The effect of shingles vaccination at different stages of dementia | Hacker News Reader

The effect of shingles vaccination at different stages of dementia

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202 pointsArchelaos173 comments

I wonder when we'll finally accept that there's no such thing as a harmless latent disease. Chickenpox, EBV, HPV, they're all associated with either neurodegeneration or cancer.

We should be vaccinating kids against all of them rather than sending them to Chickenpox parties.

I looked into a chickenpox vaccine a while back, but it turns out the current varicella vaccine uses a live virus. So if you're fortunate enough not to have been exposed to chickenpox, taking the vaccine could put it into your body. The Shingles vaccine, on the other hand, has no live virus at all. But you can't get that til 50.

ETA: Since someone downvoted this: I'm not criticizing vaccination, and you should absolutely get your kids vaccinated! But for someone (like me) at the age where you've seen friends with Shingles (ugh), adding live chickenpox virus to your body feels like a risky idea, even before this news.

Its an attenuated vaccine, which means it was grown to be weaker then the wildtype by growing it in non-human cells making it more specific to what it was grown in. I have never had chickenpox because i had the vaccine. If had chickenpox as a child you were extremely unlucky because its completely unnecessary.

It depends how old / where, the US didn't start vaccinating widely until around 30 years ago.

We didn't have this new-fangled chickenpox vaccine during my Gen-X childhood.

Or a lot of millenials. My parents were annoyed we had to go through it while Japan had been vaccinating since the 80s.

> But you can't get [the shingles vaccine] til 50

This is inaccurate. I know several people who got it younger than that after contracting shingles and recovering.

More specifically, it's highly doctor-dependent. The FDA hasn't approved shingrix for people under 50; some doctors are willing to prescribe it without FDA approval, others are not. I personally had shingles in my early thirties and have thus far been unable to have my doctor prescribe shingrix.

Also, I would like to point out that having shingles was possibly the single most physically unpleasant experience of my life and boy it sure would have been fantastic to have been able to get the shingles vaccine before I got shingles, as opposed to sometime after! because wow, having shingles sucks.

This also means you may have to pay for it out of pocket, rather than having it covered by insurance.

> some doctors are willing to prescribe it without FDA approval

But the pharmacies are still reluctant to administer it. My doctor prescribed it for me but when I got to the pharmacy they made me fill out some forms... because I checked the box that said I had no serious health issues and I was under 50, the pharmacist absolutely refused to administer it even with a prescription.

We will start finding out whether people who got the varicella vaccine instead of chicken pox get shingles at a similar rate soon — the older members of this population are approaching shingles age.

Here’s a study that looks good:

https://academic.oup.com/jid/article/226/Supplement_4/S470/6...

The headline conclusion is:

> Latent VZV can be wild-type VZV (wt-VZV) from natural infection, vaccine-strain VZV (vs-VZV) from immunization with live attenuated vaccine, or both. Based on available data in children and adolescents, the risk of HZ from vs-VZV appears to be approximately 80% lower than the risk from wt-VZV, with a lower incidence found in 2-dose as compared to 1-dose vaccine recipients [9, 10].

A major caveat is that the relevant age groups were very much too young for shingles vaccines at the time the study was published.

The age gating of needing to be 50 years old to get the shingles vaccine is really obnoxious. I had shingles outbreaks twice in my life, one in my early 30's and once at 48. Obviously, both before 50 years old.

I had to argue with my doctor to prescribe the Shingles vaccine at 49. And when I had it in my 30s, nobody even bothered to give me any antivirals, which did exist at the time, or nerve pain relief.

After I had the shingles vaccine, nerve pain that I'd been suffering with every time I got the slightest little allergy or cold suddenly disappeared, and I haven't had it since more than a year later.

If you are under 50 years old, and had chickenpox, and especially if you've had one outbreak of shingles, force your doctors to prescribe the vaccine. It costs $100-$200 without insurance coverage, and it is worth it.

I'm 48, in the US, and had chicken pox as a child.

After my 43 y/o sister-in-law had a debilitating shingles outbreak last year I asked my PCP about the vaccine. He stated that he was wary to prescribe it to be. His reasoning was something like:

There was a previous shingles vaccine that didn't work very well. It was found that it didn't offer long-term protection and the protection could not be improved with a booster. The current vaccine is still new and the long-term protection and ability to be extended by a booster are unknown. Since most of the worst outcomes of shingles correlate to old age it makes sense to defer the vaccination hedging against the failure of the vaccine to provide long-term protection and to allow more time to elapse to learn more about how the vaccine works long-term.

Edit: My PCP's general advice was to defer the vaccination as long as possible. He felt that 60 was reasonable.

I haven't looked into the veracity of any of his reasoning, but I am willing defer to his expertise and bide my time. My sister-in-law had a really bad experience, and I remember my grandfather having a terrible experience when I was a child. I'm definitely fearful and would like to prevent it.

That's your reasoned choice. I wasn't given that opportunity to make that choice. Most people aren't given that choice. That's my complaint.

Especially when the delta is less than one year. That's just quibbling.

I didn't mean to imply my choice was good or bad and to make any value judgement about your circumstances. I'm sorry if it seemed that way.

The age restriction seems obnoxious to me, too. I'd love to gather criticisms of this reasoning with citations that I can take to my PCP. It gives me the willies rolling the dice with this. I would much rather get the vaccination now but I also see his point. (I'm entirely too much the layman to go out looking for studies about the long-term protection of this current vaccine.)

re: the delta - He was advising me to defer the vaccination as long as possible. I'll edit my note to reflect that. Quibbling about a year is silly. He advised waiting until at least 60.

