Shingles vaccine recommended regardless of chickenpox exposure

Dear Dr. Roach: I am a female and 66 years of age. I had a varicella zoster blood test a couple of years ago to see if I had ever had chickenpox, because I had concerns about getting the shingles shot. (I had my first-ever flu shot quite a few years ago, and am convinced that I reacted badly, coming down with a severe case of the flu within a couple hours of the shot.) I know that it is said that you do not get the flu from the flu shot, but this reaction made me question getting the shingles shot.

My blood test showed that my antibodies (IGG) are 2,279. My dermatologist called me with the results and said: “Yes! You definitely had the chickenpox, big time.” I understand that normal count of antibodies would be around 135 to 165. He questioned whether I have enough protection that I might not need the shingles shot. But he said he wasn’t sure how to weigh in on this one. He suggested I call the Centers for Disease Control and Prevention, but I thought I’d ask your opinion.

D.T. I wouldn’t test a person in your situation for antibody levels. Whether or not you had been exposed to chickenpox, I still would recommend a shingles vaccine, which is what the current guidelines recommend.

However, now that you have the result, it isn’t clear from the CDC guidelines what you should do. My recommendation is that you still get the vaccine. The reason is that antibody levels are representative of the part of the immune system called “humoral.” This part of the immune system is critical for bacterial infections, and it is led by the antibodyproducing B cells. For viral infections such as varicella zoster, it’s the cellular immune system that is critical. This is led by T cells. A high antibody titer, a measure of concentration, such as yours might not predict a strong cellular immunity. Furthermore, the downside of getting a shingles vaccine is small: It is not very expensive, and the risk of serious side-effects is very small. I don’t think that the high antibody level you have will make it more likely that you will have a side-effect.

The injectable flu vaccine contains no live flu virus. It isn’t possible to get flu from a shot. Some people do get a reaction of lowgrade fever and muscle aches, which rarely lasts more than a day or two: That’s the most likely explanation in your case. Of course, you might have had very bad timing and were coming down with the flu right when you got the shot, but the timing makes me doubt that degree of coincidence. Nonetheless, flu shots save lives.

Dear Dr. Roach: I might seem ignorant, but I have tried to get a definition of a “statin” from professionals, with no satisfaction. Statins are talked about but never defined.

P.E.

A statin drug is one that inhibits the enzyme HMG-CoA reductase. This is a critical enzyme in the synthesis of cholesterol, which happens in the liver. We all need cholesterol for important body function, such as making cell membranes and hormone synthesis.

The generic names of this drug class all end in “-statin”: lovastatin (Mevacor), atorvastatin (Lipitor) and rosuvastatin (Crestor) are among the most common. Some natural compounds, especially red yeast rice, act the same way that synthetic statins do, and have the potential for both benefit and harm.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth @med.cornell.edu