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Shingles Overview


Herpes Zoster (Shingles) & Shingles Vaccine Quick Facts

Shingles

  • Herpes zoster (shingles) is a viral infection caused by the Varicella Zoster (chicken pox) virus.1 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. This is believed to be from direct contact with the shingles lesions.2
  • Herpes zoster is not caused by Herpes simplex Types 1 and 2 associated with cold sores and sexually transmitted genital herpes;3
  • Shingles involves inflammation of the nerves and a very painful blistering skin rash that typically lasts two to four weeks;4
  • 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;5
  • 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;6
  • Herpes zoster is most common in individuals over 50 years of age7, however, Individuals with weakened immune systems are at higher risk;8
  • Treatment with antivirals may shorten the time it takes to recover from shingles;9

Shingles Vaccine

  • The CDC recommends healthy adults 50 years and older be vaccinated against shingles;
  • There are two vaccines licensed in the U.S.: Zostavax, a live virus vaccine, licensed in 2006 and manufactured by Merck10 11 and Shingrix, a genetically engineered12  recombinant, adjuvanted vaccine, licensed in 2017 and manufactured by GlaxoSmithKline Biologicals.13 Both vaccines are approved for use in the U.S. by healthy adults over 50 years and Shingrix was given preference by the ACIP in 2017;
  • Reported complications from Zostavax 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);14
  • Reported complications from Shingrix vaccine include swelling, pain and redness at the injection site, headache, muscle pain, shivering, fatigue, gout (including gouty arthritis), and optic ischemic neuropathy;15
  • Zostavax vaccine effectiveness is reported to be about 51 percent16 while Shingrix is reported to be over 90 percent effective,17 but no test is available to determine immunity to shingles and long-term vaccine effectiveness is unknown;18
  • Zostavax vaccine contains live attenuated varicella zoster virus and vaccine strain virus transmission of chickenpox from the vaccinated to susceptible individuals has been reported;19
  • 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.20
  • Using the MedAlerts search engine, as of August 31, 2018, there have been 46,561 reports of shingles vaccine reactions, hospitalizations, injuries and deaths following shingles vaccinations made to the federal Vaccine Adverse Events Reporting System (VAERS), including 142 related deaths, 1,023 hospitalizations, and 766 related disabilities.

Food & Drug Administration (FDA)

Centers for Disease Control (CDC)

Search for Vaccine Reactions

NVIC is proud to host MedAlerts, a powerful VAERS database search engine. MedAlerts examines symptoms, reactions, vaccines, dates, places, and more.

Reporting a Vaccine Reaction

Since 1982, the NVIC has operated a Vaccine Reaction Registry, which has served as a watchdog on VAERS. Reporting vaccine reactions to VAERS is the law. If your doctor will not report a reaction, you have the right to report a suspected vaccine reaction to VAERS.

Vaccine Reaction Symptoms & Ingredients

Our Ask 8, If You Vaccinate webpage contains vaccine reaction symptoms and more. 

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.

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What is Shingles?

What are shingles symptoms and who is at risk?

Herpes zoster, also known as shingles is an inflammation of nerves and the surrounding area of skin caused by Varicella Zoster (chickenpox) virus infection.21 Shingles usually occurs when the dormant Varicella Zoster virus is reactivated in an adult, who has recovered from chickenpox as a child.22 

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.23

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.24

Scientists do not understand the biological mechanisms underlying reactivation of varicella zoster infection but risk factors are thought to include aging, immunosuppression, exposure to varicella zoster infection during pregnancy and having had chickenpox under age 18 months.25

Shingles most commonly occurs in individuals over 50 years of age.26 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,27 experts believe that half of Americans reaching 85 years of age will experience shingles at some point in their lifetime.28 

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.29 

What causes shingles?

The same varicella zoster virus that causes chickenpox causes herpes zoster (shingles) disease.30  Individuals, who recover from chickenpox, usually acquire long lasting immunity to chickenpox.31 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.32

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.33

(Herpes zoster is not caused by Herpes simplex Types 1 and 2 associated with cold sores and sexually transmitted genital herpes).34

Is Shingles contagious?

