Shingles
Vaccination
About
(Please note: Initially, I wrote this information with links to CDC information about these vaccines, diseases and surveillance in the United States. However, on February 8th, 2025, the CDC ceased to post new surveillance updates due to the recent directives of the Trump administration. Therefore, the general information should still be applicable but links may be broken and/or outdated).
Most of us have had shingles (the herpes zoster virus) or we know someone who has had shingles and how miserable it is. Shingles is a "bad boy": It can be excruciating (sometimes for months and even years) and invasive. A shingles rash typically develops in those who have had chickenpox. When a person has a case of chickenpox, the rash goes away, but the chickenpox virus stays behind in the body, laying dormant on a person's nerve root. Suddenly, years later, when least expected, the virus rears its ugly head again - causing pain, which develops into a rash. This usually occurs when the person has become immune compromised for some reason or another (stress, steroid use, and others).
The shingles vaccine is often given to adults who have had chicken pox in the past. The current vaccine, Shingrix, is given in a series of two (given two to six months apart). Never had chicken pox? Today, it is assumed that most people have had chicken pox as children - even such a mild case that they were unaware that they even had it! Back in the day, when a child got chickenpox, the neighborhood families (and friends) would all bring their kids over to meet with the sick child so he or she could get exposed, get sick and develop immunity (which usually did happen). That practice slowed down and, in 1995, they began giving chicken pox (varicella) vaccines. Even if you don't think you have had chickenpox, most providers still recommend the vaccine to those over 50 years.
In any case, it is recommended that anyone who may have chickenpox get the shingles vaccination. I have seen shingles in my clinic fairly often. It can be relatively mild, but frequently, it is very uncomfortable and quite painful for the sufferer. If shingles gets into the eye or the ear, it can cause blindness or loss of hearing, respectively. While early antivirals can be effective, the rash and pain can be challenging to control. Get the vaccine before you get shingles or after an outbreak clears up. You do not want it again.
Drug reps (pharmaceutical salespeople) instruct practitioners to tell patients, "There will be pain at the injection site caused by this vaccination." When a drug rep recommends that we warn patients about the injection pain, you know it must hurt! But, as many people know, a bit of pain in the arm sure beats getting shingles.
So question: In 1995, they started giving people the chicken pox vaccine, a live attenuated (weakened) vaccine. Does this live virus from the chickenpox vaccine stay dormant in your body the same way the regular chicken pox virus does? It may be too early to tell, but according to the CDC, this can and does happen from the vaccine but far less frequently than when you have actual chickenpox.
How long does the shingles vaccine immunity last? A person who got the original shingles (Zostavax) vaccination will gradually lose immunity over approximately ten years. Shingrix, the more recent shingles vaccine, lasts "at least seven years." The newer vaccine is reported to be more effective than Zostavax. however, they still have not recommended a third booster.
Note: Shingles vaccines are so expensive that traditional Medicare, Medicare Part D plans and some private insurance companies do not cover it.
Q&A
I pass out when I get shots. Should I avoid getting them?
Passing out when you get a shot is not that uncommon. First, discuss this with a healthcare provider. Most of these reactions are vasovagal reactions. Most of the time, your mind is just fine about it, but your body does not like it one bit. Once you decide to get the vaccine, be sure to hydrate before and tell the person giving you the vaccine that you sometimes pass out when you get it. The person giving you the vaccine will accommodate your problem by laying you down before you get the vaccination. They will give you the shot and keep an eye on you afterward.
I am immune compromised. Should I get vaccinated?
Those with immunocompromising conditions or on medications that cause potential immune compromise should talk to an immunologist before getting a live virus vaccination because they may not be able to fight off the potential disease that the live virus can cause.
Does Insurance cover vaccinations?
Although insurance is supposed to cover preventive services, it sometimes does not. Call your insurance company to see if they cover the ones you want and ask where they are covered. Some are only covered in medical facilities like doctors' offices or clinics, and others are only covered at pharmacies (i.e., shingles). They are the COVID-19, flu, pneumococcal, and hepatitis B vaccines.
Traditional Medicare is especially tricky: As of this writing, it only covers Hepatitis B for beneficiaries who are at medium or high risk for the virus and Tdap for those with a documented injury.
The other four vaccines—shingles, RSV, Tdap, and hepatitis A—are covered by Medicare Part D, the optional prescription drug program available to people with Traditional Medicare or Medicare Advantage plans. Again, be sure to ask your insurance company if they are covered and where. If you do not do this correctly, you can end up with a hefty vaccination bill.
I have heard that I should NOT take Tylenol or Ibuprofen (Advil, Motrin) after a vaccination - that it will dull my immune response. Is this correct?
Most sources agree that it is acceptable for adults to take ibuprofen or Tylenol (acetaminophen) after a vaccination for side effects: Those medicines will not cause a problem with immune response. That being said, if your side effects are not too bad and you do not need to take those medications, you feel you can weather through the side effects, try to do that. Use a cool cloth at the site for soreness, move the arm you got the injection a lot, and dress in cool clothing if you feel hot. Still, if you need the medications for side effects, take them.
For more information about vaccines see the CDC
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