(Zoster): Questions and Answers information about the and

What causes shingles? Is there a treatment for shingles? Both and shingles are caused by the same Several antiviral medicines can be used to treat shin- , the (VZV). After a person gles. These should be started as soon as has had chickenpox, the virus rests in the body’s nerves possible after the appears. They can help shorten permanently. Approximately 30% of all people who the length and severity of the episode. Antiviral treat- have been infected with chickenpox will later develop ment is most effective if administered within 24 to 72 herpes zoster, commonly known as zoster or shingles. hours of the appearance of the rash. medicine may also help with pain caused by Why do some people develop shingles shingles. and others don’t? Shingles occurs when VZV reactivates and causes Is there a test for shingles? recurrent disease. It is not well understood why this Yes. Shingles is usually diagnosed based on symptoms happens in some people and not others. The risk of and the appearance of the rash. A definite diagnosis is getting shingles increases as a person gets older. made by growing the varicella virus from a skin . People who have medical conditions that keep the from working properly, or people who Can you catch shingles from an infected person? receive immunosuppressive drugs are also at greater No, shingles cannot be passed from one person to risk to get shingles. another such as through sneezing, coughing, or casual What are the symptoms of shingles? contact. While it is possible for the VZV virus to be spread from a person with active shingles to a person Shingles usually starts as a rash with that scab who has never had chickenpox or never been vaccinated after 3 to 5 days. The most frequently mentioned against chickenpox (if they have direct contact with the symptom is pain. The rash and pain usually occur in a rash), the person exposed would develop chickenpox, band on one side of the body, or clustered on one side not shingles. of the face. The rash usually clears within 2 to 4 weeks. Before the rash develops, there is often pain, itching, How common is shingles in the ? or tingling in the area where the rash will develop. Before vaccines became available, it was estimated Other symptoms of shingles can include , head- that 1 million cases of shingles occurred in the U.S ache, chills, and upset stomach. each year.

What are possible complications from shingles? Can you get shingles more than once? Very rarely, shingles can lead to , hearing Yes, but rarely. Most people will have only one occur- problems, blindness, scarring, rence of shingles in their lifetime, but second and third (), or death. occurrences have been reported. For about one person in five, severe pain can continue even after the rash clears up, a situation called post- What kind of is available? herpetic (PHN). As people get older, they are Recombinant (RZV; Shingrix, Glaxo- more likely to develop PHN, and it is more likely to SmithKline) contains a single genetically-engineered be severe and long lasting. The pain may be sharp or protein from the zoster virus. RZV is not alive and can- throbbing, and it may extend beyond the area of the not replicate in the body. original rash. The skin may be unusually sensitive to Between 2006 and 2020, a live zoster vaccine (ZVL; touch and to changes in temperature. PHN can last for Zostavax, Merck), was distributed in the U.S. ZVL months, or even years. contained a weakened form of the virus that produced immunity in the body without causing illness.

continued on the next page � Saint Paul, Minnesota • 651-647-9009 • www.immunize.org • www.vaccineinformation.org www.immunize.org/catg.d/p4221.pdf • Item #P4221 (12/20) Shingles (Zoster): Questions and Answers (continued) page 2 of 2

How is this vaccine given? received Shingrix also reported symptoms such as Shingrix is given by an into the deltoid mus- muscle pain, tiredness, and more frequently cle of the upper arm. than those who received a placebo. About 9% of people who received Shingrix experienced pain at the injection Who should get this vaccine? site severe enough to prevent normal activities. About 11% of people who received Shingrix experience sys- The Advisory Committee on Practices temic events (myalgia, , headache, fever, shiver- (ACIP) of the Centers for Disease Control and Preven- ing, and gastrointestinal symptoms) severe enough to tion (CDC) recommends that all adults age 50 years prevent normal activities. and older receive a 2-dose series of RZV (Shingrix). The doses should be given 2 to 6 months apart. Peo- If I have a strong reaction after my first dose of ple 50 years and older should receive RZV even if they Shingrix should I still take the second dose? previously received the live zoster vaccine or have had shingles. Not everyone who has a strong local reaction after the first dose of Shingrix will have the same reaction after How effective is the Shingrix vaccine? the second dose. CDC encourages people to get the second dose even if a strong local reaction occurs with In clinical trials Shingrix reduced the occurrence of the first dose. shingles by 97% among people 50 years and older. A second study found that Shingrix reduced the occur- Who should NOT receive zoster vaccine? rence of shingles by 90% among people 70 years and older. In this study Shingrix reduced the occurrence of People who are allergic to a component of the vaccine shingles by 85% four years after vaccination. or who had an allergic reaction following a previous dose should not receive that vaccine again. If the per- Do zoster vaccines prevent post-herpetic neuralgia? son has a severe illness, vaccination should be deferred until the illness has improved. Both Zostavax and Shingrix were shown to reduce the risk of post-herpetic neuralgia (PHN). Zostavax There is currently no information available on the use reduced the overall occurrence of PHN by 66%, of Shingrix in people who are pregnant or lactating whereas Shingrix reduced the overall occurrence of women. Shingrix should not be given to individuals PHN by 89%. who have a weakened immune system caused by treatments that they are taking such as radiation or Who recommends zoster vaccine? , or due to conditions such as HIV/ AIDS, of the lymph, bone, or blood. Zoster vaccine is recommended by CDC’s Advisory Committee on Immunization Practices, the American Is the cost of zoster vaccine covered by Medicare? Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Col- All Medicare Part D plans cover zoster vaccination, lege of Physicians, and the American College of meaning that a pharmacy can bill Medicare for the Nurse-Midwives. cost of the vaccine. Your share of payment varies by plan. Medicare Part B does not cover the zoster vac- What side effects have been reported with zoster cine. If you have private insurance, your plan may or vaccination? may not cover the vaccine; contact your insurer to find out. The most commonly reported side effects following Shingrix with study participants included pain at the Does the zoster vaccine cause shingles? injection site (69%–88% depending on age group), redness (38%), and swelling (30%). People who No.

Immunization Action Coalition • Saint Paul, Minnesota • 651-647-9009 • www.immunize.org • www.vaccineinformation.org www.immunize.org/catg.d/p4221.pdf • Item #P4221 (12/20)