Shingles is not contagious and cannot be passed from person to person, and is the result reactivation of the virus that causes chickenpox (Varicella Zoster Virus – VZV). Reactivation of this virus is what causes shingles in people who have previously had the chickenpox. However, VZV can be spread from a person with active shingles to another person who has never had chickenpox. This happens when the shingles rash is in the blister-phase and the fluid from the blisters comes into direct contact with a person.

Persons exposed to VZV virus from someone with an active shingles infection might develop chickenpox, but they would not develop shingles. Shingles is not as contagious as chickenpox and the risk of spreading infection is decreased when the rash is covered.35 When the blisters from shingles develop crusts the risk of infecting others has passed.36

According to the CDC, if you have shingles you can prevent its spread by: 37  

  • Keeping the rash covered;
  • Refraining from scratching or touching the rash;
  • Frequent hand washing;
  • Avoiding contact with people until rash has crusted over.

What is the history of Shingles in America and other countries?

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.38

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.39

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.40

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.41

There are also reports that young children and teenagers, who have gotten chickenpox vaccine, are experiencing shingles as well.42

Can Shingles cause injury and/or 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.43

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.44

Who is at highest risk for getting Shingles?  

Scientists do not understand the biological mechanisms underlying reactivation of varicella zoster infection but risk factors are thought to include aging, immunosuppression, exposure to chickenpox infection during pregnancy and having had chickenpox under age 18 months.45

Individuals who have had the chickenpox can develop shingles and half of all cases occur in people age 60 and over. According to the CDC, it is estimated that between 500,000 to 1 million cases of shingles occur annually in the U.S. and that about a third of Americans will develop shingles (herpes zoster) at some point in their life. 46 Most people who develop shingles will only have one episode, however, it is possible for individuals to develop shingles a second or third time.47

What is the history of Shingles vaccine use in America?

In 2006 the first shingles (herpes zoster) vaccine approved by the FDA for use in the U.S. was Zostavax by Merck.48 49  Zostavax is a single dose live attenuated virus vaccine licensed for use in healthy Americans age 60 and older that do not have weakened immune systems. Zostavax is a much more potent version of Varivax chicken pox vaccine. In 2011 the FDA expanded Zostavax use to include Americans age 50 to 59.

In 2017 Shingrix, a new genetically engineered, adjuvanted, recombinant vaccine, was approved by the FDA for use in healthy adults age 50 and older. In October 2017 the CDC gave preference to the use of Shingrix over Zostavax, except in cases where individuals had an allergic reaction to Shingrix.50

Shingles vaccine is one of the few vaccines not covered by the National Childhood Vaccine Injury Act of 1986, which means individual may sue the vaccine manufacturer directly for vaccine injuries associated with the vaccine. Currently Merck, the manufacturer for Zostavax is defending itself against 60 lawsuits that allege the vaccine caused serious side-effects, including death. The outcome of these proceedings is pending.51

Who should not get Shingles vaccine?

Zostavax52 53 and SHINGRIX54 vaccines for shingles are licensed for use in healthy adults over age 50. Neither vaccine is licensed for use in children or younger adults.

In 2018, the CDC recommended that all adults over 50 years of age receive two doses of Shingrix vaccine.  Shingrix was recommended over Zostavax despite unknown long-term serious side effects and long-term effectiveness. 55

Contraindications to receiving the Zostavax 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.56

The manufacturer product insert also lists the following reasons for individuals to not get the Zostavax 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.57 58

Contraindications to receiving the Shingrix vaccine cited by the CDC include:

  • a previous life-threatening or severe allergic reaction to Shingrix or any component of the vaccine
  • Pregnant or breastfeeding women
  • If you are moderately or severely ill.59

Can Shingles be prevented and are there treatment options?

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.60 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.61

Who is at highest risk for suffering complications from Shingles?

