Herpes Zoster (Shingles) & Shingles Vaccine
- Herpes zoster (shingles) is a viral infection caused by the Varicella Zoster (chicken pox) virus but, unlike chickenpox, shingles is not contagious;
- Herpes zoster is not caused by Herpes simplex Types 1 and 2 associated with cold sores and sexually transmitted genital herpes;
- Shingles involves inflammation of the nerves and a very painful blistering skin rash that typically lasts two to four weeks;
- Symptoms of shingles include pain, itching or tingling of areas of the skin, usually on the trunk of the body, along with fever, headache, chills and an upset stomach;
- Complications of shingles include post-herpatic neuralgia (chronic nerve pain), loss of vision, hearing problems, brain inflammation (encephalitis), Bell’s Palsy, pneumonia and, rarely, death;
- Herpes zoster is most common in individuals over 50 years of age, however, Individuals with weakened immune systems are at higher risk;
- Treatment with antibiotics may shorten the time it takes to recover from shingles;
- There is one live virus shingles vaccine, licensed in 2006, for use in the U.S. by adults over 50 years: Zostavax, manufactured by Merck;
- The CDC now recommends adults 60 years and older receive one dose of shingles vaccine;
- Reported complications from shingles vaccine include local swelling, pain and redness at injection site; zoster-like skin rash, headache, joint pain, muscle pain, fever, abnormally swollen glands and hypersensitivity reactions including anaphylaxis (shock);
- Shingles vaccine effectiveness is reported to be about 51 percent;
- The shingles vaccine contains live attenuated varicella zoster virus and vaccine strain virus transmission from the vaccinated to susceptible individuals has been reported;
- Mass use of chickenpox vaccine by children in the U.S. since 1995 has limited natural boosting of Varicella Zoster immunity in the adult population and there has been a significant increase in cases of Herpes zoster among adults.
- Using the MedAlerts search engine, as of September 1, 2015 there had been 1,141 serious adverse events reported to the Vaccine Adverse Events Reporting System (VAERS) in connection with shingles containing vaccines since 1990. Over 33% of those serious shingles vaccine-related adverse events occurring in seniors 65-75 years of age. Of these shingles-vaccine related adverse event reports to VAERS 90 were deaths, with 40% of the deaths occurring in seniors over 70 years of age.
Food & Drug Administration (FDA)
Centers for Disease Control (CDC)
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Reporting a Vaccine Reaction
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IMPORTANT NOTE: NVIC encourages you to become fully informed about Shingles and the Shingles vaccine by reading all sections in the Table of Contents , which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.
What are shingles symptoms and who is at risk?
Herpes zoster (shingles) is an inflammation of nerves and the surrounding area of skin caused by Varicella Zoster (chickenpox) virus infection. Shingles usually occurs when the dormant Varicella Zoster virus is reactivated in an adult, who has recovered from chickenpox as a child.
A painful rash most often begins on one side of the face or body and progresses to form blisters that usually scab over in seven to ten days. One to five days before the rash appears, there is often pain, itching or tingling in the areas where the rash later develops. Other symptoms of shingles can include fever, headache, chills and an upset stomach. Shingles typically clears up within two to four weeks.
individuals, who have experienced and recovered from natural chickenpox as children, usually have only one bout with shingles in their lifetime. However, in rare cases a second or even a third episode has been reported.
Shingles most commonly occurs in individuals over 50 years of age. Today, after chickenpox vaccine has been widely used by children since 1995 and has interrupted natural circulation of the varicella zoster virus in the U.S. population, some experts believe that most Americans reaching 85 years of age will experience shingles at some point in their lifetime.
Other populations at risk for developing shingles are those with weakened immune systems due to HIV/AIDS or other diseases that affect healthy immune function. Drugs used for organ transplants and cancer treatment can also increase the risk of shingles.
What causes shingles?
The same varicella zoster virus that causes chickenpox causes herpes zoster (shingles) disease. Individuals, who recover from chickenpox, usually acquire long lasting immunity to chickenpox. After recovery from chickenpox, the varicella zoster virus becomes dormant (inactive) and immunity to chickenpox is asymptomatically boosted when adults come into contact with children, who have chickenpox. However, for reasons that doctors do not fully understand, in some individuals the dormant varicella zoster virus becomes active again and causes shingles.
Individuals suffering with shingles cannot transmit shingles to others. However, someone, who has not already recovered from chickenpox disease, can get chickenpox from a person with shingles.
(Herpes zoster is not caused by Herpes simplex Types 1 and 2 associated with cold sores and sexually transmitted genital herpes).
Is there an association between chickenpox vaccine and an increase in shingles?
Yes. In 2005, Gary Goldman, PhD, was among the first researchers to publish an analysis of the mass use of chickenpox vaccine by children in the U.S. since 1995. His conclusion was that, by limiting the circulation of wild type Varicella Zoster virus in the population through mass vaccination, there is limited asymptomatic boosting of natural chickenpox immunity among adults, who had recovered from chickenpox as children. This would, in turn, cause an epidemic of shingles. (International Journal of Toxicology 2005; 24(4): 205-213. http://ijt.sagepub.com/content/25/5/313.abstract )
In 2008 the Health Protection Agency (HPA), an independent organization formed by the government of the United Kingdom in 2003, published new modeling that confirmed that mass use of chickenpox vaccine would lead to an increase in shingles despite the shingles vaccine.
