Q. Who should get the shingles vaccine, and why?
A. Shingles (herpes zoster) is a reemergence of the virus that causes chickenpox. The virus lies dormant in nerves after infection, and can reactivate later in life, causing a temporary but painful rash in the skin. In some cases, shingles can leave long-term nerve pain at the site of the outbreak. Nearly one in three Americans will develop it, and symptoms are often worse with age.
A shingles vaccine (Zostavax) is now available, and is recommended for anyone over the age of 60, provided they don’t have severely depressed immunity because of a medical condition or medications. Although it targets the same virus as the chickenpox vaccine, rather than preventing infection it helps the immune system control the virus that is already present. “The idea is to prevent something that for many people can be very disabling,’’ says Elisa Choi, an infectious disease specialist at Harvard Vanguard Medical Associates. In a clinical trial of adults over 60, the vaccine reduced the risk of shingles by half and long-term nerve pain by two-thirds.
A recent study in the Journal of Internal Medicine affirmed that the vaccine is generally safe and well tolerated. Yet relatively few older adults have been vaccinated. Choi says there are several reasons, including cost (the vaccine is relatively expensive and not covered by all insurance) and lack of awareness among clinicians of adult vaccines. “It’s absolutely worth asking about from the patient’s side, if the doctor doesn’t bring it up him or herself,’’ she says.