The Shingles Vaccine is the Longevity Hack that Already Exists

Got menopause? You may be due for your shingles vaccine

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I finally had my second dose of the shingles vaccine last week. I’m a little late, as the vaccine is currently recommended here in the United States for everyone aged 50 and older (and for those aged 19 and older with a suppressed immune system). I am 58 years old.

Side note/rant: At least these are the current recommendations; once Dr. Dave Weldon gets his pro-plague, anti-science paws on the CDC, who knows? After all, he has promoted the falsehood that there is a link between childhood vaccines and autism, raised unsupported safety concerns about the HPV vaccine, and appeared in not one but two anti-vaccine films. He’s a real piece of work; you can read more about him at skepticalinquirer.org if you can stomach it. You can also read about the many ways he could affect access to vaccines here in the United States in this article from The Guardian.

Rant over. Back to shingles, or rather not getting shingles.

Part of my delay in getting vaccinated was scheduling; despite working at a medical center, getting a vaccine appointment when I was available during a work day (over lunch) wasn’t easy, and I didn’t want to lug myself into the office on my day off. But I have to be honest; my concern about reacting to the vaccine also played a role in my sluggish scheduling. Even though I had never had a significant vaccine reaction previously, I’d heard the shingles vaccine could be pretty bad for some people, and so that activated both the non-rational part of my brain (It could be so bad!) and the rational part, because I either had to commit to getting the vaccine on a Friday, which meant even trickier scheduling and also possibly ruining the weekend recovering, or get the shot during the week and hope for the best (and hope is not a good strategy). For me, when there are seemingly so many decisions to make, indecision gets pretty comfortable.

I finally sat down and actually read about the vaccine, and I realized I needed to make it happen because the data is so strong in favor of the vaccine, and there is so much downside with shingles. And so I am happy to report that my immune system is now supercharged! However, as the uptake of the shingles vaccine is pretty low, I wanted to discuss the vaccine in case you had concerns like I did or weren’t sure if this vaccine was needed. As 9% or so of people eligible in the United States for the vaccine have received two doses, I think it’s really important to discuss.

Also, I ended up with a pretty significant vaccine reaction, so in the name of transparency, I'll get into that. I think it’s important to be upfront about side effects because downplaying vaccine negatives leads to distrust. But the TL;DR (too long, didn’t read) is that the vaccine reaction was a minor trade-off, considering the benefit.

What is Shingles?

Shingles is the reactivation of the chicken pox virus or varicella zoster virus (often abbreviated as VZV). After chicken pox, the virus stays dormant in sensory nerves, which are the nerves that receive and send signals related to touch, such as pain, vibration, and temperature. At some point after chickenpox (usually years later), the virus can reactivate in the nerve and cause shingles.

The classic outbreak is a painful rash (often excruciating) confined to a dermatome, an area of skin innervated by one of these sensory nerves. If this sensory nerve happens to be in the head, singles can have devastating consequences for an affected eye, even blindness. There are other potential complications of shingles, such as stroke, spinal cord inflammation, and brain inflammation. A common longer-term complication is post-herpetic neuralgia, which is persistent pain in the affected sensory nerve, and this pain can sometimes persist for months and be debilitating. Shingles can be much worse for people with a weakened immune system.

The short version is that getting shingles sucks big time, and you don’t want to get it! I’ve seen many people with shingles over the years, and no one has ever said, “Well, that was a walk in the park!”

How Common is Shingles?

If you have had chickenpox and you live to be 85, your lifetime risk of shingles is 50%. The risk of shingles increases with age, and much like chicken pox, the older you are, the more severe the outbreak.

The risk of post-herpetic neuralgia is about 5-15%, and this risk increases with age. It is also more common in women than in men.

Shingles Vaccine Basics

This is a relatively new vaccine, but it has been studied for 10 years and counting. This should not concern people from a safety standpoint, as severe reactions to vaccines happen within 1-2 months of the injection, so we have plenty of safety data.

The shingles vaccine currently on the market in the United States is called Shingrix. It is made from a bit of the virus, a protein that triggers an immune response (this protein is not from the actual virus; instead, it’s made in a lab). Because it’s a protein and not the virus, there is no chance of getting chicken pox or shingles from the vaccine. It also means that this vaccine is safe for people who are immunocompromised, as opposed to the older shingles vaccine, Zostavax, which is no longer marketed in the United States. Zostavax is made from a weakened form of the virus, so it is unsafe to give to anyone with a weakened immune system.

The Shingles is Highly Effective, Even for People Over Age 70.

