Preventing Shingles

Posted: Sunday, January 23, 2011 | Posted by Debajyoti Datta | Labels:

Shingles, also known as Herpes Zoster, usually occurs in elderly adults. It is characterized by painful eruption of vesicular lesions that follow a dermatomal distribution. The thoracic and lumbar roots are most commonly affected.
Pain precedes the appearance of the lesions and is severe and debilitating. The incidence and severity of herpes zoster increases with increasing age due to age related decline in immunity. Post herpetic neuralgia is a common complication of herpes zoster in the elderly. Facial nerve paralysis, herpes zoster ophthalmicus and bacterial superinfection are among other complications. Antiviral therapy with Acyclovir reduces the duration of the illness. A live attenuated Varicella Zoster Virus vaccine is also available to prevent herpes zoster.

herpes zoster shingles eruption rash
Herpes zoster in the neck. Image from wikipedia.
In a recent study published in JAMA, Hung Fu Tseng et al. examined the effect of a Oka/Merck strain of varicella zoster virus based vaccine in reducing the incidence of herpes zoster. The study was a retrospective cohort study conducted among members of Kaiser Permanente, Southern California. The study included 75761 vaccinated subjects in 60 years or more age group. 227283 unvaccinated subjects in 60 years of more age group were included as controls. The controls were randomly selected and age matched. Immunocompromised individuals were excluded from the study as the vaccine is contraindicated in them. Exclusion of immunocompromised subjects also removes its confounding effect as it is a risk factor for herpes zoster. The main outcome of interest was incidence of herpes zoster. Bias was accessed by measuring the rate ratios of 13 different acute conditions which are not protected by the vaccine. If the rate ratios of these conditions are not grouped around 1, it would indicate that the vaccinated and the unvaccinated groups differ from each other and unmeasured confounders are at play. The rate ratio of herpes zoster was much greater in magnitude than the other conditions indicating that the outcome was not due to any bias.

In univariate analysis, the incidence of herpes zoster in vaccinated individuals was 6.4 (95% CI, 5.9-6.8) per 1000 person-years and among unvaccinated individuals, it was 13.0 (95% CI, 12.6-13.3) per 1000 person-years. The risk of herpes zoster among unvaccinated individuals varied with age, sex, race and lung disease. The difference in incidence of herpes zoster persisted upon adjustment for sex, race, chronic diseases and health care utilization. The fully adjusted analysis gave a hazard ratio of 0.45 (95% CI, 0.42-0.48). When a more strict criteria for immunocompetency was used, the adjusted hazard ratio was 0.46 (95%CI, 0.43-0.49). The vaccine also reduced the risk of herpes zoster ophthalmicus and hospitalization due to herpes zoster. Overall reduction in incidence of herpes zoster was 55%.

The limitations of the study are potentially unmeasured confounders and external validity.

Tseng HF, Smith N, Harpaz R, Bialek SR, Sy LS, & Jacobsen SJ (2011). Herpes zoster vaccine in older adults and the risk of subsequent herpes zoster disease. JAMA : the journal of the American Medical Association, 305 (2), 160-6 PMID: 21224457


  1. Mayo said...
  2. Here's a site with good, comprehensive information about shingles, including causes, symptoms, treatment and those for whom the vaccine works - and a page with a run down of who should get the new shingles vaccine - and who shouldn't.

  3. Anonymous said...
  4. Preventing Shingles is like preventing any other
    disease known to mankind.
    Immunization,as a way of prevention is lacking for the following reasons
    A)Affordabily and portability:Only a limited percentage of the population has the appropriate
    access to it.
    B)Specicity to any type of Herpes
    C)Side effects.
    Based on these drawbacks,a new approach in prevention and treatment of any infection is now
    surfacing.It is based on discovering the Innate
    Immunology,yet unknown to the Medical profession

  5. Richie said...
  6. Are the herpes vaccine really effective on preventing shingles outbreak or is this another marketing hyperbole?

  7. Debajyoti Datta said...
  8. Hi Richie,

    The study mentioned found the herpes vaccine to be effective in a community setting and there wasn't any significant bias. Although the authors had consulted for Merck, it does not negate the findings. The study is robust and it doesn't look like a marketing hyperbole.

  9. Felix said...
  10. You mentioned that the virus usually occurs in elderly patients but it happened to my wife recently and she was only 28 yrs of age. She was also in good health; no fever or any aches or pains but was probably somewhat stressed from her job. I am concerned that by merely cuddling our kids ( 5 and 3.5 yrs old) that she could transmit the virus to them?