Most healthy people who develop shingles and get treatment quickly after an outbreak will experience a cessation of pain within 5 weeks and the blisters will leave no scars. Individuals at highest risk for complications are immunosuppressed individuals, e.g. - organ transplant recipients, HIV infected, and individuals receiving cancer treatments that weaken the immune system.62

The most common complication experienced from shingles, postherpetic neuralgia (PHN), resolves within a few weeks or months after infection. 63 PHN occurs after the rash disappears and is a persistent pain in the areas where the shingles rash appeared. In rare cases pain from PHN can interfere with daily life for many years. According to the CDC, the risk for PHN from a shingles infection increases with age and it is estimated that 13 percent of shingles cases in persons age 60 and older will experience PHN, while being rare in cases where persons are under the age of 40.64 

Other serious complications can involve the eye and result in loss of vision. Rare complications include pneumonia, hearing problems, blindness, brain inflammation (encephalitis), and death.65 

What is Shingles vaccine?

There are two shingles vaccines licensed for use in the U.S.; Zostavax live attenuated vaccine by Merck and Shingrix recombinant vaccine by GlaxoSmithKline Biologicals.

Zostavax live attenuated shingles vaccine licensed in 2006 is a much more potent version of Varivax chickenpox vaccine containing 19,500 plaque forming units of Oka/Merck varicella zoster virus versus 1,350 plaque forming units in the chickenpox vaccine.66 Administration of this preservative free vaccine is a subcutaneous (under the skin) in a .65mL single dose series containing sucrose, hydrolyzed porcine (pig) gelatin, urea (urine component), sodium chloride, monosodium L-glutamate, sodium phosphate dibasic, potassium phosphate monobasic, potassium chloride, MRC-5 cells (1966 aborted human male lung tissue)67, neomycin and bovine (cow) calf serum (blood plasma).68 More information can be found in the manufacturer’s product insert maintained on the U.S. Food and Drug Administration’s (FDA) website.

Shingrix adjuvanted recombinant vaccine licensed in 2017 is a two dose series vaccine administered intramuscularly (injected into muscle) and is a genetically engineered vaccine. Each preservative free .5mL dose contains sucrose, sodium chloride, dioleoyl phosphatidylcholine (DOPC), potassium dihydrogen phosphate, cholesterol, sodium dihydrogen phosphate dihydrate, disodium phosphate anhydrous, dipotassium phosphate, polysorbate 80, Chinese Hamster Ovary (CHO) cell proteins, and DNA. This vaccine is an adjuvanted vaccine using AS01, which is a squalene (shark oil) based adjuvant. More information can be found in the manufacturer’s product insert maintained on the U.S. Food and Drug Administration’s (FDA) website.

How effective is Shingles vaccine?

According to the CDC, Zostavax vaccine reduced shingles by about half (51%) in adults 60 years and older.69 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.”70 However, efficacy studies showed a significant decrease in vaccine effectiveness one year post-vaccination and by nine years, Zostavax was determined to be no longer effective at preventing shingles.71

Shingrix vaccine is estimated to reduce shingles by over 90% in adults 50 years and older.72 The length of protection from Shingrix past 4 years is unknown.73

Can Shingles vaccine cause injury and death?

Yes. The Zostavax product insert states that “transmission of vaccine virus may occur between vaccines and susceptible contacts.”,74  i.e. - the vaccinated individual is contagious with vaccine strain chickenpox and can infect others with chickenpox, if they have not previously had chickenpox. Other 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.75 Optic Neuritis following Zostavax vaccine has also been reported in a published case study.76

Shingrix adverse events in clinical trials include pain, swelling and redness at the injection site; headache; fever; fatigue; shivering; gastrointestinal issues; gout; and optic ischemic neuropathy. GlaxoSmithKline has committed to various post marketing studies for the Shingrix vaccine licensed in 2017. According to data presented by the CDC during the June 2018 Advisory Committee on Immunization Practices (ACIP) meeting, since its licensure in October of 2017 to April of 2018 there were 680 reaction reports submitted to the federal Vaccine Adverse Event Reporting System (VAERS), with no unusual or unexpected patterns and events. The majority of reports were in females and were not serious events, with the most common reaction being injection site pain.77

Using the MedAlerts search engine, as of May 31, 2018, there have been 42,604 reports of shingles vaccine reactions, hospitalizations, injuries and deaths following shingles vaccinations made to the federal Vaccine Adverse Events Reporting System (VAERS), including 128 related deaths, 850 hospitalizations, and 660 related disabilities.