In the initial randomized clinical trial, which followed people for three years, those who received the vaccine had a 97.2% lower chance of getting shingles than those who did not received the vaccine, which is pretty impressive. Even more impressive is that this response was across the board, so it was the same for those in their 70s as it was for those in their 50s. In comparison, the older Zostavax reduced the risk of shingles by 70% for those ages 50-59 but only 35% for those ages 70 and older. If you have heard the shingles vaccine isn't that effective for older folk, know that simply isn’t the case for Shingrix.

For those vaccinated with Shingrix and who do get shingles, the disease tends to be milder, and there is a suggestion that there is a reduced rate of post-herpetic neuralgia.

The initial studies that gave us the 97% efficacy data are Pharma studies, although they have been well scrutinized. We also have some real-world data from a study that looked at the effectiveness of Shingrix in a large patient population (meaning they looked at the medical records to see who got vaccinated and if any of these people developed shingles) and found that the effectiveness of Shingrix was 79% in the first year and by years three and four it was 73%. This is lower than the 97% I quoted above because how the vaccine performs in the real world is usually slightly different. For example, the studies submitted for vaccine approval typically have healthier people, which might result in a better vaccine response. Also, in the original study, people were followed closely, so there is almost certainly more accurate documentation of who got shingles and who did not.

Shingles is generally awful. I’ve seen a lot of people with it, and not one person has ever said, “It wasn’t bad at all.” Considering the lifetime risk of an unvaccinated person getting shingles is 50%, reducing the risk by even 73% (in the real-world data) is significant, in addition to the lessened course of the disease.

Can you Get Shingrix if you Already Had Zoster?

Yes.

Can you Get Shingrix if you Previously Had Zostavax?

Yes., although there isn't a hard and fast rule about when this should happen. As the effectiveness of Zostavax drops with time, revaccination is likely a good idea. There are studies looking at vaccination with Shingrix five years after Zostavax, but a shorter interval may be appropriate, especially for people in their late 60s and 70s.

Doesn't the Vaccine’s Effectiveness Drop with Time so What’s the Point?

There is now longer-term follow-up data with Shingrix, and the results show very little loss of protection over time. Between years six and 11 after the vaccine, the vaccine was 80% effective at preventing shingles for everyone age 50 and older and 73% effective between years six and 11 for those 70 or older.

The effectiveness of the older Zostavax vaccine drops significantly by four years, so some people may have the vaccines mixed up.

Could a booster be needed down the road? Sure, we could find out by year 15 that there is enough loss of protection that another shot is required, and we could find out that the immune response is still robust at year 15. But even if a booster were needed, so what? There is no other medication where needing an extra dose or two over time is evidence that the medication isn't helpful, so we shouldn’t judge vaccines this way! Yes, it’s a pain to need boosters over time, but that’s how it works sometimes because the immunity to some infections can decrease.

Are the Side Effects That Bad?

There is a lot of talk about shingles being “the worst” vaccine for side effects.

With the vaccine, 79.1% have injection site pain versus 11.2% for the placebo, so most people will have some arm soreness for a day or two after their shots. Here’s a breakdown of some of the other side effects of the vaccine vs placebo, and you can see across the board that reactions were more common with the vaccine than placebo. When these reactions occurred, they typically lasted a day:

Looking at the grade 3 reaction column, the risk of a side effect being so bad that it prevented daily activities was 11.4%. While one in ten is not insignificant, this also means that 89% of people will not have this awful but temporary reaction (which is still far better than the shingles).

I was one of those grade 3 people. The first dose for me left me with some muscle pain and shaking, but not enough to really impair me. However, with dose number two, I had a grade 3 reaction for every listed side effect except temperature–I just didn’t take it because I felt too terrible to look for the thermometer. It was an awful 36 hours, and the shaking and muscle pains were especially awful. I really did nothing but shake, sleep, and complain. And yes, 36 hours of feeling really shitty was an acceptable trade-off for significantly reducing my risk of shingles and possibly reducing my risk of dementia (which I will address in a follow-up post, as there is a lot of emerging data suggesting the vaccine reduces the risk of dementia).

This vaccine was a clear case of short-term pain vs. longer-term, more significant gains for me.

What About Serious Adverse Reactions?

Post-marketing surveillance continued after the vaccine was on the market, meaning data was being collected as it was rolled out and more people were taking it. This type of work is essential as some side effects could be too rare to identify in an initial study of thousands or even tens of thousands of people. This kind of follow-up suggests that Shingrix is associated with three additional cases of Guillain-Barré syndrome (GBS) per million vaccine doses for people 65 and older. However, this work can’t prove cause and effect. GBS is a very rare and serious neurological condition where the immune system attacks the nerves, and it can lead to weakness and temporary paralysis, but most people recover.