> If you are under 50 years old, and had chickenpox

I'm 2 out of 3, any info on that scenario?

I ended up getting shingles when I was 17. Terrible and rare I heard but for the most part I've never had any major outbreaks since then.

I wasn't aware the shingles vaccine starves off nerve pain. I've noticed more nerve pain with pins and needles and neuropathy now that I'm 41 which I assume is what you are talking about. I used to think I was getting pre-diabetic before this as I wasn't aware of nerve flare ups being a thing given how young I was when I found out.

Has there not been any studies around this with those with shingles taking the vaccine and freeing them from their symptoms? First time I've heard this.

I don't understand this kind of reasoning. You don't think that the 100s of PhDs that worked on this would have accounted for the riskiness of adding a live chickenpox virus vs not adding it? People need to start trusting experts more and do less of "common sense" over-thinking imo.

I feel a lot of people think the "experts" are conniving in their offices rubbing their hands together thinking up ways to be diabolical.

To be fair to a lot of people, the "experts" have a long list of goddamn stupid and horrific things in the past to make blind faith in them questionable at best. Most recently, COVID highlighted the elite panic where they thought that lying to people about mask's effectiveness was a good idea to try to conserve them for medical workers for earlier shortages, along with making everyone waste time with obsessive cleaning against a threat they already knew didn't exist. They decided to try to be strategic and all they did was prove that they were willing to lie and thought that they knew better than you. Despite medical ethics including what can be best summed up as "don't lie to your patients, you don't know better than them for what is best for them".

Reputation is hard to build and easy to break, and well every decade there are enough events to break it even before dealing with propagandists and lumping all experts into the same basket. The experts said there were WMDs in Iraq too. Increased transparency combined with a less than stellar history means that institutions have fully earned their cynical reception. Horrifyingly is the damage that such misconduct has wrought, as even when they are actually 100% right this time people have reasons to doubt them.

I'm in my late 40s, don't remember ever having chickenpox as a child, and I have a choice between getting the chickenpox vaccine now, or waiting til I'm eligible for Shingrix. Having seen friends get Shingles before turning 50 (and boy was it bad), plus watching some of their close family members get chickenpox from contact with them, I kind of want to avoid that stuff. But there's not a ton of expert guidance on whether the right move is to gamble on 50/Shingrix or to get vaccinated now! And when you toss in these dementia concerns, I'm even more confused. I think this would be a different calculation if I was younger, but I honestly don't know what the right move is for someone in my cohort. I decided to wait.

ETA: Someone in comments above points out that the data is still coming in on this question. It looks like the best move is not to ever be exposed to varicella (maybe me?), and the second best move is to be vaccinated with chickenpox, and possibly the ultimate best move is to get Shingrix, but there's a lot of missing data and some timing problems here.

Most of the herpesvirus family have associations with neurodegenerative disorders, also including HSV.

A lack of oral hygiene and gum disease is associated with nerodegeneration.

Lots of metabolic diseases have associations with nerodegenerative disorders. Insulin, kidney, liver dysfunction.

The gut microbiome...

Putting immune or metabolic stress on the brain can cause it to go into this disease state death spiral.

> A lack of oral hygiene and gum disease is associated with nerodegeneration.

It's important to remember that association/correlation is not causality. People who brush their teeth reliably are probably more likely to exercise and do other healthy behaviors, too (avoid smoking, ...).

It's also very possible to practice great oral hygiene and have bad gum disease. Gum disease seems to be carried by a potentially strong genetic risk factor.

Oral flora is also mutable and impacted by environment and life.

Kiss the wrong person (totally by chance) and you'll start getting cavities left and right.

As nice as this statistical thinking alone is, it can also slow things down.

There's a reason why this finding is valuable. It suggests a mechanistic hypothesis that bacteria are entering the bloodstream, heart, and passing the blood-brain barrier.

This is a very valuable line of investigation that can lead to a smoking gun for one class of casual mechanisms and potentially to preventative care or treatment.

If we blindly follow just the statistics, we'd never get any real science done.

Correlation does not imply causation. But when it gives you something to investigate, don't sit on it.

That's been studied and the evidence suggests that there is some causation. Bacteria that cause your gum disease can get into the bloodstream and reach the brain, where they release enzymes that cause inflammation and can damage cells.

In particular this can seriously impair microglial cells which is something you really don't want to have happen if you value maintaining a well functioning brain.

There's a hypothesized mechanism, but again, no actual demonstration of causality. No one is RCTing brushing teeth, for obvious reasons.

Proposed mechanisms are better than statistical handwaving.

This gives researchers (the lab kind) something to investigate.

I respect this kind of science a lot more than statistical paper pushing.

> We should be vaccinating kids against all of them rather than sending them to Chickenpox parties.

We do in the US. I was kind of surprised when my now 2 and 4 year olds were vaccinated against Chickenpox, since I remember doing the Chickenpox party thing myself when I was younger (staying home with some friends over, playing Daytona USA on my Sega Saturn, I think?).

> We do in the US

For now. The current administration is chipping away at child vaccines, just today removing Hep B vaccine from the recommendations list. AFAICT you can still choose to get it for your kid, and insurance should still cover it, but I won't be the least bit surprised if before 2028 some of these vaccines are actually banned outright.

This administration does appear to be flaming out a bit at least. Seems like there's a chance the Dems take the House before the 2026 midterms. I think there's a chance Trump's term ends early.

I've speculated for a while that what he does is so over the top and frequently self-destructive that I wonder if he's actually trying to get kicked out.

But while I agree that there's a chance, I think it's vanishingly small. I do hope that the dems can take the house in the midterms and put the brakes on the massive expansion in executive power.