Shingles vaccine is one of the few vaccines not covered by the National Childhood Vaccine Injury Act of 1986, which means individual may sue the vaccine manufacturer directly for vaccine injuries associated with the vaccine. Currently Merck, the manufacturer for Zostavax, is defending itself against 60 lawsuits that allege the vaccine caused serious side-effects, including death. The outcome of these proceedings is pending.78

Who is at highest risk for complications from Shingles vaccine?

According to the product insert for Zostavax contraindications to receiving this vaccine include:

  • Individuals with a history of anaphylactic/anaphylactoid reactions to any ingredient in the vaccine, such as gelatin, neomycin, or any other component of the vaccine. See What is Shingles Vaccine for more information on ingredients;
  • Individuals who are immunosuppressed or immunodeficient; and
  • Individuals who are pregnant – pregnancy should be avoided for 3 months following vaccination. There is insufficient data on the risks and impacts of this vaccine on pregnant women.79

According to the product insert for Shingrix contraindications to receiving this vaccine is a history of severe allergic reactions to any component of the vaccine - See What is Shingles Vaccine? for more information on ingredients.  The product insert also states that while some animal studies have been conducted, there is no data to establish vaccine associated risks on the use of Shingrix in pregnant women.80

What questions should I ask my doctor about the Shingles vaccine?

NVIC’s If You Vaccinate, Ask 8! Webpage and downloadable brochure suggests asking eight questions before you make a vaccination decision for yourself, or for your child. If you review these questions before your appointment, you will be better prepared to ask your doctor questions. Also make sure that the nurse or doctor gives you the relevant Vaccine Information Statement (VIS) for the vaccine or vaccines you are considering well ahead of time to allow you to review it before you or your child gets vaccinated. Copies of the VIS for each vaccine are also available on the CDC's website and there is a link to the shingles VIS in NVIC’s shingles “Quick Facts” section. 

It is also a good idea to read the vaccine manufacturer product insert that can be obtained from your doctor or public health clinic because federal law requires drug companies marketing vaccines to include certain kinds of vaccine benefit, risk and use information in product information inserts that may not be available in other published information. NVIC also provides this information in our shingles Quick Facts section.

Other questions that may be useful to discuss with your doctor before getting the shingles vaccine are:

  • If other vaccines in addition to shingles vaccine are scheduled at this office visit, am I allowed to modify the schedule so fewer vaccines are given at once?
  • What should I do if I have a high fever or get very ill after vaccination?
  • What other kinds of reaction symptoms should I call to report after shingles vaccination?
  • If the shingles vaccine doesn’t protect me, do I have any other options for preventing shingles infection?

While shingles vaccines are not covered under the National Childhood Vaccine Injury Act of 1986 and not eligible for federal vaccine injury compensation, doctors and all vaccine providers should provide you with risk and benefit information on shingles and shingles vaccine before vaccination. They should also record serious health problems following vaccination in the permanent medical record; keep a permanent record of all vaccines given, including the manufacturer’s name and lot number; and report serious health problems, injuries and deaths that follow vaccination to VAERS and you have a right to receive that same information from all vaccine providers.

NVIC Press Releases, Statements & Commentaries Related to Shingles

Additional Bibliography of References

Articles

References

1 CDC. Shingles (Herpes Zoster) – Shingles Home - For Health Care Professionals – Clinical Overview. Revised Feb. 21, 2018

2 CDC. Shingles (Herpes Zoster) – Shingles Home – About Shingles - Transmission. Revised Jan. 19, 2018

3 Mayo Clinic. Shingles. Mar. 9, 2018

4 CDC. Shingles (Herpes Zoster) – Shingles Home – About Shingles – Signs and Symptoms. Revised Oct. 17, 2017

5 Ibid

6 CDC. Shingles (Herpes Zoster) - Shingles Home – About Shingles – Complications. Revised Jan. 19, 2018

7 Medical News Today. What is Shingles? Nov. 29, 2017

8 CDC. Shingles (Herpes Zoster) - Shingles Home – About Shingles – Overview. Revised Jan. 19, 2018

9 Janniger, C. Herpes Zoster Medication. Medscape. Mar. 6, 2018

10 FDA. Zostavax (Frozen). Product Information Sheet. Mar. 21, 2018

11 FDA. Zostavax (Refrigerator Stable). Product Information Sheet. Mar. 21, 2018

12 NIH. National Institute of Allergy and Infectious Diseases. Research – NIAID’s Role in Research – Vaccines – Types of Vaccines. Apr. 3, 2012