Even though the risk of GBS is extremely rare, I get that it sounds scary. However, it is essential to know that having shingles is also linked with GBS–for those who have shingles between the ages of 18 and 65 years, the risk of GBS increases sixfold, and for those who are 65 and older when they have shingles, the risk of GBS increases fourfold. It seems the risk of having GBS may be at least as high, if not higher, after getting shingles than after having the vaccine. However, again, none of this work can prove cause and effect.

The Evidence Supports the Shingrix Vaccine

I will say this again. Shingles sucks. I have seen enough people with it over my career to know I don’t want it. And while I had the awful reaction that 10% of people can expect, it passed. Acetaminophen helped, and I needed some Rolaids for my upset stomach. I laid myself on the couch, napped, and shivered for about 24 of my post-vaccine hours, but by 36 hours, it had passed, and that short unpleasantness was worth it knowing that I have now significantly reduced my chances of getting shingles, which, by the way, really sucks if you get it. Have I mentioned that?

As a woman who plans to live until at least 85, protecting myself against shingles is definitely part of my longevity plan.

Stay tuned for the breakdown on the shingles vaccine and lowering the risk of dementia. And if you have any questions about the vaccine that I didn’t answer, please leave them below.

References

1. Galetta KM, Gilden D. Zeroing in on zoster: A tale of many disorders produced by one virus. J Neurol Sci. 2015 Nov 15;358(1-2):38-45. doi: 10.1016/j.jns.2015.10.004. Epub 2015 Oct 3. PMID: 26454371; PMCID: PMC4628852.

2. Zachary A Marcum, Purva Jain, Alan Embry, Brent Arakaki, Irisdaly Estevez, Emma Viscidi, Incidence of Herpes Zoster and Postherpetic Neuralgia and Herpes Zoster Vaccination Uptake in a US Administrative Claims Database, Open Forum Infectious Diseases, Volume 11, Issue 5, May 2024, ofae211, https://doi.org/10.1093/ofid/ofae211

3. Forbes HJ, Bhaskaran K, Thomas SL, Smeeth L, Clayton T, Mansfield K, Minassian C, Langan SM. Quantification of risk factors for postherpetic neuralgia in herpes zoster patients: A cohort study. Neurology. 2016 Jul 5;87(1):94-102. doi: 10.1212/WNL.0000000000002808. Epub 2016 Jun 10. PMID: 27287218; PMCID: PMC4932239.

4. Cintia Muñoz-Quiles, Mónica López-Lacort, Alejandro Orrico-Sánchez, Javier Díez-Domingo. Impact of postherpetic neuralgia: A six year population-based analysis on people aged 50 years or older, Journal of Infection; 2018: 77: 131-136.

5. Lal H, Cunningham AL, Godeaux O, Chlibek R, Diez-Domingo J, Hwang SJ, Levin MJ, McElhaney JE, Poder A, Puig-Barberà J, Vesikari T, Watanabe D, Weckx L, Zahaf T, Heineman TC; ZOE-50 Study Group. Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. N Engl J Med. 2015 May 28;372(22):2087-96. doi: 10.1056/NEJMoa1501184. Epub 2015 Apr 28. PMID: 25916341.

6. Ousseny Zerbo, Joan Bartlett, Bruce Fireman, et al. Effectiveness of Recombinant Zoster Vaccine Against Herpes Zoster in a Real-World Setting. Ann Intern Med.2024;177:189-195. [Epub 9 January 2024]. doi:10.7326/M23-2023

7. Strezova A, Diez-Domingo J, Al Shawafi K, Tinoco JC, Shi M, Pirrotta P, Mwakingwe-Omari A; Zoster-049 Study Group. Long-term Protection Against Herpes Zoster by the Adjuvanted Recombinant Zoster Vaccine: Interim Efficacy, Immunogenicity, and Safety Results up to 10 Years After Initial Vaccination. Open Forum Infect Dis. 2022 Oct 23;9(10):ofac485. doi: 10.1093/ofid/ofac485. PMID: 36299530; PMCID: PMC9588150.

8. Long-term Shingrix Data

9. Shingrix package insert

10. Anderson TC, Leung JW, Harpaz R, Dooling KL. Risk of Guillain-Barré syndrome following herpes zoster, United States, 2010-2018. Hum Vaccin Immunother. 2021 Dec 2;17(12):5304-5310. doi: 10.1080/21645515.2021.1985890. Epub 2021 Dec 2. PMID: 34856864; PMCID: PMC8903960.

11. Goud R, Lufkin B, Duffy J, et al. Risk of Guillain-Barré Syndrome Following Recombinant Zoster Vaccine in Medicare Beneficiaries. JAMA Intern Med. 2021;181(12):1623–1630. doi:10.1001/jamainternmed.2021.6227