The cynic in me things the Dems take the legislative branch next year, curtail executive power but are unable to undo anything and then win a massively nerfed executive position in 2028.

I'm with you. I also think it would not take long before we all found out that the Supreme Court only embraces limitless executive power when the office is held by their party. We've already seen evidence of that, Trump has succeeded using arguments that Biden failed with just a couple years ago. Right about the time 2028 rolls around, the Supreme Court will suddenly decide that they've gone too far and need to reel in an out-of-control executive branch.

Just wait for repeal of two-term limits approved by SCOTUS so there'll be no need to test the other party theory

This is an extremely optimistic view. I don't think the Dems can take the legislative branch (certainly not the Senate).

The Dems still seem relentlessly unserious about trying to win enough votes to govern, sadly.

I think the recent Tennessee election shows that even though things have soured, they haven't soured enough for sweeping changes in elections. Special elections are strange litmus tests to be basing anything on. Regardless of what polls may lead you to believe, there are still plenty of people that will not vote for the other party regardless of how "bad" their party's candidate is.

To regain control of both houses with enough margins to ensure impeachment & conviction would be an incredible swing. I just don't see it happening.

Texas just got its redrawn maps approved by SCOTUS. I'm still expecting SCOTUS to reject California's though when that case comes to them. The court will do its part in keeping the GOP in power.

TN shows that the Dems can't get their shit together and run an appropriate candidate in a Trump +22 seat. Instead they primaried their other candidates in a 28/25/24/23 split and chose a DSA candidate to lose the general. This is why I'm not optimistic about Dems winning the legislature, especially the Senate.

Don't forget the one or two cool circular chickenpox scars that you might still have today.

It was like a badge of honor.

We vaccinate for many of those already. The vast majority of seniors have the shingles virus already. Only a small percentage would likely have dementia not linked to another likely cause. Just as HPV only causes cancer in some individuals.

It wouldn't surprise me if it turns out all these tie back to immune dysregulation and are just triggered by different viruses in different people.

For Multiple Sclerosis multiple studies have shown it is strongly correlated with an EBV infection and only an EBV infection. After the infection it just becomes a genetic lottery with a really shitty prize.

> We should be vaccinating kids against all of them rather than sending them to Chickenpox parties.

This has been the standard of care ever since the vaccine became available in the 90s (US). The origin of the "parties" was that first-time chickenpox was perceived to be less harmful in children than adults prior to the vaccine, so you wanted to make sure people's first exposure wasn't in adulthood.

Is getting chickenpox the first as an adult more dangerous than as a kid not true or unproven?

It's true -- you'll have a worse time on average and a higher chance of severe side effects.

If you had an overwhelming chance of getting chicken pox, getting it in early school age reasonably seemed to be the best option.

Much worse. A friend died at around 35. I didn't see him at the end but he was apparently covered in pox.

Unfortunately that is not the case for me in the Netherlands. No Chickenpox vaccination is offered and making sure kids get it early is still considered the right way to do immunization.

The idea being that it's better for people to get it as kids, because if you give them vaccines as kids you'll have to give them boosters as adults. Whereas a latent disease will provide a lifetime of immunity.

It's not offered but you can still get it. I had to literally ask my huisarts (GP) to google it after he said there is no such thing. Luckily, he did and local hospital pharmacy had it in stock.

> The idea being that it's better for people to get it as kids, because if you give them vaccines as kids you'll have to give them boosters as adults. Whereas a latent disease will provide a lifetime of immunity.

Adults vaccinated against chickenpox do not need boosters as adults.

... immunity from chickenpox, but shingles can erupt. Also, how 'latent' is the virus, really?

The virus lies dormant in spinal and cranial ganglia for decades. If it reactivates, the immune system suppresses it, in the meantime. Past age 50-60, immunity wanes and these reactivations cannot be suppressed which allows the virus to travel back to the corresponding skin region as the spine segment to cause shingles. Presumably, after this the virus can also cross the blood brain barrier to cause neurodegeneration.

I don't have any unique insight on it, but I think herpesviruses are probably worse than we realise.

They hide from the immune system inside nerves or other immune cells, and seem to have a lot of weird associations with other issues over our lifetime, particularly neurological and immune problems.

I grew up in India (70,80,90) before coming to the US in 2000. I’m not a vaccine sceptic. But this sort of thing makes me cringe.

I’ve had chicken pox, mumps and measles growing up. Everyone I grew up with had those. No one is experiencing dementia or any sort of neurodegeneration. There was a chicken pox epidemic in my engineering university dorm. I didn’t catch it since I had it earlier as a kid. Either way none of the people who had it are having issues.

I think take the vax to prevent the disease. The neurodegenerative side effects are just advertisement for the vaccine.

> No one is experiencing dementia or any sort of neurodegeneration.

Measles specifically cause lifelong disabilities, so yes, people do actually suffer those.

If you were born in 1970, you (and presumably the people you grew up with) are ~55. The sample set in this particular study are 71-88 years old (plus 7 years after), so 16+ years older than you (years that also coincide with increased prevalence of noticeable dementia and neurodegeneration).

Consider yourself lucky. My mom had measles as a kid (1940s) and for several years had a high rate of ear infections, etc.

Are you seriously still in contact with everyone you grew up with? And everyone you went to undergraduate with?

Yes - at least 25-30 people. Some more back in India but I hardly go back much these days.

I mean chicken pox was pretty rampant. Everyone I knew got it - I mean everyone at some point before becoming an adult. It was just a rite of passage.

‘I haven’t witnessed second order effects therefore they don’t exist’ is a myopic position to take. The advertisement argument is so cynical and depressing I find it hard to even think about rebutting. It probably doesn’t make sense to try, because it’s an axiomatic world view, these are kinda hard to argue with.

