Ask the Expert: Should You Get the Shingles Vaccine?
Dr. Goswami and Dr. Lachtchinina
If you suffered through chickenpox as a child, there is no doubt that you never want to experience that type of discomfort again. While it’s rare to get chickenpox twice, for many the chickenpox virus reappears years later in the form of another painful disease: shingles. In fact, there are approximately one million new cases of shingles each year. Drs. Alpana Goswami and Janna Lachtchinina, board certified internists, discuss the facts about shingles and the benefits of the shingles vaccine.
What is shingles?
Shingles is a painful skin rash that is often accompanied by blisters. Shingles is caused by the varicella-zoster virus, which is the same virus that causes chickenpox. If you experienced chickenpox as a child, the virus remains dormant in your body and can reactivate many decades later.
Who is at risk for shingles?
Anyone who had chickenpox can develop shingles. As you age, the antibodies you developed to the chickenpox virus begin to fade. By the time you reach your 60s, you have few antibodies left to protect you. Any major health event can then lead to a reactivation of the virus.
Shingles is most likely to develop in someone whose immune system is compromised. This includes those suffering from such conditions as COPD, asthma, inflammatory bowel disease, kidney disease, rheumatoid arthritis, or another chronic condition. Medication that suppresses the immune system, such as radiation, chemotherapy or steroids, also puts individuals at increased risk. For some, age itself is the greatest risk factor. After the age of 50, the lifetime risk of developing shingles is 30 percent.
Shingles should be treated like any active viral infection. If you are experiencing active symptoms, it’s especially important to stay away from those with weakened immune systems and those who have never had chickenpox.
What are the symptoms of shingles?
The most common symptoms include pain and a tingling or burning sensation. In most patients a rash develops within 24 to 48 hours of the onset of pain. The rash can then turn to blisters that may leak fluid before crusting over.
The most common areas for the rash to develop are the scalp, neck, shoulders and chest wall. The shingles rash typically does not cross the midline of the body. While the majority of patients develop a rash, there are some patients who experience the pain and burning sensation but no rash develops.
When should I see my doctor?
Most patients seek medical help because the pain and burning feel so peculiar. We usually see patients within 24 to 48 hours of the onset of symptoms and that’s the best time to begin treatment. The later you begin treatment for shingles, the greater the chance you will develop complications from the illness.
Lesions on the eyes or face can affect the nerves around your eye and the eye muscles, so seeing an ophthalmologist quickly is crucial to avoid complications that can affect your vision.
If I develop shingles, how long does it last and are there any long-term side effects?
Active symptoms typically last an average of 10 to 15 days, although these symptoms can linger depending on how extensive the affected area is. Some people develop blisters that leak fluid before crusting over. Patients can also experience flu-like symptoms, including body aches, fever, chills, and fatigue. It typically takes four to six weeks for all the symptoms of shingles to resolve.
Postherpetic neuralgia (PHN) is the worst complication of shingles and the risk of experiencing this complication increases with age. PHN is a severe nerve pain that can last from days or weeks to months or even years in extreme cases. Anyone whose rash occurs on the scalp, neck and shoulder area may be at an increased risk of experiencing PHN. While the majority of individuals who get shingles will not have PHN, it can be debilitating for those who do experience it.
How is shingles treated?
Because the shingles virus is a herpes virus, the mainstay of treatment involves antiviral therapy for a minimum of one to two weeks. It’s extremely important to complete the course of therapy even if you are feeling better. It usually takes about 48 to 72 hours to see the impact of the antiviral medication. When initiated quickly after the onset of symptoms, antiviral medication may shorten the severity and duration of the illness and decrease the chance of developing PHN.
Pain is most often treated with non-steroidal anti-inflammatory medications, although sometimes the pain is so severe that narcotic medication is required. If the patient cannot tolerate narcotics, we can also prescribe anticonvulsant drugs.
Itching can be treated with over-the-counter medications such as cortisone, calamine lotion and Benadryl cream. The goal is not to scratch the blisters, which could cause the area to become infected. Topical medications can also be used to protect the skin from infection.
