About a month ago I was in line at the pharmacy and was amazed at how many times patients were offered the latest vaccines. “Did you get you RSV?” “How about your COVID-vaccine?” Pretty soon you will see offers for the flu vaccine which typically starts showing up at pharmacies in August and September although it should not be given any sooner than October.
If anything can be learned from the COVID-vaccines is that shorter acting vaccines, such as the flu and COVID 19, typically only last 3 months and you want them to peak during the season. Flu season typically starts (no sooner than November and can extend into March). I still do not recommend the COVID vaccines for several reasons. Each new COVID vaccine is just that, a new COVID vaccine. It is typically a new variant combination and unfortunately, we do not know the long-term side effects. All they can tell us is that it will increase your spike protein which should increase your protection but there are still no long-term studies on each subsequent vaccination and you have to realize this is not a vaccine in the traditional sense. This is genomic medicine which is integrated into your genome for the rest your life. Also, no one is dying from COVID anymore and hospitalization is extremely rare. (Of course there are exceptions to this but again extremely rare).
The typical vaccines are still recommended. Tdap, Pneumococcal, and Shingles. If you are older than 60 you should have a pneumonia vaccine (Pneumovax) and be boosted 10 years later. Unless you have underlying lung disease or had a splenectomy all you will need is 2 throughout your lifetime. If you are older than 65 you will want to get the newest pneumonia vaccine (Prevnar PCV 23-CAPVAXIVE). I am not recommending the RSV vaccine unless you have severe lung disease or are immunocompromise because some of them are messenger RNA based, and again, there are no long-term studies. RSV is typically a fatal disease in children and individuals with severe obstructive lung disease. Tetanus and pertussis should be given every 10 years. I have patients who are still reluctant to get any vaccine but I point out to them that you do not see tetanus anymore because of the vaccine. Lastly, I recommend shingles vaccination. The pharmacies will recommend after 50, but your immune system is strong enough, so I typically recommend after age 60, otherwise I think is just another way for them to get another dose in you.
Of all the vaccines this one may be most important. Obviously, no one wants to get shingles, which is the varicella vaccine (chickenpox) that can reactivate as your immune system decreases with stress both physiologic and age related (as our immune system weakens as we age). One in three people in United States will get shingles. While both are caused by the same virus, shingles and chickenpox are not the same illness. They present differently because, while chickenpox is the initial infection, if and when the virus reactivates, it travels along nerve pathways to the skin producing shingles. Pain is typically the first symptom. Other symptoms include sensitivity to touch, itching and red rash and blisters. Individuals may also experience fever, headache, sensitivity and fatigue. Symptoms typically target 1 or 2 areas of the skin and is usually on one side of the body. Many individuals will say they will deal with the infection but what must be understood is that the pain from shingles can last a lifetime because it can chronically damage the nerve it is affecting.
The U.S. vaccination rates remain low with about 35% of adults over 60 getting the shingles vaccination. In the United States and the United Kingdom, the shingles vaccine is called Shingrix. It is more than 90% effective at preventing shingles in adults 50 years and older with healthy immune systems. If, despite being vaccinated, you were to contract shingles it could decrease the risk of postherpetic neuralgia (pain from shingles) by up to 90% as well. Study show range and how long Shingrix is affected anywhere from 4 years to 11 years. It is my belief that this will need to be boosted after 10 years to maintain the efficacy.
The most important potential side effect and side effect is not the appropriate term, but positive benefit was brought about in a 2025 paper in Nature, out of Wales which may have produced the strongest evidence that a vaccine can reduce the risk of dementia. This study was led by Stanford medicine researchers analyzing the health records of Welsh older adults discovered that those who received the shingles vaccine were 20% less likely to develop dementia over the next 7 years and knows who did not receive the vaccine.
The findings that were published April 2 in Nature supported emergent area that viruses that affect the nervous system can increase the risk of dementia. In a follow-up study published in December 2 of that same year in Cell, the research is found that the vaccine may also benefit those already diagnosed with dementia by slowing the progress of disease that found a 51% reduction in risk of dementia among Shingrix vaccination individuals, even after taking into account differences like socioeconomic status and other lifestyle factors. There is a growing body of research which suggest that virus is a persistent our bodies, such as varicella zoster, are implicated in development of dementia. These viruses are constantly trying to reactivate. The hypothesis is that this is a kind of chronic stressor to the immune system that may drive immune aging or inflammatory pathways which are key processes and chronic diseases including dementia. A second potential explanation is that the immune system against vaccination may go beyond their intended purpose and help against other diseases.
Does the vaccine cause side effects? According to the CDC, no serious side effects are associated with Shingrix but there can be some side effects which deter some patients which include pain and swelling at the injection site, fever, flulike symptoms and muscle aches which may last for a few days. The side effects typically emerge after the first dose and can also occur after the second dose as well. Surprisingly, the side effects are typically worse in younger patients as opposed to older patients.
I would highly recommend that everyone receive the shingles vaccine. I still would recommend after age 60 although further studies may reveal earlier vaccination could result in decreased risk of dementia otherwise getting the vaccine earlier than 60 does not show significant benefits at prevention. As a physician, I always say shingles is a cool thing to see as the rash is quite unique, but a horrible thing to have based on the severity of pain. On that note. If ever you think you have a spider bite, it is shingles until proven otherwise so always let us know sooner rather than later because treatment only works if we catch it within the first 72 hours. “There is no vaccine against stupidity.”–Albert Einstein. Stay healthy my friends.
Doug