That’s not what I’m saying. I’m saying for people my age and my parents and grandparents - they all had these diseases. I don’t think you can even make a comparison for chicken pox - literally everyone used to get that one. Same for measles and mumps.

Keep in mind I’m not saying don’t take the vaccine. I’m just saying I don’t believe that these second order effects are as prevalent as they’re made out to be

> I’ve had chicken pox, mumps and measles growing up. Everyone I grew up with had those. No one is experiencing dementia or any sort of neurodegeneration.

Are you asserting dementia and neurodegeneration don't exist in India, or merely not in your set of close personal acquantances? Because if its the latter, that... hardly means anything. The expected prevalence even with a past history of diseases that increase the risk isn’t high enough that it not happening that you are aware of in your personal circle is... really noteworthy at all, unless your circle is large and/or you have detailed access to the private medical information of everyone in it.

I am part of the tail end of purposely exposing kids to chicken pox, I got them in 1989 and the vaccine was released a few years later. I wish the vaccine would’ve been available, I know multiple people that have experienced shingles in their eyes. Crossing my fingers until I make it to 50 and can get my shingles vaccine.

I was born in '85 and got chickenpox at 7. My parents aren't quiet antivaxxers but they also have a sort of "you don't need all vaccines" attitude (so no way I was getting the new chickenpox vaccine).

I've recently had shingles and, let me tell you, it sucks ass. I thought my liver was going to explode.

I'll be getting the shingles vaccine as soon as possible.

this is nice side benefit. but when you hit 50 you want the shingrex (two shots) vax ASAP. you def do NOT want shingles.

my dad (who has had the shingrex) sometimes still gets a mild case on his legs and when it does it is too painful to have anything touch his legs. no pants, not even a sheet.

my mom (who passed before shingrex) got a bad case in one eye and went blind in that eye.

so nice that kids have been getting the chickenpox vaccine for a while now and shouldn't have to deal much with shingles as the age.

I already got it, apparently there's a weird uptick in men to the point where some doctors are like, nah you don't have that, and then sure enough they realize you do upon further inspection. For context I know men who have gotten it in their mid to late 20s I got it in my early 30s. I'm not sure what the cause is, but for additional context, Shingles is way more common in women.

So there might need to be more studies into shingles and why men are getting it more frequently and younger.

I've heard a theory that since the chickenpox vaccine for kids, natural exposure to the virus in the wild is way down, and our immune systems are more likely to forget about it. Not specific to men of course, but a possible explanation for an increase in shingles generally.

There's been a few studies that found increase in shingles as the chicken pox vaccine became more widespread in the US, actually. With the usual caveat that correlation is not causation.

How was the study done?

If the vaccine became available in the 90s, and it was given to kids mostly, those people are 40 at most now, so how is the increase in shingles measured? More cases when younger? More older people getting it?

Thinking about it within this context doesn't make much sense.

The increase in shingles is in people who weren't vaccinated as kids. People who were vaccinated as kids and never got infected don't get shingles at all AFAIK.

Ok.

So this is why earlier in the thread they said, less wild chicken pox, more shingles, because immune system goes stupid as there is no wild chicken pox?

I had chicken pox as a kid, the vaccine became available in my country in 98, several years after, so it seems I'm screwed for shingles.

Hello! Another datapoint here, both I and a friend of mine got shingles in our early 30s. I had to go to two different doctors because the first just assumed that it was "bad acne" (my shingles followed the trigeminal nerve across my face). Second doctor immediately clocked it as shingles. It was perhaps the second most painful experience of my life, not so much because it was intensely painful but because the pain was constant and resistant to relief.

I'm told that stress can cause shingles to flare up, in that stress also suppresses the immune system, and both my friend and I were going through one of the most stressful phases of our lives at the time, so I always chalked it up to that. Not a very strong hypothesis, though.

I had shingles across my back in 7th grade. I remember at the time being told since I didn’t have chickenpox as a kid that led to my shingles. I was also told that once you have shingles you are immune. I have since learned both are not true. I also will get pain in the same location that my shingles started when under great stress.

I got the shingles vaccine last year.

I thought I was the youngest but I was 16. You win.

How old are you now? Did th vaccine help your symptoms?

57 now. I have had such an abrupt life style change that I no longer experience stress like I did. I don’t know if the vaccine helped it’a been less then a year.

I never had the chickenpox as a kid, either. The doc shrugged and noted that I obviously had the virus in my system, so I must have had a sub-clinical case. I recall that when we were young, my sister had a very mild case of chickenpox, so I assume that I got some exposure from her even though at the time assumed I managed to avoid it.

I got it last year, as a man in my early 30s. My doctor didn't believe me but his eyes widened as I showed him the rash. It took him one second to say that is shingles, with no doubt. If you get it you have to get to the doctor ASAP to get the antiviral medicine before it spreads. It is the most painful thing I have gone through.

I'm pretty sure I got is because of stress. I quit my job, sold my home and all my stuff to travel for a year. I was awarded shingles the week after handing in my resignation.

I’ve self medicated with OTC acyclovir before getting a stronger prescription and it worked quite well. The trick was to diagnose quickly, the tell was the itching wouldn’t stop even while scratching.

Pro tip: keep some cold sore oral medicine at hand.

Add another datapoint here if you'd like, got it in my late 20s this year. Fortunately I caught it very early and didn't have as bad of a case as many here seem to have had. My doctor said it's not uncommon to have shingles as a young person, and when I researched it more I found studies that agree with some sibling comments re: lack of exposure to people with chicken pox making it more common.