The HPA estimated that, while mass vaccination would reduce the incidence of chickenpox in children, there is a projected increase of over 20% in the incidence of shingles in adults. The HPA confirmed that this projected increase in shingles is because adults are no longer coming in contact with natural chickenpox cases due to vaccine acquired immunity among children. In addition, studies from countries that routinely vaccinate children against chickenpox, such as the U.S., demonstrate that there is an increase in shingles in unvaccinated persons, who have not had chickenpox or the chickenpox vaccine.
A study in 2002 confirmed that adults exposed to natural chickenpox disease were protected from developing shingles and that there is concern that mass vaccination against chickenpox will cause future epidemics of shingles among more than 50 percent of Americans aged 10 to 44 years.
There are also reports that young children and teenagers, who have gotten chickenpox vaccine, are experiencing shingles as well.
Can Shingles Cause Injury and Death?
Yes. The most common condition caused by shingles is post herpetic neuralgia (PHN) that involves a longer period of nerve inflammation. PHN symptoms include severe pain where the shingles rash appeared after the rash clears up. PHN can be debilitating and usually lasts only a few weeks. However, in rare cases, the chronic nerve inflammation and pain has persisted for years. The elderly are at a higher risk for PHN, with the pain being more severe.
Shingles can also affect the eye and cause loss of vision or blindness and can lead to hearing and balance problems, facial paralysis, pneumonia, brain inflammation (encephalitis) and death.
Antiviral medicines, such as acyclovir, valacyclovir, and famciclovir are believed to shorten the length and severity of the illness and are most effective when started as soon as possible after the rash appears. Pain medication may also help to relieve the pain caused by shingles. Itching associated with shingles, like with chickenpox, can be relieved by using wet compresses and anti-itch products like calamine lotion and colloidal oatmeal baths.
About Shingles Vaccine
The live virus shingles vaccine is actually a very strong booster dose of the Varicella Zoster (chickenpox) vaccine. Zostavax vaccine for shingles and Varivax vaccine for chickenpox are both manufactured by Merck and are the only licensed vaccines to prevent chickenpox and shingles in the U.S.
In the Zostavax product information insert, Merck describes the ingredients of shingles vaccine:
“ZOSTAVAX is a lyophilized preparation of the Oka/Merck strain of live, attenuated varicella-zoster virus (VZV). ZOSTAVAX, when reconstituted as directed, is a sterile suspension for subcutaneous administration. Each 0.65-mL dose contains a minimum of 19,400 PFU (plaque-forming units) of Oka/Merck strain of VZV when reconstituted and stored at room temperature for up to 30 minutes. Each dose contains 31.16 mg of sucrose, 15.58 mg of hydrolyzed porcine gelatin, 3.99 mg of sodium chloride, 0.62 mg of monosodium L-glutamate, 0.57 mg of sodium phosphate dibasic, 0.10 mg of potassium phosphate monobasic, 0.10 mg of potassium chloride; residual components of MRC-5 cells including DNA and protein; and trace quantities of neomycin and bovine calf serum. The product contains no preservatives.”
Who Should Not Get Shingles Vaccine?
Zostavax vaccine for shingles is licensed for use only in adults over age 50. It is not licensed for use in children or younger adults.
The CDC recommends that all adults over 60 years old get one dose of shingles vaccine. Contraindications to receiving the vaccine cited by the CDC include:
- a previous life-threatening or severe allergic reaction to gelatin or the antibiotic neomycin;
- a previous life-threatening, or severe reaction to any other component of shingles vaccine;
- Tell your doctor if you have any severe allergies.
The manufacturer product insert also lists the following reasons for individuals to not get the shingles vaccine, among others:
- Persons who are immunosuppressed or immune deficient, such as those with a history of leukemia, lymphoma or other disorders affecting the bone marrow or lymphatic system, AIDS of those on immunosuppressive therapy;
- Women who are pregnant (“It is not known whether Zostavax can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity…..Pregnancy should be avoided for 3 months following administration of Zostavax.”);
- Concurrent acute illness or fever.
How effective is the vaccine?
According to the CDC, the vaccine reduced shingles by about half (51%) in adults 60 years and older. Length of protection offered by the vaccine is unclear and studies are underway to determine exactly how long the vaccine protects against shingles.
The manufacturer product insert states: “Vaccination with Zostavax does not result in protection of all vaccine recipients. The duration of protection beyond 4 years after vaccination with Zostavax is unknown. The need for revaccination has not been defined.”
Can shingles vaccine cause serious adverse events?
The manufacturer product insert states that “transmission of vaccine virus may occur between vaccines and susceptible contacts.” Reported vaccine adverse events in clinical trials or post-marketing, include pain, swelling and redness at the injection site; headache; zoster-like skin rash; fever; shock; joint and muscle pain; swollen glands; and respiratory symptoms.
By September 2015, the federal Vaccine Adverse Event Reporting System (VAERS) had received 1111 serious vaccine adverse reports following Zostavax vaccination, including 36 reported deaths . Serious shingles vaccine reaction symptoms reported to VAERS include rash, joint pain (arthralgia), muscle pain (myalgia), fever, abnormally swollen glands (lymphadenopathy) and hypersensitivity reactions including anaphylaxis (shock).