Q: I’m 67 and had shingles four years ago. Am I immune to it now? If not, should I get the new shingles vaccine?
A: Zostavax, the vaccine against herpes zoster (shingles), hasn’t been tested in people who’ve had a prior episode of shingles, so I don’t have a precise answer to your question. However, with a few exceptions, the U.S. Centers for Disease Control and Prevention recommends the vaccine for all adults ages 60 or over.
Shingles is a painful rash produced by the varicella- zoster virus, the same virus that causes chickenpox. After a chickenpox infection, VZV remains in the body in an inactive form and can revive later in life, particularly in people whose immune systems have been weakened by age, cancer, chronic infections, or immune-suppressing medications. The reactivated virus causes a blistering rash on one side of the body and sometimes fever, headache or nausea. The most debilitating symptom is severe pain – called post-herpetic neuralgia – that lasts for several months after the rash goes away and can cause insomnia, weight loss and depression.
Zostavax works by boosting immunity to VZV. It was approved in 2006 based on a three-year trial involving 38,000 adults ages 60 and over. On average, the vaccine reduced the risk for shingles by 51 percent and the risk for post-herpetic neuralgia by 67 percent. It had few side effects, apart from a rash at the injection site and occasional flulike symptoms. We don’t know about its effectiveness or side effects beyond three years.
If you’ve already had shingles, your risk of recurrence is low because you’ve developed some immunity to the virus. However, we don’t know how long that immunity lasts, and immunity in general wanes with age. Talk to your clinician about the risks and benefits of taking the vaccine. Zostavax is given as a single injection and costs between $150 and $250. Check your insurance to see if it’s covered. If you decide to have the vaccination, you’ll need to plan ahead: Zostavax must be stored in a freezer and injected within 30 minutes after it is mixed. Many medical offices don’t have such freezers, so they send patients to centralized Zostavax clinics.
– Celeste Robb-Nicholson, M.D., editor in chief, Harvard Women’s Health Watch
