 Adult Vaccination Adult vaccination can be thought of as a cornerstone of successful aging. But a major issue hampering the uptake of shingles vaccination is the lack of awareness of the disease. Shingles is caused by a reactivation of the chicken box virus later in life. After your body beats back chicken box, the virus hides in waiting in your spinal cord, waiting for an opportunity to strike back. When it does, the virus can surge forth, traveling along the path of a nerve, branching out the spinal cord, and wrapping around one side of the body to the front, producing skin blisters along the way in a characteristic belt-like pattern that does not cross the midline in the front. Both shingles and the name of the virus Zoster are from the Latin and Greek respectively for belt. The blistering rash can be intensely painful, leave scarring or discoloration behind, but usually disappears in a few weeks on its own. However, approximately 30 to 50% of people suffer post-herpetic neuralgia, persistent pain that can last for a year or more that sometimes can be debilitating. Usually it affects nerves around your trunk, but in 10 to 25% of cases it can erupt across your face, which can lead to permanent facial muscle weakness, hearing loss, or blindness. As if that's all not bad enough, having shingles as much as quintuples your odds of having a stroke over the subsequent few weeks, a risk that gradually declines over the following 6 to 12 months. It's surprising more people don't know about it, since the lifetime risk of shingles is 30%, meaning nearly 1 in 3 will get it sometime in their lives. Young adults only have about a 1 in 1,000 chance of getting it every year, whereas in older adults that climb to closer to 1 in 100 each year. That comes out to a million cases of shingles every year in the United States. Thankfully, there is a shingles vaccine. The first became available in 2006, using a live weakened strain of the virus. The efficacy was only about 50% and couldn't be used in immunocompromised individuals, such as those with HIV or on immunosuppressive drugs, such as many on chemotherapy. Thankfully in 2017, a recombinant shingles vaccine was approved with a 90 to 97% efficacy for preventing an outbreak. It requires two separate injections, two to six months apart, and is expensive like 280 bucks, but covered by Medicare and most private insurance plans. It also can cause transient systemic symptoms, such as muscle aches, fatigue, headaches or fever and chills, serious enough to interfere with everyday activities about 10% of the time, but the new vaccine is considered so much more effective that it's recommended for everyone starting at age 50, even if you were previously immunized with the old one. Given that the new vaccine is only about five years old, longer term safety and efficacy data is still coming in, but so far so good, as soon as I turned 50, I lined up for mine.