Age and the Shingles Vaccine

The Medical College of Wisconsin's Deidre L. Faust, MD, answers questions about Zostavax, the shingles vaccine that has been available since 2006.

Question 1: I am 50 years old, but I would like to get the shingles vaccine. Why is it only indicated for those over age 60?

A: While shingles can occur at any age, (my son had shingles at 18 months, shortly after receiving the chicken pox vaccine), the incidence increases with age as immunity seems to wane.

The Shingles Prevention Study was a large-scale study (nearly 40,000 patients) done to look at the effectiveness of the shingles vaccine in preventing herpes zoster (the virus that causes chicken pox and shingles), its complications, and also potential risks associated with getting the vaccine. The study was only done in patients over age 60.

Providing a "booster" when immunity is failing seems to help to reduce the incidence of shingles and this is likely the mechanism behind the vaccine. For now, the shingles vaccine is only indicated for those over age 60 and any use under the age of 60 is currently considered "off label" use.

Question 2: I am 67 years old and I am not sure if I have had chicken pox or not. Should I still get the shingles vaccine?

A: The Shingles Prevention Study included patients who had a known history of chicken pox or who had lived in the United States for at least 30 years. They presumed that if subjects lived in the US for greater than 30 years that they likely had immunity as >90% of the US adult population has had chicken pox.

During the study, there were some cases of chicken pox-like rashes. Since the study was not specifically looking at chicken pox immunity, it is unknown whether or not the chicken pox-like reactions occurred in those who only had presumed immunity from living in the US rather than a true case of chicken pox.

The shingles vaccine is not necessary unless you have had chicken pox, but I would presume based on your age that you have had them. Prior to getting the vaccine, you could ask your doctor to check your chicken pox or varicella titers to determine whether or not you have had chicken pox. It is easy enough to do and may prevent you from having a chicken pox-like rash from the vaccine.

Deidre L. Faust, MD, is a Staff Physician (Internal Medicine) at the Medical College of Wisconsin's Plank Road Clinic. Her column appears in the Milwaukee Journal-Sentinel.

For more information about this topic, see the HealthLink article All About Zostavax.