Shingles – The Reactivation of Chickenpox

January 9, 2019

Have you ever had chickenpox? If the answer is yes, there is a chance you could get shingles.

Shingles, also called herpes zoster, is a reactivation of the chickenpox (Varicella) virus. We do not know what reactivates the virus, but experts believe a weakened immune system may place patients at risk. You are more likely to get shingles if you have cancer, HIV, or another disease that lowers the body’s defenses, are over 50, under a lot of stress, have had a physical trauma, or take long-term steroids or other medicines that can weaken the immune system. About one out of every three people in the United States will develop shingles in their lifetime. There are an estimated 1 million cases of shingles each year in this country. Anyone who has recovered from chickenpox may develop shingles – even children. However, the risk of shingles increases as you get older.

Shingles causes painful rashes and blisters that may appear on one side of the body or face. Pain can persist even after the rash is gone, which is called postherpetic neuralgia (PHN). It is also possible to get shingles more than once. One way to avoid getting shingles is not getting chickenpox in the first place – however, for anyone over the age of 40, this is practically impossible. Another prevention opportunity is getting vaccinated against shingles.

There Are Now Two Shingles Vaccines Available – Zostavax and Shingrix

Zostavax, available since 2006, is recommended for healthy adults over 60 years old. Zostavax is a single dose, live zoster virus vaccine. This vaccine reduces the risk of developing shingles by 51% and PHN by 67%. Zostavax should be administered if a person is allergic to Shingrix, prefers Zostavax, or requests immediate vaccination and Shingrix is unavailable.

Shingrix, approved by the FDA in 2017, is recommended for adults over 50 years old. This is a two dose, recombinant (inactive) zoster vaccine. Shingrix can be administered regardless of a prior episode of herpes zoster, a prior dose of Zostavax, chronic medical conditions, getting other adult vaccines in the same doctor’s visit or a prior varicella infection. Shingrix provides strong protection against shingles and PHN with a more than 90% initial efficacy and more than 85% sustained protection for the first four years following vaccination.

The Centers for Disease Control and Prevention (CDC) recommends that anyone who has had Zostavax also get Shingrix and that Zostavax cannot be used as a substitute for a second dose of Shingrix. Although some people will develop shingles despite vaccination, the vaccine may reduce the severity and duration of the virus. Protection from the vaccine lasts about 5 years.

There have been recent shortages of Shingrix because of the high demand. A reasonable option is to get on a waiting list to receive Shingrix and get Zostavax in the interim, but patients need to wait at least eight weeks before getting Shingrix after Zostavax is received.

Shingles vaccines are given at the doctor’s office and at some pharmacies. All Medicare Part D plans and many private health insurance plans will cover the cost. There could be out-of-pocket costs depending on the plan and it is best to check with the insurance carrier before getting the vaccine. If insurance does not yet cover Shingrix, consider getting Zostavax until coverage for the new vaccine begins.

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