13 FDA. Shingrix. Product Information Sheet. Oct. 20, 2017

14 FDA. Zostavax (Frozen). Product Information Sheet. Mar. 21, 2018

15 FDA. Shingrix. Product Information Sheet. Oct. 20, 2017

16 CDC. Vaccines and Preventable Diseases – Vaccines by Disease – Shingles. Revised Jan. 25, 2018

17 CDC. Vaccines and Preventable Diseases – Vaccines by Disease – Shingles – Shingles Vaccination. Revised Feb. 28, 2018

18 CDC. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. MMWR Jan 26, 2018; 67(3);103–108

19 Ibid

20 Goldman, G.S., King, P.G. Review of the United States universal varicella vaccination program: Herpes zoster incidence rates, cost-effectiveness, and vaccine efficacy based primarily on the Antelope Valley Varicella Active Surveillance Project data. Vaccine, 2013 Mar 25; 31(13): 1680–1694

21 Mayo Clinic. Shingles. Mar. 9, 2018

22 NIH. National Institute of Neurological Disorders and Stroke. Shingles: Hope Through Research – What is Shingles? Modified Mar. 23, 2018

23 CDC. Shingles (Herpes Zoster) -Shingles Home – About Shingles – Signs and Symptoms. Revised Oct. 17, 2017

24 CDC. Shingles (Herpes Zoster)- Shingles Home – About Shingles – Overview. Revised Jan. 19, 2018

25 CDC. Clinical Features – Recurrent Disease (Herpes Zoster). Epidemiology and Prevention of Vaccine-Preventable Diseases - The Pink Book: Course Textbook.  - 13th Edition (2015)

26 Medical News Today. What is Shingles? Nov. 29, 2017

27 Goldman, G.S., King, P.G. Review of the United States universal varicella vaccination program: Herpes zoster incidence rates, cost-effectiveness, and vaccine efficacy based primarily on the Antelope Valley Varicella Active Surveillance Project data. Vaccine, 2013 Mar 25; 31(13): 1680–1694.

28 CDC. CDC Recommends Shingles Vaccine. May 15, 2008

29 CDC. Shingles (Herpes Zoster) – Shingles Home – For Health Care Professionals – Risk Factors. Revised Feb. 21, 2018

30 WebMD. What is Shingles and What Causes it? Sep. 13, 2016

31 CDC. Chickenpox (Varicella) – Chickenpox Home – For Health Care Professionals – Clinical Overview. Revised Jul 1, 2016

32 CDC. Prevention of Varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR July 12, 1996 / 45(RR11);1-25

33 CDC. Shingles (Herpes Zoster) Shingles Home – About Shingles – Transmission. Revised Jan. 19, 2018

34 Mayo Clinic. Shingles. Mar. 9, 2018

35 CDC. Shingles (Herpes Zoster) Shingles Home – About Shingles – Transmission. Revised Jan. 19, 2018

36 CDC. Shingles (Herpes Zoster) Shingles Home – About Shingles – Transmission. Revised Jan. 19, 2018

37 CDC. Shingles (Herpes Zoster) Shingles Home – About Shingles – Transmission. Revised Jan. 19, 2018

38 Goldman, G.S., The Case against Universal Varicella Vaccination. Int J Toxicol. 2006 Sep-Oct;25(5):313-7.

39 The National Archives – Public Health England. Latest HPA Modelling reveals chickenpox vaccination would lead to more shingles among elderly despite introduction of shingles vaccination. Sep. 17, 2008.

