New recommendations from the CDC’s Advisory Committee on Immunization Practices call for a zoster vaccination for all adults aged 60 and older, even if they have never had a single shingles episode.
Shingles is a painful, often blistering, localized skin rash caused by the chickenpox or varicella-zoster virus (VZV). As Aisha Jumaan, PhD, of the CDC explains, “Varicella zoster is one virus, but it causes two diseases. Primary infection causes chickenpox, and once that resolves, the virus travels to the sensory nerves of the spinal cord, lies dormant, and reactivates later in life.
When it reactivates, it does so as zoster.” According to Jumaan, an estimated 10%-30% of the population will eventually develop shingles, a condition that can cause severe pain for weeks, months, or years. The vaccine is 50% effective against zoster but approximately 70% effective against the pain associated with zoster—meaning vaccinated people who develop shingles are likely to have a much less painful episode.
Jumaan points out that VZV can reactivate in children, but it’s most likely to occur among persons 50 and older. Although immunocompromised persons and persons taking immunosuppressive agents are also at increased risk, the zoster vaccine is contraindicated in individuals who have HIV with T-cell counts <200 cells/µL, who have other immunocompromising conditions, who are taking immunosuppressive medications, who are undergoing radiation therapy, or who are pregnant.
The addition of the shingles vaccine recommendation represents a key change in the CDC’s annual Adult Immunization Schedule for October 2007-September 2008. The updated schedule is slated for publication in the Annals of Internal Medicine in November.