For me it was a rash on my hands, and I thought it was my dogs leash. It was not until I got the uh blisters that my wife told me what I probably had, and it was too late by then unfortunately. The nerve pain is not worth it. I would have gotten the shot immediately had I known early enough. To make matters worse, I think I went to a family event, and the AC where we were staying had just died, so my itchiness was through the roof in South Florida. Nothing was as awful as the random nerve pain though, I cannot imagine being 50+ and getting the nerve pain.

Shingles is what sent Sen Feinstein on the downward spiral.

I got it on my scalp at 17. That so sucked. My GF got it on her face at 55. And doctors were really concerned it would spread to her eyes or ears.

Another data point. I caught it in my 60s.

I didn't know there's a vaccine. Nobody in healthcare here in Finland has mentioned it, so maybe it's not on offer.

Neighbouring country here, it’s a private vaccination but the companies are pretty forwards about it being available. But you do unfortunately have to wait until you’re 50.

Well sounds like I'm the youngest around here. I got it when I was 16/17. Honestly I kind of forgot about it for awhile but have weird nerve pain sometimes when I'm stressed now that I'm 41 so I assume it still lingers in me.

Looking to find out more about the vaccine and it's impacts on existing shingle victims.

I know one of my wife's childhood friends she got it at like 17 too. What was really interesting is her parents never had chickenpox, and they never caught it from them or something like that? Her brother also never caught it. There's some weird immunity to it I suppose or maybe it doesn't affect everyone the same.

Having had the pleasure of having it once already, in my 30s, it drives me nuts that I have to wait to vaccinate against it. Maybe the sickest I've ever been.

If it offers consolation, I share your story and just developed it a second time recently (about 7 years after the first, brought on by overtraining again).

Being familiar with the prodrome and early symptoms, I was able to get treatment way sooner than I did the first time. Between that and perhaps having a more primed immune system, this second encounter was far shorter and less intense.

Still not fun, and I'm hoping it'll earn me early access to the vaccine, but I'm more optimistic about it being muted if that doesn't happen and it comes back a third time.

This was definitely a huge factor for me. Since it was on the skin I waited for a dermatologist when I should have gone to any doctor immediately, I'm sure it would have been fairly clear since I eventually was able to suss out that it was shingles on my own before I got to the dermatologist.

Shingles sucked lol, definitely not a great time.

Get your GP to prescribe it! You can get it under 50, just need a prescription.

(I had shingles in my 20s; it sucks; I got shingrix in my 30s by Rx.)

I have a few friends in the US that haven't been able to pull this off

Absolutely true. And note that there apparently are antivirals available to help mitigate it and should be obtained promptly upon the outbreak.

I didn't know this and now after having shingles I have postherpetic neuralgia and am cursed with chronic pain for the rest of my life. It's not bad enough to check out, but it certainly isn't fun.

Can you say you’re immunocompromised to get it younger?

You can get your GP to prescribe it. The 50 cutoff is just the age you can get it without a prescription.

i thought the vaccine in the study isn't shingrex.

Agree shingles isn't nice. I had it a couple of years ago aged 59. It can be brought on by covid weakening the immune system.

Get it before 50. Ask your GP to prescribe; they can and will. The 50 cutoff is stupid.

> shingrex (two shots)

Huh. Well that's good to know. I got the shot in April, but unless I am already getting very forgetful, my doctor did not mention a second shot. And I haven't gotten any calls from them about it (they are normally proactive about the routine things, so this is a little bit of a surprise).

So if it's always a two-shot regimen, I need the second one ASAP. It's almost 8 months now since I got the first one. Thanks to you I just sent my doc a note to find out.

My PCP told me to hold off until late 50s on the argument that there's no indication for boosters, and if I were to live a long, full life that the protection would be waning as I enter my more vulnerable years.

I understand the argument and it makes sense on paper, but this doesn't seem to be a general sentiment.

My PCP made the same argument (which I wrote much less clearly than you did in another comment). My sister-in-law had it last year (at 43) and she was miserable. Rolling the dice on this scares the willies out of me.

I looked this up recently because I was vaccinated for it a couple years ago. What I found was that you're recommended to get a booster after 7 years (my doctor said around 10 years when I got the shot).

This is counter-intuitive for me. Immune system senescence is a thing. Naively I would assume it should be better to get it early, as a younger immune system has better odds to react strongly to the antigen, providing long lasting protection. Often the elderly organism doesn't react, or the reaction is too weak, to vaccine stimulation. E.g. see https://www.sciencedirect.com/science/article/abs/pii/S01652...

If I was worried about that at all I'd just get another shot in my 60s or 70s, whether it is "indicated" or not.

I got Shingles around age 30 which is pretty uncommon. I was really lucky, it presented as rash on my upper back, more on one side than the other. I did not know what it was and I had no pain or itching. One day I got a mild fever out of nowhere. The fever went away pretty quickly and it wasn't until a few days later when the blisters started popping that I felt horrible pain but that was only for the better part of half a day. The rash completely healed and I have no remaining issues from it that I'm aware of. I'm so fortunate I had a mild case and I would hate to get it when I am older. My doctor said it's unlikely to reoccur now before I get the vaccine at 50, thank goodness.

Too bad you can't get it until you're over 50 or immunocompromised.

Why not?

good question. but that is how it is in the US and MX.

I think you can if you self pay, but insurance only pays in certain circumstances.

I tried and they won't give me. Gonna ask my primary care to request it.

I’m more worried that by the time I’m 50 it will no longer be available…

It's not been formally evidenced as beneficial in younger, healthy people (there just haven't been studies) so receiving it is "off label".

It's possible to find someone who would write a prescription for it anyway, as with many off label prescriptions with low perceived risk of harm, but insurance is unlikely to cover it.

