Conflicting views on Shingrix vaccine need

Dear Dr. Roach: I have seen questions about the Shingrix vaccine. In 1991, at age

29, I was part of the Merck Varicella vaccine study at Columbia University in New York City. To qualify, I went through extensive testing, and it was confirmed I’d never had chickenpox. I received two doses of the vaccine during the trials, and they followed my titer levels for 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 in use.

I am getting conflicting opinions about whether I need the Shingrix vaccine. My internist said, “Since you never had the chickenpox and received the chickenpox vaccine, Shingrix would not be recommended for you.” What is your opinion? — J.K.

Dear J.K.: The vast majority of adults have had chickenpox. 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 testing.

For those 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, and Shingrix dramatically does so.

Two doses of the Shingrix vaccine normally causes only mild side effects. Balanced against that is the expected 97% reduction in the risk of shingles. Shingles is much worse than the side effects of the vaccine and can sometimes cause complications, especially post-herpetic neuralgia, which is persistent burning pain.

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