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Comment by matthewdgreen | Hacker News Reader

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.

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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.

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.

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.

> 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.

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