Jan Willem Elte, The Netherlands
Vaccination
Shingles (Herpes Zoster) is a disease characterized by a painful, blistering rash caused by the reactivation of the virus that causes chickenpox. The symptoms usually are limited to a limited skin area at one side of the body. After having had chickenpox the virus can lie dormant in the nerves and become active again if the immune system weakens due to aging or to an illness.
For several years years the recommendation by the EMA (European Medicines Agency) and the CDC (Centers for Disease Control and Prevention, USA) is to give two doses of recombinant zoster vaccine RZV, named Shingrix) to prevent shingles and related complications.
This recommendation is for for all aged ≥ 50 years and for immunodeficient or immunosuppressed persons ≥ 18 years. People who have already experienced an episode of shingles are also recommended to receive the two vaccinations of Shingrix with an interval of 2 – 6 months.
Vaccination is aimed to prevent the most prominent problem of shingles : the post-herpetic neuralgia, which is a long-lasting nerve pain following shingles, which can be devastating and sufficent for suicide sometimes to be contemplated.
The benefits of the vaccination are therefore potentially great and may last for 6 – 10 years. The side-effects are mostly local and benign (pain or redness and swelling), with occaisional flu-like symptoms as well, though usually for only 2 – 3 days.
The vaccine is, however, not always administered to the recommended groups of patients, mainly because of its high costs. This policy varies per country, despite the clear recommendations from experts.
Dementia risk
Recent research from Wales and from the University of Oxford have suggested that shingles vaccination results in a lower risk for dementia. A study from Australia showed similar results. All studies showed that the protective effect for dementia was more pronounced in women than in men. The studies had several limitations, but the conclusions seemed to be solid.
TAKE HOME MESSAGE: if you are over 50 or with any cause of immunodeficiency, it would be a good idea to ask your doctor about suitability for shingles vaccination.
Literature:
- Anderson TC et al. Use of recombinant zoster vaccine in immunocompromised adults aged ≥ 19 years: recommendations of the advisory committee on immunization practices – United States, 2022. Morbidity and Mortality Weekly Report. 2022; 71: 80-84.
- www.cdc.gov/shingles.hcp/vaccine-cosiderations/index.html. October 22, 2024.Shingles vaccine recommendations.
- www.ema.europa.eu/en/medicines/human/EPAR/shingrix.
- Twillert M van, Gordelroos en de hernieuwde roep om landelijke vaccinatie. Medisch Contact 20, 15 mei 2025.
- www.rivm.nl/gordelroos/gordelroosvaccinatie
- Brooks M New level of evidence links shingles vaccine to lower dementia risk. Medscape medical news, May 2025.
- Eyting M et al. A natural experiment on the effect of herpes zoster vaccination on dementia. Nature 2025; 641: 438–446
- Pomirchy M et al. Herpes zoster vaccination and dementia. Doi.10.1001/jama.2025.5013.
- Taquet M et al. The recombinant shingles vaccine is associated with lower risk of dementia. Nature Medicine 2024; 30: 2777-2781.