  11. Debajyoti Datta said...
  12. Hi Felix,

    Sorry to hear about your wife. Although herpes zoster commonly occurs in the elderly, it can occur in any age group. Persons suffering from herpes zoster can transmit the virus to unimmunized or seronegative individuals so its better to keep children separated if they are not immunized or they haven't had chickenpox previously.

  13. Felix said...
  14. Thank you Mr. Datta (or should I say Doctor?). My kids were have all their vaccinations done which I suppose includes chicken pox. This may or should make it safe for my wife and kids to physically internact, I hope.

  15. Shingles Home Remedy said...
  16. It is extremely important to begin treating your condition as soon as possible, there are special supplements you can take, as well as special lotions, creams, or recipes to follow for a good bathing procedure.

  17. Jasper Harper said...
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  19. Louise Johnson said...
  20. I smoked for 20 years, October 2014 i was diagnosed of Emphysema I may have had it for 6 months to 1 year prior to diagnosis. It started with a dry cough, shortness of breath, and fatigue. A chest x-ray confirmed it and I was placed on corticosteroids. my doctor told me there is no permanent cure for the disease, i was given bronchodilators to help me relax my bronchiolar muscles, I managed on with the disease till a friend told me about a herbal clinic from johannesburg who sell herbal medicines to cure all kind of lung related diseases including emphysema, I spoke to few people who used the treatment here in USA and they all gave positive responses I contacted this herbal clinic via there email and made purchase of the emphysema herbal medicine, i received the herbal medicine through DHL within 5 days, when i received the herbal medicine i applied it as prescribed and was totally cured of emphysema within 7 weeks of usage, the symptoms reduced till i even forgot i had emphysema, i went back to my doctor for diagnosis with spirometry and he confirmed i was free from the disease, contact this herbal clinic via there email or website on

  21. joel lisa said...
  22. Am Lisa by name, i was diagnosed with Herpes for 3years ago i lived in pain with the knowledge that i wasn't going to ever be well again i contacted so many herbal doctors on this issue and wasted a large sum of money but my condition never got better i was determined to get my life back so one day i saw mr Brown post on how Dr Aba saved him from the VIRUS with herbal medicine i contacted Dr Aba on his email address we spoke on the issue i told him all that i went through and he told me not to worry that everything will be fine again so he prepared the medicine and send it to me through courier service and told me how to use it,after 14days of usage I went to see the doctor for test ,then the result was negative,am the happiest woman on earth now. this testimony is real.thanks to Dr Aba God bless you. you can also reach him on his whatsApp number +2348107155060

  23. Unknown said...
  24. Hello to everyone in this blog, i want to use this means to inform you about this herbalist who have cure to herpes this man help with his herbal cure which i took for just 2 week and 4 day, it have been long i have being suffering from this sickness without any help all doctor told me there is no cure until i found out there is herbal cure and luckily i found Doctor sigolo who help with 2 week and 4 day, i am so grateful to see i am cured i have used this herbal going to 6 months now without no side effect and his herbal is 100% accurate and he also have herbal cure to different sickness like ( 1 Cancer 2 Hiv 3 Low sperm count 4 Barrenness 5 Hvp 6 Herpes7 Genital Wart8 Rare disease 9 Hepatitis) so if you are in the same situation like me and you have someone suffering from HSV1 and 2 you can also cantact this doctor for the herbal medicine and get cured this is his email: DR.SIGOLOHEALERTEMPLE@GMAIL.COM
    You can also email me if you have any question about him through
    I’m maria matilde leonor

  25. julia Farbio said...
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  27. anonymous lilly said...
  28. Hello... I am from United states.
    I want to appreciate Dr OKOLI for using his herbal medicine to cure my Herpes. since 3 years, I have been having this herpes disease and it has been giving me challenges, I was so perplexed cause i have been taking several drugs to be cured but every of my effort was in vain,one morning i was browsing through the internet then i saw several testimonies about Dr OKOLI curing people of their Herpes disease and immediately i contacted Dr OKOLI on his email:, told him about my troubles and he told me that i must be cured, gave me some instructions and which i rightly followed. so he prepared a herbal medicine for me and sent to me which i used for 2 weeks and everything was like a dream for me and my Herpes disease was totally gone, why don't you contact him today and be free from your disease because he is very good and honest Doctor... His email is, or Visit his website now at or call and whatsApp him on Mobile +2347031991061

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