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Can the shingles vaccine prevent a recurrence?

Asked by Robert, Atlanta, Georgia

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Once someone has shingles, after the infection clears, should he get the shingles vaccination to prevent recurrences?

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Conditions Expert Dr. Otis Brawley Chief Medical Officer,
American Cancer Society

Expert answer

Dear Robert:

Thanks for your question. You ask about a vaccine that can help a lot of people.

Shingles is a painful skin rash that occurs in older people and people who are immunosuppressed due to other diseases or treatment with immune-suppressing drugs. It is a reactivation of the chickenpox virus (which is also called herpes zoster). There is a vaccine to prevent shingles. It is called Zostavax, which Merck makes.

Zostavax does not treat shingles. In clinical trials of adults 60 or older, Zostavax reduced the risk of shingles by about half and reduced the risk of the painful condition that sometimes follows the rash (postherpetic neuralgia) by two-thirds. People who got shingles after vaccination appeared to get less severe outbreaks. While the vaccine is known to last for at least six years, it likely lasts much longer.

In patients who have had shingles, Zostavax has been shown to help prevent future occurrences. Importantly, these people should receive the vaccine after the original shingles rash has disappeared.

The Food and Drug Administration has approved the drug for those 60 and older. There is no statement about use of the drug in people younger than 60. This is unfortunate as perhaps one-third of patients getting shingles are 50 to 59. In a survey a few years ago, more 95 percent of adults over 50 had evidence of a previous chickenpox infection and thus were at risk for shingles.

The original chickenpox infection usually occurs in childhood and seemingly goes away. But the virus stays quiet in the body until it is reactivated as shingles. The number of people at risk for shingles will change over the years because we've had a chickenpox vaccine in use since 1995. It's given to children at age 12 months to 18 months and again at age 4 to 6.

The vaccine is safe for most people; it should not be given to those who may have an allergy to the shot, people with a weakened immune system or pregnant women. The most common side effects of the vaccine were redness, soreness, swelling or itching at the shot site and headaches.

It's a live, weakened -- or attenuated -- virus vaccine. People who get the vaccine will not spread chickenpox and can associate with infants and young children, pregnant women or people with weakened immune systems. Neither the chickenpox vaccine nor the shingles vaccine affects herpes simplex 1 or 2, which are different viruses in the herpes family.

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