Current ACIP (CDC) recommendations are to vaccinate against herpes zoster in individuals aged ≥ 60 years. The FDA has approved the vaccine for use in individuals aged ≥ 50 years. One can get shingles at any age, even in childhood. So, why wait until age 60 to offer vaccination?
Unfortunately, the current vaccine, Zostervax, only provides protection for about 5 years. Since the risk of post herpetic neuralgia (PHN) increases with age, the ACIP decided it best to wait until age 60 before giving the vaccine. The CDC did offer some suggestions as to why a provider might elect to administer Zostervax to someone younger than age 60.
♦ Occupation is one consideration. A 55-year-old physician working with immunocompromised children and planning to retire at age 60 might elect to get vaccinated at age 55 to avoid missing work if he should he develop shingles.
♦ Someone who might not tolerate PHN well due to another condition (severe depression, another chronic pain syndrome) could also be considered a candidate for earlier vaccination.
♦ Limited life expectancy is another reason a person might benefit from vaccination before age 60. Work is being done on a new vaccine that is expected to work much longer than 5 years.
Try these 2 questions about zoster vaccination raised by a 60-year-old patient in your office.
The otherwise healthy 60-year-old is in for his annual physical and happens to have a nasty cold. He had a moderate case of shingles 3 months earlier and has recovered fully. He asks if he can get vaccinated today because he had heard that one can get shingles more than once.
1. You tell him:
A. He is very unlikely to ever get shingles again, so doesn’t need the vaccine.
B. Yes, he can get the vaccine but it is recommended that he wait 6-12 months after his bout with shingles.
C. Yes, he can get the vaccine but should wait until he is feeling well to avoid possible interference with his immune response to the live vaccine since he is presumably producing interferon now.
D. Yes, he can get the vaccine today.