Many/most doctors won't do that, though, especially without at least some kind of specific reason (like having recurrent cases already).

"Low risk" unfortunately doesn't mean no risk. I wish to be vaccinated against all disease, but rationally I must acknowledge very low probability event of harm from vaccination. It's why they're recommended only for 50 and older.

As someone who got shingles in his 30s, it seems weird that a vaccine requires formal evidence to be beneficial to a younger population. Are there known side-effects that might outweigh the benefits? Shingles sucks at any age, making people wait to get the vaccine just because shingles is more common in the elderly seems odd.

I also had it in my 30's (and now again in my 40's) so I get it.

But there's a whole "evidence based medicine" thing that many of us usually try to champion, and it turns out the collecting such evidence is something expensive and priority-constrained. Due to lack of suitably targeted studies, there's just not formal evidence that the vaccine will be effective or lasting for us, or on what risks might apply to younger people with more robust immune systems.

There's also just a consideration about rationing the drug itself (it's seen shortages), and so prioritizing availability to more at-risk populations is not totally unreasonable.

All that said, it's not like it's impossible or illegal to get. You just need to find a prescriber who'll sign off for it (they exist), and you might need to pay cash rate for it at the pharmacy.

So, I understand this, and I absolutely support evidence-based medicine. I guess I'm at a loss as to why decades of giving this vaccine to folks 50+ is not sufficient to assess risk for people under that age, or never inspired more study into side effects. I also think that people who are 50+ are living long enough these days that we could probably make a good assessment as to how long the vaccine lasts (if we're not assessing that, I'd be kind of surprised and concerned as to why not).

Prioritizing drugs in the event of shortages is totally understandable, though pretty easily fixable if you give the manufacturers time to plan for general availability (hopefully they would see it as an opportunity to make money by broadening market share, not an opportunity to make money by restricting supply).

> As someone who got shingles in his 30s, it seems weird that a vaccine requires formal evidence to be beneficial to a younger population. Are there known side-effects...

We don't know the side effects or the beneficial effects since it hasn't been studied/approved for that (we likely have studied it, but not with enough rigor for FDA approval). It is, in all likelihood, fine, but when it comes to medication, we typically want a study rather than a guess.

It's just the usual FDA conservatism only for interventions (status quo bias).

Seems the price where I live is about 500 euros for two doses, not extremely expensive, though a few times more than e.g. Twinrix and some other common vaccines that aren't covered by regular insurance.

It's not clear from the information on local private clinic web pages whether they'll make a fuss or not but I kind of doubt it. It's not uncommon that people manage to pay themselves to prescriptions for methylphenidate and amphetamine, it would be weird if shingles vaccine was more gatekept than those.

It was less expensive to study in older populations because they get shingles at higher rates, so it was only studied in older populations. That's all.

Early on there were also arguments that supply was limited, so the age minimum was to restrict supply to those who could benefit the most (frail elderly). But that ship has long sailed.

I'm 42 in Canada and just got the first shot yesterday. Doctor prescribed it because I'm getting psoriasis and I guess that puts you at a higher risk of developing shingles. With the prescription, it was fully covered.

More specifically, a person presenting with psoriasis has already been at higher risk.

Presumably if you were vaccinated as a child against chickenpox (Herpes Zoster) and didn't get chickenpox then you already have the protection.

There are no dementia statistics versus vaccination for that demographic because vaccination started about 1995.

There is also a relevant XKCD: https://xkcd.com/1950/

If you are thinking that dementia is caused by shingles, then also consider that shingles is caused by chickenpox.

is this a regional/country thing? I'm 30 and I never got chickenpox vaxx, and I never heard of anyone getting such a thing growing up. but I also never heard of anyone getting chickenpox either when I was a kid. it just wasn't a thing? I only knew about it from american cartoons.

not an antivaxx community, people got MMR and HPV and tetanus vaxx. this was normalworld suburban britain. I didn't even know there was a chickenpox vaxx until now.

NHS has been refusing to vaccinate against chickenpox for many years. Finally changed its mind in the last year or two.

(Got both of my kids (5&7) vaccinated privately. Don't regret it at all.)

>NHS has been refusing to vaccinate against chickenpox for many years.

what the fuck. why?

god damn I hate rNHS national cult. better get myself vaxxed to undo this idiocy.

I believe the worry was twofold:

1) That people who couldn't be vaccinated would get the virus later in life (because it would be less common), when it's a much more serious illness.

2) That there was a protective effect against shingles from having people regularly encounter the disease by encountering children with chicken pox.

But it turns out that the latter isn't actually an issue.

wtfff

are there more vaccines they're hiding from us?

Apparently, while it is currently available to certain people in the UK, the chickenpox will only become generally available to children starting next year: https://www.gov.uk/government/news/free-chickenpox-vaccinati...

britain is a developing country

I think lots of kids in the USA got the MMRV vaccination when very young. MMRV stands for: • Measles • Mumps • Rubella • Varicella (Chickenpox). Apparently some places do the Varicella vaccine separately (VARIVAX?).

Over the last few years we have been discovering many diseases are secondary complications from viral infections, such as the linked study, or Multiple Sclerosis due to Epstein-Barr virus.

Perhaps that has rebalanced the cost/benefit analysis of some vaccines?

A childhood vaccine that prevents a percentage of dementia cases would be amazing!