It is possible to get shingles more than once. Patients who suspect they may be experiencing a recurrence of shingles should begin treatment as soon as they observe the new symptoms, since early treatment may prevent these patients from getting the full-blown rash.
Should I get the shingles vaccine and, if so, when?
A vaccine for shingles was approved by the FDA in 2006.The vaccine is currently approved for adults over the age of 50 but the American College of Physicians recommends waiting to vaccinate until the age of 60 to ensure that the vaccine is most effective when the complications from shingles can be more severe. As you age, your odds of developing a more serious case of shingles, as well as postherpetic neuralgia, increase.
After the age of 60, the shingles vaccine is 51 percent effective in preventing shingles and 67 percent effective in preventing postherpetic neuralgia. The protective effects of the vaccine diminish after five years, so the later you receive the vaccine the better chance you will have of protecting yourself. Those who still develop shingles after receiving the vaccine should experience less severe symptoms.
Approximately 4 percent of patients who develop shingles will experience a recurrence of the disease. If you have already experienced shingles, getting vaccinated may help you prevent a recurrence and should reduce the duration and severity of new symptoms should the disease recur.
Is there anyone who should not get the shingles vaccine?
The shingles vaccine is a live virus and, therefore, should not be given to anyone with a weakened immune system. This includes individuals who are being treated with radiation or chemotherapy or who are on steroid medications. The vaccine also should not be given to anyone who has had a life-threatening reaction to the ingredients in the vaccine, so talk to your doctor about your specific health situation.
Does the shingles vaccine have any possible side effects?
Minor reactions at the site of the injection include redness, swelling and itching. Patients may also experience some flu-like symptoms. Always call your primary care physician if you experience any side effects from a vaccination.
How long should a patient wait to get a shingles vaccine once they’ve had shingles?
You have to wait until the lesions are completely gone, which usually takes 4-6 weeks. I recommend waiting 6-8 weeks before getting the vaccination.
If you were never vaccinated for chicken pox (over 50, there was no vaccination at that time), and have never had chicken pox, can I get shingles? Should I be vaccinated for chicken pox and shingles?
If you’ve never had chicken pox, no. If you did not get chicken pox as a child, don’t get either vaccinations, it is likely that you are immune to the disease. It’s very rare to give an adult the vaccine for chicken pox. Adults do not do well with childhood vaccinations because they can end up with complications.
I had a mild case of shingles two years ago. I thought it was just a rash, but it hurt and wouldn't go away so I went to a walk-in clinic. They said it was shingles and it was treated. When I saw my internist months later for a physical, she said not to get the shingles shot, since actually having the disease is much better than the shot.
Is what my internist said correct? Should I get the shingles vaccine, and if so, how long is the vaccine good for?
No, you still need the vaccine, especially if they didn’t prove it was shingles. Most people have no side effects from the shot, so unless you have another medical condition that compromises your immune system or have had a bad reaction in the past, there is no reason the side effects should scare you off. You should get the vaccine, definitely, if you are over 60.
Since the shingles vaccine is relatively new, how long the vaccine lasts is a question that's still being studied. At this point we know the vaccine provides 5 years of protection at the very least, but it's possible that you would only need to get it once in your life . By the time you would need a follow-up shot, the research will be much further along!
About Dr. Alpana Goswami
Dr. Alpana Goswami received her medical degree from Maulana Azad Medical College in New Delhi, India. She completed residencies at The Johns Hopkins Hospital and Greater Baltimore Medical Center. She is board certified in internal medicine and has a special focus on diabetes, hypertension, hyperlidemia, heart disease, obesity and fitness. Dr. Goswami previously served as the chair of internal medicine at Suburban Hospital.
About Dr. Janna Lachtchinina
Dr. Janna Lachtchinina received her medical degree from one of the top universities in Russia and completed her training at a George Washington University affiliated hospital. She is board certified in internal medicine and is focused on treating chronic medical conditions as well as acute disease management and preventive healthcare.
Learn more about Dr. Goswami and Dr. Lachtchinina by visiting http://drgoswami.com/.The office of Dr. Goswami and Dr. Lachtchinina
11125 Rockville Pike, Suite 110
Rockville, MD 20852