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JAMA Patient Page
July 24/31, 2018

Shingles Vaccination

JAMA. 2018;320(4):416. doi:10.1001/jama.2018.7263

Shingles vaccination is effective for preventing shingles and complications of shingles.

Shingles, or herpes zoster, is a condition characterized by a painful, sometimes blistering rash over a limited part of the body. It can occur in people who have had chickenpox in the past. When someone recovers from chickenpox, the virus that caused it remains inactive inside the body. Sometimes the virus remains inactive forever, but other times it can become reactivated, resulting in shingles. Most people with shingles recover fully, but it can cause lingering pain even after the rash has resolved. This chronic pain condition is called postherpetic neuralgia and it can have a major effect on quality of life. The older a person is when he or she gets shingles, the more likely postherpetic neuralgia will develop. Shingles can be treated with pain medications as well as antiviral medications in some cases. Shingles and postherpetic neuralgia can be prevented by vaccination.

Types of Shingles Vaccines

Shingles vaccination has been available in the United States since 2006 with the approval of the zoster live vaccine. Since then, this vaccine has been recommended for routine use in all adults aged 60 years or older and is approved for use in adults aged 50 years or older. This vaccine reduces the risk of shingles by about 50% and the risk of postherpetic neuralgia by about 67% in adults aged 60 years or older. Because it is a live vaccine, it should not be given to people with weakened immune systems (such as people being treated with chemotherapy or other strong immune-suppressing medications).

In October 2017, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention issued a recommendation for use of a new shingles vaccine called the recombinant zoster vaccine. This vaccine is recommended for adults aged 50 years or older. Based on current data, the recombinant zoster vaccine appears to be more effective than the older vaccine, reducing the risk of both shingles and postherpetic neuralgia by about 90% in adults aged 50 years or older. It is not a live vaccine and should be safer than the older vaccine for people with weakened immune systems, but these data have not yet been published. There are no published data on how effective the new vaccine is in those with weakened immune systems. The recombinant zoster vaccine involves a series of 2 shots given 2 to 6 months apart.

Who Should Be Vaccinated Against Shingles

All adults older than 50 years should be vaccinated against shingles, regardless of whether they recall having had chickenpox or whether they have had the chickenpox (varicella) vaccine. If you have had a blood test proving that you have not had chickenpox, you should not be vaccinated against shingles and should instead be vaccinated against chickenpox. However, it is not necessary to get a blood test to check for past chickenpox infection prior to getting shingles vaccination. You should also be vaccinated against shingles even if you have had shingles already to prevent you from getting it again.

The ACIP has recommended that US adults aged 50 years or older who have already had the older zoster live vaccine should also receive the newer recombinant zoster vaccine. For adults aged 50 years or older who have not had any shingles vaccination, the new recombinant vaccine is preferred over the older live vaccine. There may be out-of-pocket expenses associated with receiving this vaccine.

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For More Information

To find this and other JAMA Patient Pages, go to the For Patients collection at jamanetworkpatientpages.com. A JAMA Patient Page on shingles was published in the January 12, 2011, issue of JAMA.

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
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Source: Centers for Disease Control and Prevention