I caught chickenpox as an young adult in the US. Recently paid NZ$700 to have shingles vaccination privately (NZ provides it free at 65; however I know many people that have had a hideous time dealing with shingles and I'd like to avoid that).

fly to a 2nd or 0th world country and pay a doctor to do it

from one of the previous papers:

"To provide causal as opposed to correlational evidence, we take advantage of the fact that, in Wales, eligibility for the zoster vaccine was determined on the basis of an individual’s exact date of birth. Those born before 2 September 1933 were ineligible and remained ineligible for life, whereas those born on or after 2 September 1933 were eligible for at least 1 year to receive the vaccine."

Eyting, M., Xie, M., Michalik, F. et al. A natural experiment on the effect of herpes zoster vaccination on dementia. Nature 641, 438–446 (2025). https://doi.org/10.1038/s41586-025-08800-x

Article specifically refers to vaccination with live attenuated virus... Should a difference be inferred between Shingrix and Zostavax (in the context of the effect on dementia, not shingles)

Background to the question is providers here seem to be switching to Shingrix for (claimed) higher effectiveness against shingles, but there's at least some suggestion that Shingix is not live (attenuated) virus...

From https://www.ox.ac.uk/news/2025-06-25-how-do-vaccines-reduce-...

> The shingles vaccine now in widespread use (Shingrix) has more of an effect than the previous one (Zostavax). A key difference between these vaccines is that Shingrix contains an ‘adjuvant’, an ingredient designed to enhance the vaccine’s effect. It is therefore possible that the adjuvant contributes to Shingrix’ greater effect than Zostavax on reducing dementia.

Definitely got shingrix once I hit 50. The first one hit me pretty hard..

Did a blood antibody test, for some reason, no rubella anti-bodies. Will get that + dTap (9 years old, need tetanus booster soon anyway) before they outlaw them..

Same... and the second one hit me just as hard. Glad I did it though.

Anyone skilled in the medical arts got a dumbed down synopsis of this?

(I just had my first shingles vaccine 2 weeks ago)

I'm not skilled, but it feels like a validation for the virus theory of dementia

https://med.stanford.edu/news/all-news/2025/03/shingles-vacc...

"The remarkable findings, published April 2 in Nature, support an emerging theory that viruses that affect the nervous system can increase the risk of dementia. If further confirmed, the new findings suggest that a preventive intervention for dementia is already close at hand."

A lot of things can cause dementia. IIRC, men who use Cialis have a lower risk of dementia, which indicates that better blood flow is beneficial as well.

Our skulls are hard for a reason. Brains are sensitive.

The original study had a sample size of 10. A follow-up study with n = 13,000 did not find a correlation.

https://www.alzheimers.gov/news/no-association-viagra-and-ci...

Isn’t it more accurate to say that people with pulmonary arterial hypertension had no dementia protection from viagra?

I don’t think that there are many things known to have as strong of an effect as HZ vaccines. The current evidence is that the vaccine eliminates like 20% of all cases, suggesting that HZ (aka chickenpox) is directly responsible for at least 20% of dementia cases, possibly much more.

Yes, many things can cause dementia. Repeated traumatic brain injuries can cause dementia.

But the leading form of dementia is Alzheimer's. Somewhere in the order of 40% of us are expected to get Alzheimer's before we die. The list of things that have been demonstrated to cause Alzheimer's is much, much shorter.

For the last 40 years, the leading theory about Alzheimer's is that it is caused by the beta-amyloid plaques that are found in the brain after death. This theory has produced exactly zero treatments that meaningfully affect clinical symptoms, despite many drug trial and literally billions in research per year. Seriously, between various sources, we've spent something like a quarter of what it cost to put man on the Moon. (It is hard to make a precise comparison, because a lot of that funding was private.)

This single study represents more progress on effective treatments of Alzheimer's than all of that work combined. The importance of the result should not be dismissed.

I didn't want to dismiss the results. Indeed, as you say, they are meaningfully better than everything that the amyloid theory was able to produce.

Oxygenation and infection-fighting.

Top defense.

Taking valacyclovir should help prevent or delay as well.

aye. is likely the reason Trump's hands are showing serious bruises and band-aids; regular treatments to keep him from losing it

I think the bruises are from pounding his desk in frustration.

And WTF is wrong with wearing a Band-Aid? You're criticizing someone for wearing a f**ing Band-Aid!?* Are you nuts?! [pounds desk] Whassamattayou? Can't you stick to the point instead of talking about f**ing Band-Aids?*

> But the first clinical trial to test that theory has found that a common antiviral for herpes simplex infections, valacyclovir, does not change the course of the disease for patients in the early stages of Alzheimer's.

https://www.cuimc.columbia.edu/news/antiviral-treatment-fail...

Yeah they looked at 120 people age 71 and above for that study. By that point its a little late.

Perhaps worth noting because I'm not sure how many people realize it:

Chickenpox is actually a neurological disease; that's how it re-emerges as shingles later in life. The virus infects nerve cells but (as far as we know) hides out in them without damaging them. Because nerves are critical to bodily function and don't regenerate nearly as efficiently as (for example) skin, liver, or other "sheet tissues" (tissue made of small cells is easier to regenerate; nerves can be as long as a meter and regeneration involves growing a new cell that entire distance), the body has a pile of immunosuppressant signals to prevent killing the nerve while trying to fight an infection. "Hey white blood cells: I know we hate chickenpox, but we hate not being able to swallow more, so maybe lay off the throat nerves, right?"

... but as a result, one doesn't generally purge the chickenpox infection after it occurs. Breakouts into other tissue are swiftly suppressed by our immune systems our whole lives (so swiftly that you don't get symptoms or become contagious), but as we age and the immune system weakens, a breakout can become a full infection and the result is shingles.

... and now, it seems that the "infects nerves without damaging them" hypothesis should be up for question.

It looks like the shingles vaccine has positive effects that prevent dementia. (Well, that's in the title.)