40 Ibid

41 Brisson, M., Gay, NJ, Edmunds, WJ, et al. Exposure to varicella boost immunity to herpes-zoster: implications for mass vaccination against chickenpox. Vaccine. 2002 Jun 7;20(19-20):2500-7

42 Goldman, G.S., King, P.G. Review of the United States universal varicella vaccination program: Herpes zoster incidence rates, cost-effectiveness, and vaccine efficacy based primarily on the Antelope Valley Varicella Active Surveillance Project data. Vaccine, 2013 Mar 25; 31(13): 1680–1694

43 CDC Shingles (Herpes Zoster) – Shingles Home – For Health Care Professionals – Complications. Revised Feb. 21, 2018

44 CDC Shingles (Herpes Zoster) – Shingles Home – About Shingles – Complications. Revised Jan. 19, 2018

45 CDC. Clinical Features – Recurrent Disease (Herpes Zoster). Epidemiology and Prevention of Vaccine-Preventable Diseases - The Pink Book: Course Textbook.  - 13th Edition (2015)

46 CDC. Clinical Features – Recurrent Disease (Herpes Zoster). Epidemiology and Prevention of Vaccine-Preventable Diseases - The Pink Book: Course Textbook.  - 13th Edition (2015)

47 CDC. Shingles (Herpes Zoster). About Shingles – Overview. Jun. 15, 2018.

48 FDA. Zostavax (Frozen). Product Information Sheet. Mar. 21, 2018

49 FDA. Zostavax (Refrigerator Stable). Product Information Sheet. Mar. 21, 2018

50 CDC. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. MMWR 67(3);103-108. Jan. 26, 2018.

51 Luhana, R. Merck Files Motion to Consolidate Zostavax Lawsuits in Florida. The Legal Examiner. May 30, 2018.

52 FDA. Zostavax (Frozen). Product Information Sheet. Mar. 21, 2018

53 FDA. Zostavax (Refrigerator Stable). Product Information Sheet. Mar. 21, 2018

54 FDA. Shingrix. Product Information Sheet. Oct. 20, 2017

55 CDC. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. MMWR Jan 26, 2018; 67(3);103–108

56 CDC. Vaccine Information Statements – VIS Home – Live Shingles VIS. Feb. 12, 2018

57 FDA. Zostavax (Frozen). Product Information Sheet. Mar. 21, 2018

58 FDA. Zostavax (Refrigerator Stable). Product Information Sheet. Mar. 21, 2018

59 CDC. Vaccine Information Statements – VIS Home – Recombinant Shingles VIS. Feb. 12, 2018

60 WebMD. What Meds Treat and Prevent Shingles? Sep. 7, 2017

61 Medline Plus Shingles – aftercare. May 21, 2016

62 NIH. National Institute of Neurological Disorders and Stroke. Shingles Information Page – Prognosis. Updated Jun. 27, 2018.

63 NIH. National Institute of Neurological Disorders and Stroke. Shingles Information Page – Prognosis. Updated Jun. 27, 2018.

64 CDC. Shingles Clinical Overview – Complications. Updated Feb. 21, 2018.

65 CDC. Shingles – Complications. Updated Jan. 19, 2018.

66 Fisher, B.L., The Emerging Risks of Live Virus & Virus Vectored Vaccines. NVIC.org. 2014.

67 Coriell Institute for Medical Research. NG05965 DNA from Fibroblast. Accessed Jun. 26, 2018.

68 CDC. Vaccine Excipient & Media Summary. The Pink Book. Accessed June 2016.

69 CDC Vaccines and Preventable Diseases – What Everyone Should Know about Zostavax. Revised Jan. 25, 2018

70 FDA. Zostavax (Frozen). Product Information Sheet. Mar. 21, 2018

71 CDC. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. MMWR Jan 26, 2018; 67(3);103–108

72 CDC. Shingles (Herpes Zoster) – Shingles Home – For Health Care Professionals – Vaccination. Revised Feb. 21. 2018

73 CDC. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. MMWR Jan 26, 2018; 67(3);103–108

74 FDA. Zostavax (Frozen). Product Information Sheet. Mar. 21, 2018

75 Ibid

76 Han S.B, Hwang J.M., Kim J.S. et al. Optic neuritis following Varicella zoster vaccination: report of two cases. Vaccine. 2014 Sep 3;32(39):4881-4

77 CDC. ACIP Home – Meetings.

78 Luhana, R. Merck Files Motion to Consolidate Zostavax Lawsuits in Florida. The Legal Examiner. May 30, 2018.

79 FDA. Zostavax (Frozen). Product Information Sheet. Mar. 21, 2018.

80 FDA. Shingrix. Product Information Sheet. Oct. 20, 2017.


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