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Consider the shingles vaccine to prevent a recurrence; Ask the Doctors

Capital - 12/3/2017

Dear Doctor: I had shingles about 10 years ago, just after I turned 50, and it was just as difficult and painful as everyone says. Now I hear that it's possible I can get it again. Is this really true? Should I get the vaccine?

Dear Reader: Unfortunately, it's true that having had shingles once does not bestow immunity. While a second bout is rare -- it's estimated that as few as 1 percent of people who have had shingles get it again within the first three years -- the odds do increase over time. According to the Centers for Disease Control and Prevention, 7 percent of people who have had shingles will go on to have another bout within seven years.

For those who don't know, shingles is a nasty rash that can occur in people who have previously had chicken pox. It happens when the varicella zoster virus, which causes chicken pox, emerges from its dormant state and travels along nerve fibers to the skin. In addition to a blistering rash, shingles can be accompanied by nerve and muscle pain and extreme skin sensitivity. Although you can get shingles at any age, half of all cases occur in people 60 and older.

Someone with active shingles can't spread the rash, but because the liquid in the blisters contains the virus, they can spread chicken pox. That makes it vital to not have physical contact with anyone who has not had or has not been vaccinated for chicken pox while you have shingles. As though the pain, itching and burning of the rash weren't bad enough, people with shingles also run the risk of being left with ongoing nerve pain, a condition known as post-herpetic neuralgia.

While this all sounds quite grim, there is some encouraging news. A new shingles vaccine called Shingrix has been released. In clinical trials with over 38,000 people, it has shown to be 90 percent effective in preventing shingles in people between 50 and 80 years old, according to clinical data from the CDC. However, when the age groups between 50 and 80 are analyzed separately, efficacy varies.

The two-dose vaccine got a preliminary nod from the CDC in October. An advisory committee recommended that Shingrix should be administered in place of an older existing vaccine, called Zostavax. Given in a single dose, Zostavax isn't as effective as the newer vaccine. It offers a 51 percent reduction in shingles, and reduces nerve pain by about 65 percent.

The CDC's advisory committee is recommending that individuals 50 and older be vaccinated with Shingrix. The committee is also urging that anyone who has already been vaccinated with the older, single-dose vaccine now also receive the new one. The vote in favor of the new vaccine was not unanimous, however. In fact, it was nearly a split decision, with eight members voting for the new guidelines, and seven voting against. A final recommendation from the CDC regarding Shingrix could come as soon as next year.

In the meantime, we would suggest you discuss these developments with your doctor. If you are a candidate for either the new or old vaccines, they may help prevent a recurrence of a painful and challenging condition.

Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.

Credit: Dr. Eve Glazier; Dr. Elizabeth Ko

 
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