This study was possible due to a "natural experiment" where one country gave people from a very specific birth date the vaccine (so people born right before and right after that date were very similar, except for the vaccine).

It's not clear why this is the case. It might be that the virus the vaccine supresses plays a role in dementia development, or it might be that the vaccine causes an immune response that has other indirect positive impacts.

Statistics show that in some populations there is less dementia among those who received the shingles vaccine than among those who didn't.

This is probably a key sentence: "...the effect of actually receiving the HZ vaccination was a 3.1 (95% CI: 1.0–6.2, p = 0.007) percentage point reduction in new diagnoses of MCI over 9 years."

MCI = mild cognitive impairment

What's interesting to me is that the effect doesn't appear to be specific to Alzheimer's--rather they see a reduction in all forms of dementia diagnosis.

I suspect the thinking is something along the lines of ... dementia is either caused or heavily influenced by inflammation. Reactivation of HZ virus causes neurological inflammation. So, HZ vaccination is gonna prevent some forms of inflammation and help you avoid dementia--a little bit.

FWIW, I'm trained as a molecular biologist and have a some knowledge of clinical trials, dementia, etc., but I am far from an expert on this.

The highlights are a good start. (I’m a doctor, just a nerd who likes to read papers.)

My comments in brackets.

- Herpes zoster vaccination reduced dementia diagnosis in our prior natural experiments. [Previous work. I’m familiar with the Wales experiment where they had a sharp age cutoff for getting the vaccine in their national health system. Comparing those just below and just beyond the cutoff allows for analysis similar to a randomized controlled trial (aka ‘natural experiment’). The results showed a ~20% decrease in dementia due to vaccine, so the results were already pretty strong.]

- Here, we find a lower occurrence of MCI and dementia deaths among dementia patients [MCI = ‘mild cognitive impairment’. This is a more refined result than prior work, harder to see in the data than a clear dementia diagnosis.]

- Herpes zoster vaccination appears to act along the entire clinical course of dementia. [This is not surprising given the earlier results, but the demonstration is harder, and it may lead to recommendations for earlier HZ vaccination, IIRC currently at 50 or 55 in the US.]

- This study’s approach avoids the common confounding concerns of observational data [Basically they are improving their methods and getting stronger results, classic good science.]

Months ago when this research was showing up (not on HN) there was a disclaimer that the benefit differed for Shingrix vs Zostavax (discontinued in the United States around 2017), and that Zostavax was shown to cause these benefits (Wales study for example).

Shingrix had a potential side effect of Guillain-Barre https://en.wikipedia.org/wiki/Guillain–Barré_syndrome#Vaccin...

It's interesting that the linked article references, in different terms, the distinction, obliquely. Zostavax is attentuated; Shingrix recombinant.

"Our findings suggest that live-attenuated HZ vaccination prevents or delays mild cognitive impairment and dementia and slows the disease course among those already living with dementia."

Is it known or suspected whether Shingrix offers the same benefits as Zostavax for dementia?

I haven't yet seen that result asserted, but maybe others have.

From article https://www.ox.ac.uk/news/2025-06-25-how-do-vaccines-reduce-...

> Recent studies have shown convincingly that vaccines against shingles (Herpes zoster) reduce the risk of dementia. The shingles vaccine now in widespread use (Shingrix) has more of an effect than the previous one (Zostavax). A key difference between these vaccines is that Shingrix contains an ‘adjuvant’, an ingredient designed to enhance the vaccine’s effect. It is therefore possible that the adjuvant contributes to Shingrix’ greater effect than Zostavax on reducing dementia.

Link to study https://www.nature.com/articles/s41541-025-01172-3

I don't know if this study changes the conclusion that Shingrix is more affective than Zostavax.

interesting...thanks for sharing that!

Sorry, I just realized the typo but I can no longer edit: I’m not a doctor, just a nerd. I blame my phone and my own crappy copy-editing. I hope this didn’t confuse too many of you.

Shingles attacks your nervous system. Avoiding shingles prevents it from damaging your brain, so it isn’t surprising the vaccine reduces dementia.

There are multiple causes for dementia. If I read figure 2 right, the vaccine slightly reduces the chance of mild cognitive impairment, but cuts the chances of dying from dementia by about a third(!)

Also interesting: The vaccine helps at different phases of disease progression.

The simplest explanation is that dementia is due to cumulative damage, not a single event, and that getting shingles is a big hit.

The vaccine probably prevents dementia in the same way staying out of planes makes you invulnerable to parachute failures.

A lot of dead BASE jumpers disagree...

The emerging evidence, taken together, shows a ~20% reduction in dementia over 7 years. So it’s actually pretty dramatic. https://med.stanford.edu/news/all-news/2025/03/shingles-vacc...

What do they mean with 'dying from dementia'? As typically you don't die from dementia but something like pneumonia or something else. Personally, I wouldn't wish dementia on anyone and definitely wouldn't want to extend my life while having dementia.

not eating is an example, i believe, from my father who had chemo induced neurotoxicity predicted well over a decade earlier.

Get vaccinated. Stay healthy. Science works.

This is fascinating

how do you get downvoted for thinking science is cool, serious

Your original comment doesn't add anything substantive to the conversation, and would've been better served by simply upvoting the link, or other comments. It could even come off as sarcastic to certain people, it's hard to know what you're really thinking or why you find it fascinating.

In case you've never seen the guidelines, you're discouraged from talking about downvotes: https://news.ycombinator.com/newsguidelines.html

ah yes because there are so many doctors and biologist giving their take on a computer nerd forum

It seemed important to you to get positive karma on said nerd forum, but keep on keeping on, negative six

its people like you that make this place toxic

Reply on news.ycombinator.com