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The Second Attack: Unveiling the Shingles Vaccine’s Effectiveness in Preventing Recurrences

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The Recurrence of Shingles: Why a Vaccine is Important

No one wants to think about experiencing the burning, stabbing, painful misery of shingles again. However, it's crucial to be aware that shingles can strike multiple times, even rarely up to a third occurrence. The good news is that getting vaccinated against shingles can significantly reduce the chances of a recurrence.

Frequency of Recurrence

There is some disagreement among experts regarding how often shingles recurs. In a study analyzing medical records of nearly 1,700 patients who had previously suffered from shingles between 1996 and 2001, researchers found that over 5% of these patients were treated for a second episode within an average of eight years. This rate of recurrence is almost as likely as the initial occurrence of shingles for individuals aged 60 and older. However, other studies have shown a much lower rate of recurrence. Regardless, the bottom line remains the same: having shingles once does not provide immunity against future episodes.

The Dormant Shingles Virus and its Reactivation

Shingles is caused by the varicella zoster virus, the same virus responsible for chickenpox. After having chickenpox, the virus remains inactive within your nerves. However, it can reactivate later in life, leading to the manifestation of shingles. When the virus reawakens, it causes inflammation in the infected nerves and the corresponding skin, resulting in a burning or stabbing pain. A few days later, a rash of blisters appears along the affected nerve. The skin may become extremely sensitive, making it intolerant to even the lightest touch.

In some cases, about 1 in 10 adults who experience shingles may continue to suffer from long-term pain even after the rash has fully healed. This condition, known as post-herpetic neuralgia (PHN), can last for months or even years, significantly impacting the individual's quality of life. While the virus returns to a dormant state after causing shingles, it can potentially reactivate again in the future, leading to recurrent episodes.

Vaccination as a Means of Reducing Shingles Risk

The likelihood of developing shingles increases as one grows older. To mitigate this risk, the U.S. Centers for Disease Control and Prevention (CDC) recommends that adults aged 50 and older get vaccinated against shingles.

There are two vaccines available in the United States to prevent shingles: recombinant zoster vaccine (RZV, Shingrix) and zoster vaccine live (ZVL, Zostavax). Shingrix is the preferred vaccine due to its higher efficacy.

The CDC advises adults aged 50 years and older to receive Shingrix, regardless of whether they have previously experienced shingles or have received the Zostavax vaccine, which has been in use since 2006. It is recommended to take two doses of Shingrix, spaced two to six months apart. These two doses provide over 90% effectiveness in preventing shingles, and Shingrix is also 90% effective in reducing the likelihood of PHN in vaccinated individuals who still develop shingles.

Although Zostavax is still available, studies indicate that it is less effective compared to Shingrix. Zostavax may be administered to some healthy adults aged 60 and older, particularly those who are allergic to Shingrix.

While there is no specific waiting period after recovering from a shingles episode before getting vaccinated, it is advisable to wait until the shingles rash has completely disappeared.

William H. McDaniel, MD

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School.

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