Figuring Out Your Risk of Shingles — and How to Protect Yourself

If you have rheumatoid arthritis, lupus or another disorder characterized as an autoimmune disease, you’re at higher risk for developing shingles (herpes zoster), according to a new study. Some chronic conditions also make you vulnerable, including chronic obstructive pulmonary disease (COPD, a respiratory problem), asthma and type 1 diabetes.

The herpes zoster vaccine is recommended for people 60 and older. Almost everyone should get it, and certainly if you suffer from one of the disorders noted in the study, discuss it with your doctor.

The vaccine is expensive – in some places more than $200 – but anyone enrolled in a health plan that adheres to the provisions of the Affordable Care Act (“Obamacare”) is entitled to receive certain vaccines without any cost-sharing requirements if they’re delivered by an in-network provider. The list includes the shingles vaccine. The others, for adults, are:

  • Hepatitis A
  • Hepatitis B
  • Human Papillomavirus (HPV) for females
  • Influenza
  • Measles, Mumps, Rubella
  • Meningococcal (meningitis)
  • Pneumococcal (pneumonia)
  • Tetanus, Diphtheria, Pertussis
  • Varicella (chicken pox, a form of herpes zoster)

Age is the most important risk factor for shingles. In addition to COPD and type 1 diabetes, other chronic diseases that showed the higher shingles risk were inflammatory bowel disease, asthma, chronic kidney disease (CKD) and depression.

An autoimmune disorder occurs when the immune system mistakenly attacks and destroys healthy body tissue, and more than 80 different types of them have been identified. Their cause is unknown.

A normal immune system’s white blood cells help protect you from harmful substances, or antigens, such as bacteria, viruses, toxins, cancer cells and blood or tissues from another person or species. The antibodies produced by a healthy immune system destroy them.

But those systems in patients with an autoimmune disorder don’t distinguish between healthy body tissue and antigens, so their response is to destroy normal body tissues, similar to the body’s response to allergy. With allergies, the immune system is reacting to an outside substance it normally would ignore. With autoimmune responses, the system reacts to normal body tissues it normally would ignore.

As reported on, the authors of the study, which was published in BMJ (British Medical Journal), say it’s uncertain whether younger patients who might be at risk because of underlying disease also should receive the shingles vaccine, even though earlier studies suggested they have a greater incidence of the disease.

According to the study, about 6 in 10 cases of shingles were women whose median age at diagnosis was 62. Most cases – 6.5 in 10 – were in patients younger than 70; 4.5 in 10 were younger than 60.

The greatest risks were among patients with severe immunosuppression – people with HIV, lymphoma (cancer of the lymph nodes) and stem-cell transplants, but the vaccine is contraindicated in these groups. Among all cases of shingles, 28 in 100 had at least one of the conditions considered risk factors.

The study showed that the higher risk was notable even in younger patients, raising the question of whether vaccination for some of them is advisable, especially considering the risk of postherpetic neuralgia. That’s pain that sometimes endures long after the rash and blisters characteristic of shingles have disappeared.

To learn more about vaccination schedules for adults, read our blog “Adult Vaccinations: Overlooked and Underappreciated.”

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