Why Avoiding the Shingles Vaccine is Essential

Shingles occurs when your immunity is low due to advancing age. However, not all candidates for the shingles vaccine should take it.

Shingles is a disease that causes a painful rash in approximately one out of three individuals during their lifetime. It is caused by the varicella-zoster virus, which is the same virus that causes chickenpox. Nearly 99% of people born prior to 1980 have had chickenpox and carry this virus dormant in their brain or spinal cord.

Shingles typically manifests when your immunity is compromised, often due to aging. The recombinant zoster vaccine (RZV) currently in use is both safe and effective. However, it is not suitable for everyone. Like all vaccines, the shingles vaccine has both benefits and risks. It is important to be aware of both and make an informed decision about receiving it.

Understanding Shingles

The varicella-zoster virus can remain inactive in your spinal or brain nerves for many years or even decades. It becomes active when your immunity is weakened due to factors such as age, certain disorders, medications, or stress. Shingles occurs when the previously dormant virus in your body reactivates.

The illness typically begins with tingling, itching, or pain, usually in the trunk area. A few days later, a reddish rash appears, initially appearing patchy. It then progresses into clusters of small, fluid-filled boils. While it is most common on the trunk, it can also develop on the head, face, limbs, or genitals. The rash always occurs on one side of the body. Other symptoms that may accompany shingles include:

Approximately 10% to 18% of individuals who contract shingles develop postherpetic neuralgia (PHN), which is chronic nerve pain that can last for months or even years. PHN can significantly interfere with daily life, particularly in older individuals. Other serious complications of shingles include blindness, pneumonia, hearing loss, hepatitis, and encephalitis (inflammation of the brain).

People with weakened immune systems are more prone to experiencing frequent and severe complications of shingles. They are likely to experience a prolonged rash and increased risk of infection.

It is important to note that shingles cannot be contracted from another person. The virus is only activated when it is already present within your nerve cells. If you have shingles, individuals who are vulnerable and come into close contact with you may contract chickenpox. This applies to individuals who have never had chickenpox or received the varicella vaccine.

Who Should Consider the Shingles Vaccine?

Adults aged 50 and older: Immunocompetent adults in this age group should receive two doses of the Shingrix vaccine, administered 2 to 6 months apart.

Adults aged 19 and older with weakened immunity: Individuals with reduced immunity due to conditions such as HIV, leukemia, lymphoma, or the use of immunosuppressive medications (e.g., following organ transplants or during cancer chemotherapy) can safely and effectively receive the vaccine. This includes people with multiple myeloma, other blood cancers, solid organ cancer, HIV, and renal transplant recipients.

Individuals who have previously had shingles: The shingles vaccine is highly effective for individuals who have previously experienced shingles. It enhances immunity against future shingles outbreaks.

Individuals who previously received Zostavax: Zostavax, an earlier shingles vaccine, is no longer in use in the US. Those who have received Zostavax should receive two doses of RZV.

Considering your age and health status, carefully evaluate the potential benefits and risks of the vaccine to make an informed decision.

Recombinant Zoster Vaccine (RZV)

RZV provides effective protection against shingles and its complications. The majority of individuals who receive this vaccine will not develop shingles. In the rare event that shingles occurs after vaccination, it typically is a milder case. The vaccine also offers protection against postherpetic neuralgia (PHN) and other complications associated with shingles.

Two doses of RZV are required, with the second dose administered 2 to 6 months after the first. In situations where there is an imminent risk of immune suppression (such as prior to chemotherapy or organ transplantation), the second dose may be given as early as one month after the initial dose.

Vaccine Side Effects

RZV is considered a safe vaccine; however, some individuals may experience the following side effects:

• Pain, swelling, and redness at the injection site
• Muscle pain
• Headache
• Tiredness
• Stomach pain and vomiting
• Dizziness, difficulty seeing, or ringing in the ears
• Shivering and fever

These side effects are usually temporary and resolve within 2 to 3 days without intervention. It is important to proceed with the second dose even if you experience any of these side effects. Severe allergic reactions or death from the vaccine are extremely rare; however, if a severe allergic reaction occurs, further doses should be avoided.

Reasons to Avoid the Shingles Vaccine

If you have never had chickenpox: Nearly everyone born after 1980 has had chickenpox at some point. A blood test can determine if you have immunity to chickenpox. If the test shows you have never had chickenpox, the shingles vaccine is not recommended. In this case, you should consider receiving the varicella (chickenpox) vaccine instead.

If you are under 50 years old: Shingles is uncommon in young individuals. Complications such as postherpetic neuralgia (PHN) rarely occur before the age of 40. Younger individuals derive little benefit from the shingles vaccine.

If you are pregnant: The previous shingles vaccine, Zostavax, contained live virus and was contraindicated for use during pregnancy due to the potential for the virus to pass to the fetus. Since November 2020, Zostavax is no longer available in the US. The current recombinant zoster vaccine (RZV), Shingrix, is not a live vaccine and is expected to be safe; however, its safety during pregnancy has not been firmly established, so vaccination is not recommended.

If you had a severe reaction to a previous dose: Individuals who experienced a severe allergic reaction after the initial dose of RZV should not receive the second dose. Additionally, caution should be exercised if you have had allergic reactions to other vaccines, as there may be shared components.

If you currently have active shingles: Vaccination should be postponed until several weeks or months after the resolution of the illness.

If you are ill: If you have a moderate or severe illness, with or without fever, it is best to delay vaccination until you have recovered.

Approximately one in three individuals will develop shingles during their lifetime. There is no way to predict if you will be affected. Unlike other diseases, you cannot take preventive measures to avoid infection. The virus may already be present in your body. Carefully consider your age and other factors when deciding whether to receive the vaccine.

By clicking Submit, I agree to the MedicineNet’s Terms & Conditions & Privacy Policy and understand that I may opt out of MedicineNet’s subscriptions at any time.

Centers for Disease Control and Prevention: "About Shingles (Herpes Zoster)," Centers for Disease Control and Prevention: "The Pink Book — Zoster," "Recombinant Shingles VIS," "Recombinant Zoster (Shingles) Vaccine: What You Need to Know," "Shingles (Herpes Zoster) — Clinical Overview," "Shingles (Herpes Zoster) — Complications of Shingles," "Shingles (Herpes Zoster) — Signs & Symptoms," "Vaccines and Preventable Diseases — Shingrix Recommendations."

National Health Service: "Shingles vaccine overview."

Open Forum Infectious Diseases: "Preventing Varicella-Zoster: Advances With the Recombinant Zoster Vaccine."