Interviewer: Zoster, you may have never heard of that, but you've probably heard of its more common name, which is shingles. And if you know somebody who's had shingles, you know you're going to want to avoid it. Luckily there's an effective vaccine for shingles.
Dr. Tom Miller is going to help us better understand shingles and if getting the vaccine is something that you should consider. And you also might want to listen if you've already had the shingles shot because you might want to consider getting another one.
What is Shingles?
Dr. Miller: Well, the most extreme case of shingles is very painful. Basically, it starts out as a blistering rash on one side of your body, and that also can be associated with quite a bit of pain. The problem is in very severe cases, and especially as we get older, as the rash resolves, the pain doesn't go away and it can last for a very long time. So a smaller percentage of folks end up with chronic pain, but this is pain that is very difficult to treat, and so the vaccination will help prevent this.
Dr. Miller: And we call this postherpetic neuralgia, this very difficult pain. And again, the vaccine has a very good track record in terms of preventing this type of pain and preventing shingles, which is the blistering rash.
Shingles Signs, Symptoms, and Complications
Interviewer: So that's the extreme case. You get this pain that will continue even after the rash goes away. It's not enjoyable at all. Is that kind of what happens most often, or what kind of normally would happen?
Dr. Miller: No, most of the time, and especially if zoster, shingles occur in younger individuals, you get the blistering rash and some pain associated with that. And it generally goes away without long-term complications. Probably because our immune system gets a little weaker as we get older, there's a higher percentage of people that develop postherpetic neuralgia, that very, very difficult pain. I've had a patient in the past who developed this and couldn't wear a shirt for a year because it was so painful.
Shingles Vaccine Effectiveness: Prevention and Postherpetic Neuralgia
Interviewer: Wow. That's enough to make me want to get the shot, just the thought that maybe that could happen.
Dr. Miller: Right. We should state that shingles, otherwise known as zoster, basically are recurrent chickenpox. So if you have chickenpox as a kid, it never goes away. It just goes and hides in your spinal column, parts of your spinal cord. And for reasons that are not entirely clear, in a percentage of people, it will come out in a specific area along one side of your body in general. It could be the ribs, the face, or the leg. It's a blistering rash, and it usually clears up in about a week to 10 days...
Dr. Miller: ...except in those cases where the pain is persistent.
Interviewer: Sure. So if I didn't get chickenpox then, I'm good?
Dr. Miller: The issue with that is most people don't remember if they had chickenpox when they were kids. Now, for those kids who are much younger than us, they have probably been vaccinated or a number of children have now been vaccinated against chickenpox. And so the question is, will they develop chickenpox or can they catch chickenpox later in life? Probably not, but they're protected. So we should see less zoster in the future as this group of individuals who were vaccinated when they were younger gets older.
Who Should Get the Shingles Vaccine?
Interviewer: All right. So that brings up my next question. Who should consider getting this vaccine?
Dr. Miller: Well, the newer vaccine, which has been around now for about five, six years is called Shingrix. And it's a two-shot series, and it is recommended that you start that at the age... You get that one time at the age of 50. You get the first shot and then the second shot is a couple of months later. Unlike the first vaccine, which was a live vaccine, this is an antigenic vaccine, and there's about a 10% risk that you could have a flu-like symptom for 36 hours, and another 10% risk that you'd have injection site pain for a day or two. Other than that, it's quite safe and can be taken by folks who are immunocompromised. With the older vaccine, you could not do that.
Interviewer: Okay. So somebody turns 50, they should consider getting Shingrix?
Dr. Miller: They should and anytime thereafter.
Interviewer: All right. Are there people that are under 50 that should consider the vaccine, such as immunocompromised individuals?
Dr. Miller: Yes.
Interviewer: And is there an age kind of range on that or just...
Dr. Miller: No, I mean if an individual does have an immunocompromising illness, then it would be up to their physician to talk to them about the types of vaccines that they would need to prevent not only shingles but other viral problems.
Interviewer: All right.
Dr. Miller: Viral infections.
Interviewer: If somebody didn't get the vaccine and they ended up with symptoms, say somebody was...
Dr. Miller: Developed shingles?
Interviewer: Yeah, exactly. Is there anything they can do about it at that point, or they just have to ride that out?
Dr. Miller: Pretty much have to ride it out. There are topicals. You can take the standard over-the-counter medications to reduce pain, but none of those are very effective. And again, fortunately, most cases of shingles are not terribly bad. They resolve without postherpetic neuralgia or chronic pain.
Shingles Vaccine Safety and Side Effects
Interviewer: And the effectiveness of the vaccine, how effective is it?
Dr. Miller: It's very effective. It's highly effective. After the second shot, it's over 90% in preventing shingles.
Interviewer: And so for that 10% that might still get shingles after they got the shot, does the shot help reduce the severity of those symptoms?
Dr. Miller: It does. That's a very good question. So if you do develop shingles, the chance of herpetic neuralgia, the chronic pain is much reduced...
Interviewer: All right.
Dr. Miller: ...if you've had the vaccine.
Interviewer: I've heard as you get older... is this true, as you get older, so say I get the two shots at 50 and as I get older, my resistance will continue to decrease after the shot, or does it stay pretty much at that 90%?
Dr. Miller: It would decrease some over time. I would say that the older vaccine, which was called Zostavax, was not as robust as the newer Shingrix vaccine. And so the durability of the vaccine's effect is much longer lasting with this newer vaccine.
Interviewer: All right. So somebody who has not had Shingrix should consider getting it even if they had the old vaccine?
Dr. Miller: That is the recommendation.
Interviewer: Yeah. And then are there boosters when I get older, like at 70, 80, 90, or not?
Dr. Miller: Not recommended at this time.
Shingles Vaccine Cost and Insurance Coverage
Interviewer: Okay, great. And is this one of those preventative measures that's covered by insurance or Medicare?
Dr. Miller: So the cost of this vaccine in total, the two shots is over $200. And so it depends on your insurance coverage. Many people aged 50 up to 65 have commercial insurance or other types of insurance or perhaps would want to pay out of pocket for that, though that's a big expense. And then Medicare does cover this shot in Part D.
Interviewer: You did talk about some of the side effects of getting the vaccine. Like with any vaccine, there's a possibility that you might get some pain in the arm or you might get some fever or something like that. I've heard some instances of people having pretty extreme reactions, like for a day, feeling like they have the flu.
Dr. Miller: While 10% of individuals will develop a flu-like symptom, they might have a fever, or malaise and just feel badly, it only lasts for about 36 hours. And you can have injection site pain that lasts for a couple of days. But this is inferior to the pain that you would develop if you have Herpes zoster that basically turns into postherpetic neuralgia. That's very, very, very painful and very difficult to treat.
Where to Get the Shingles Vaccine
Interviewer: Dr. Miller, do you recommend that patients see their doctor before getting the vaccine, or is this just one of those kinds of things that I could go into a pharmacy and get the two Shingrix shots?
Dr. Miller: You can either get it at your doctor's office if they have it, or you can get it at most pharmacies.
Interviewer: All right. And is this a conversation I should have with my doctor first or . . .
Dr. Miller: Or the pharmacist.
Interviewer: Okay. The pharmacist could help me as well?
Dr. Miller: Absolutely. They're well aware of the side effects and the potential benefits.
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