Reader questions need for Shingrix

Dear Dr. Roach: In 1991, at age 29, I was part of the Merck Varicella vaccine study at Columbia University in New York City. To qualify for the study, I went through extensive testing, and it was confirmed that I’d never had chickenpox. I received two doses of the vaccine during the trials, and they followed my titer levels for many years. As of 2007, I still had titers. The vaccine I received was the one that ended up being approved by the FDA and is currently in use.

I am getting conflicting opinions from my doctors about whether I need the Shingrix vaccine. My internist recently said, “Since you never had the chickenpox and actually received the chickenpox vaccine (Varivax), Shingrix would not be recommended for you.” What is your opinion?

J.K.

Answer: Yours is indeed an unusual situation. The vast majority (more than 99%) of adults have had chickenpox, even those who have no clinical history. Especially at young ages, chickenpox may not have the typical rash that allows a pediatrician or family doctor to make the diagnosis. As such, the Centers for Disease Control and Prevention recommends that adults over 50 get the new Shingrix vaccine without doing any testing, even in people with no known history of chickenpox.

For those few people with absence of proof of infection of chickenpox, the recommendation is to give the chickenpox vaccine, and then the Shingrix vaccine. Thus, I disagree with your internist. The chickenpox vaccine is not effective enough to reduce your risk of developing shingles, and Shingrix dramatically does so. Put another way, consider the downside: Two doses of the Shingrix vaccine normally causes only mild side effects, such as sore arm, a little bit of fever and feeling lousy for a day or two. Balanced against that is the expected 97% reduction in the risk of developing shingles. Shingles is much worse than the side effects of the vaccine and can sometimes cause devastating complications, especially postherpetic neuralgia, which is persistent burning pain that can continue for months or even years.