but after the virus becomes active again, it can only cause shingles, not chickenpox.

Q.  How do I get shingles?

A.  Shingles is caused by the varicella zoster virus (VZV), which is the same virus that causes chickenpox.  Anyone who has had chickenpox can develop shingles because VZV remains in the nerve cells of the body after the chickenpox infection clears.

Q.  Can I catch shingles from someone who has it?

A.  You  cannot catch shingles from someone else who has shingles.  However, fluid from shingles blisters is contagious and can cause chickenpox (but not shingles) in people who have never had chickenpox and who have never gotten the chickenpox vaccine.  If you have never had chickenpox and have never gotten the chickenpox vaccine, avoid contact with people who have shingles or chickenpox.

Q. How do I know if I have shingles?

A.  Shingles happen in stages.  At first you may have a headache and be sensitive to light. You may also feel like you have the flu but not have a fever.  Later, you may feel itching, tingling, or pain in a certain area.  That’s where a band, strip, or small area of rash may occur a few days later.  The rash turns into clusters of blisters. The blisters fill with fluid and then crust over. It takes 2 to 4 weeks for the blisters to heal, and they may leave scars.  Some people only get a mild rash, and some do not get a rash at all.  If you have any of these symptoms, you should contact your doctor right away to determine if you have shingles.

Q. Is there a treatment for shingles?

A.  Shingles is treated with medicines including antivirals and also medicines for pain.  Starting antiviral medicine right away can help your rash heal faster and be less painful.  If you think you may have shingles, contact your doctor right away.

Q. How do I know if I need the shingles vaccine?

A.  The Centers for Disease Control recommends the shingles vaccine for people 60 years old and older to prevent shingles. The effects of shingles can become increasingly severe as one ages.    The shingles vaccine is a one-time vaccination and there is no maximum age for getting the shingles vaccine.  Studies show that more than 99% of Americans ages 40 and older have had chickenpox, even if they don’t remember getting the disease, so most people 60 years and older have likely already had chickenpox .

At this time, CDC does not have a recommendation for routine use of shingles vaccine in persons 50 through 59 years old. However, the vaccine is approved by the FDA for people in this age group.

There are some people who should NOT get the shingles vaccine.

  • A person who has ever had a life-threatening or severe allergic reaction to gelatin, the antibiotic neomycin, or any other component of the shingles vaccine. Tell your doctor if you have any severe allergies.
  • A person who has a weakened immune system because of
    • HIV/AIDS or another disease that affects the immune system
    • treatment with drugs that affect the immune system, such as steroids
    • cancer treatment such as radiation or chemotherapy
    • a history of cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma.
  • Women who are or might be pregnant

The decision on when to get vaccinated should be made with your health care provider.

Q.  Can I still get the vaccine even if I have already had shingles?

A.  Even if you have had shingles, you can still receive the shingles vaccine to help prevent future occurrences of the disease. There is no specific time that you must wait after having shingles before receiving the shingles vaccine. In general, though, a person should wait until after the shingles rash has healed before getting the shingles vaccine.

Q. Is the shingles vaccine covered by my insurance?

A.  All Medicare Part D plans cover the shingles vaccine. The amount of cost-sharing (or money you have to pay) for vaccination varies.  Medicare Part B does not cover the shingles vaccine.

If you have private insurance or Medicaid, your plan may or may not cover the vaccine.  We recommend you contact your health insurance provider to find out the cost of the vaccine and whether or not it is covered by your plan.

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About Dr. Elisa Choi

Dr. Elisa Choi is a board-certified Internist and Infectious Disease specialist at Harvard Vanguard’s Kenmore practice, where she sees patients in Internal Medicine and also provides Infectious Disease and HIV consultations for all Harvard Vanguard patients. Dr. Choi has a strong interest in tick-borne infections, and has published articles on this topic. She is on the faculty at Harvard Medical School, where she teaches medical students in the Patient-Doctor 2 course. For the past several years, Dr. Choi has been on the Board of Directors of a non-profit organization, MAP for Health, which focuses its efforts on disease prevention, health care advocacy, and primary care access for the Asian-Pacific Islander and South Asian community. She is the current Chair of the Board of Directors of MAP for Health. Dr. Choi’s other professional and clinical interests include clinical teaching and education, women’s and LGBT health issues, sexually transmitted infections, HIV infection, hepatitis infections, infections in immunocompromised patients, and chronic infection and disease management.
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