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Shingles (Herpes Zoster)

On October 20, 2017, the U.S. Food and Drug Administration (FDA) licensed Shingrix® for adults aged 50 years and older to prevent shingles.

On October 25, 2017, the Advisory Committee on Immunization Practices (ACIP) voted that Shingrix® is:

  • recommended for healthy adults aged 50 years and older to prevent shingles and related complications
  • recommended for adults who previously received the current shingles vaccine (Zostavax® to prevent shingles and related complications
  • the preferred vaccine for preventing shingles and related complications

Once approved by the CDC director, these ACIP recommendations will be published in the Morbidity and Mortality Weekly Report. At that time, the recommendations will become official policy.

Vaccines to Prevent Shingles

Shingles (herpes zoster) is a painful skin rash that develops on one side of the face or body. Shingles vaccine reduces the risk of developing shingles and the long-term pain that can follow. Your risk of shingles and long-term pain from the disease increases as you age.

People 60 years or older should get shingles vaccine (Zostavax) to prevent the disease. This is a one-time vaccination. There is no maximum age for getting this shingles vaccine.

Shingles vaccine (Zostavax) is approved by the FDA for people 50 through 59 years old, CDC does not have a recommendation for routine use of Zostavax in people 50 through 59 years old. Adults 50 through 59 years who have questions about Zostavax should discuss the risks and benefits with a health care provider.

Anyone 60 years or older should get the shingles vaccine (Zostavax), regardless of whether they recall having had chickenpox, which is caused by the same virus as shingles. Studies show that more than 99 percent of Americans ages 40 or older have had chickenpox, even if they don’t remember getting the disease.

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. The decision on when to get vaccinated should be made with your health care provider. Generally, a person should make sure that the shingles rash has disappeared before getting vaccinated.

Protection from the shingles vaccine (Zostavax) lasts about 5 years. In adults vaccinated at 60 years or older, protection from the vaccine decreases within the first 5 years after vaccination. Therefore, if you receive the vaccine before age 60 years you might not be protected later in life when your risk for shingles and its complications are greatest.

What is Shingles (Herpes Zoster)?

Shingles is caused by the varicella zoster virus, the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays in the body in a dormant (inactive) state. For reasons that are not fully known, the virus can reactivate years later, causing shingles. Herpes zoster is not caused by the same virus that causes genital herpes, a sexually transmitted disease.

Shingles usually starts as a painful rash on one side of the face or body. The rash forms blisters that typically scab over in 7 to 10 days and clears up within two to four weeks. Before the rash develops, there is often pain, itching, or tingling in the area where the rash will develop. This may happen anywhere from one to five days before the rash appears.

Most commonly, the rash occurs in a single stripe around either the left or the right side of the body. In other cases, the rash occurs on one side of the face. Rarely, usually among people with weakened immune systems, the rash may be more widespread and look similar to a chickenpox rash.

Other symptoms of shingles can include fever, headache, chills, and upset stomach.

The most common complication of shingles is post-herpetic neuralgia, or PHN. People with PHN have severe pain in the areas where they had the shingles rash, even after the rash clears up. The pain from PHN may be severe and debilitating, but it usually resolves in a few weeks or months in most patients. However, PHN can persists for many years in some persons.

PHN occurs rarely among people under 40 years old but can occur in up to half (and possibly more) of untreated people who are 60 years or older.

Shingles may lead to other serious complications involving the eye causing vision loss. Very rarely, shingles can also lead to pneumonia, hearing problems, brain inflammation (encephalitis), or death.

Who gets Shingles (Herpes Zoster)?

Nearly one out of three people in the United States will develop shingles in their lifetime. There are an estimated one million cases each year in this country. Anyone who has recovered from chickenpox may develop shingles; even children can get shingles. However, the risk of shingles increases as a person gets older.

About half of all shingles cases occur among men and women 60 years or older.

People with weakened immune systems have an increased risk of developing shingles. For example, people with certain cancers, including leukemia and lymphoma, and human immunodeficiency virus (HIV), and people who have undergone a bone marrow or organ transplantation, or who take immunosuppressive drugs.

People who develop shingles typically have only one episode in their lifetime. In rare cases, however, a person can have a second or even a third episode.

Ready to get Vaccinated?

Microscopic view of shingles (herpes zoster).

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