Common concerns in Primary Care Medicine; Do I need a Shingles Shot?

The disease commonly called “Shingles” is caused by reactivation of a Herpes type virus (varicella or chicken pox) which we have all encountered and fought off as kids, but can lay dormant in an area of a peripheral nerve called the “dorsal root ganglion”.  For reasons that are not completely clear, the virus which sets up shop in childhood can reactivate in adults and spread along the track of the nerve it was living in.  The pattern of spread, called a “dermatomal” pattern is what gives Shingles its characteristic look, traveling in a line along the nerve it was living in.  Because of this pathophysiology, during any one flare, Shingles only stays in one dermatome on one side of the body.  A common and dangerous location for Shingles reactivation is in the first branch of the trigeminal nerve which goes near the eye.  But it can reactivate in any dermatome from head to toe.  The problem with Shingles (in addition to threatening the eye when it reactivates there) is pain.  Even after the rash goes away, the pain can stay for a long time.

shinglesdermatomes

Enter preventative primary care medicine.  There is a new vaccine out now called Shingrix that is very effective in preventing a Shingles reactivation flare.  This vaccine given in 2 parts (time 0 then 3-6 months later) is recommended for ages 50 and up to prevent the problems that come with a Shingles flare.  Whether you have had Shingles before (as long as not within 6 weeks of an acute flare) or do not recall ever having had chicken pox, that vaccine is still recommended.  This new vaccine is better then and now replaces the old vaccine called Zostavax.  Because Shingrix is NOT an attenuated live virus (like Zostavax is), it can be used more widely in standard and immunosuppressed patients.

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