Dialysis and Shingles: Get Vaccinated!

A few years ago, my husband and I got the Shingrix vaccine to prevent shingles. Each of the two injections a month apart caused a sore arm and a flatteningly-high fever for a whole day. Not fun. But, folks, I am here to tell you it was 100% worth it!* This July, on a Zoom call, I noticed a small rash on my chest. As soon as the call ended, I looked at it in a mirror. I hadn’t seen it before, and though there a few tiny blisters, it was completely painless. A quick ChatGPT search suggested I head to Urgent Care for an antiviral drug: the rash looked like shingles. What?! Color me shocked. Who knew you could have shingles and not even feel it? I felt like a fraud! But, a nurse practitioner verified the diagnosis (shingles does not cross the midline of the body and neither did my little rash). A one-week course of valcyclovir later and I was shingles-free without a single moment of pain. Yay, Shingrix!

*This was a MUCH better experience than catching chickenpox at 28!

We likely all know someone who has had Shingles. My mom did. So did a friend from our WI Civil War reenacting group—on his face, including his eye. His vision was threatened, but he recovered well. The late (and much-missed) Ant de Villiers, blogger and participant and moderator of our Home Dialysis Central Facebook discussion group, suffered terribly from post-herpetic neuralgia due to Shingles; an unfortunate side effect that is much more likely in the unvaccinated (I don’t know his vaccine status).

What is Shingles? ¹

Shingles (herpes zoster) is an ancient virus (so old Hippocrates named it after the Latin word for “belt”) that causes an extremely painful, blistering rash along nerve pathways. In 1892, shingles was linked with chickenpox, and in 1923 this relationship was confirmed by detecting chickenpox antibodies in all patients with shingles. Once the electron microscope was developed, fluid from chickenpox and shingles lesions was found to be identical. In 1965, it was hypothesized that shingles was a reactivation of the chickenpox virus (which hides in the nerves), and this was later proven. Adults exposed to natural chickenpox are protected from shingles, but childhood chickenpox vaccines—available since 1995—do not offer this protection—so adult cases of shingles are on the rise.

In fact, a million Americans develop shingles each year, and by age 60, about 1 person in 100 will experience it. The virus doesn’t tend to kill healthy people (just 96 deaths per year)—it just causes severe misery during and sometimes after infection (post herpetic neuralgia is severe, difficult-to-treat nerve pain that can occur after shingles resolves).

Shingles Risk on Dialysis ²

Unfortunately, shingles is both 20 times more common and far more severe in people whose kidneys don’t work, as they are immune-compromised and about half are over age 65. A study that looked at survival of 2,784 people with end-stage renal disease (ESRD) who developed shingles found that 51% died within 2 years (most within 8 months). Those who died tended to be white, older, frail, and have multiple illnesses. Just 27 had been vaccinated for shingles.

Get the Shingles Vaccine! ³

Shingles in immunocompromised people can lead to brain, eye, and spinal cord inflammation, blood vessel damage, and increased stroke risk (in the first 30 days). Postherpetic neuralgia is more common as well, causing severe, burning pain for 3 months or more that is resistant to treatment and reduces quality of life.

Treatment for shingles is antiviral drugs. But, these do not work as well in people who are immunocompromised—such as those who have ESRD—and they can build up in the blood and cause serious side effects. A reduced dose is needed for safety.

Instead, the best defense for shingles is a good offense: Vaccination. When people are vaccinated, they are less likely to get shingles or postherpetic neuralgia. In the U.S., the Shingrix vaccine is the only FDA-approved option, and it is highly effective, with protection rates of 96.6% (for ages 50-59), 97.4% (for ages 60-69), and 91.3% (for age 70+). The Shingrix vaccine also reduces postherpetic neuralgia by 88.8% in those over age 70. Typically, Shingrix is indicated for adults 50 and over, but immunocompromised adults ages 18 or over are also eligible to receive it. Among 196 adult hemodialysis patients who received the Shingrix vaccine, only mild side effects occurred.

Another Benefit of the Shingles Vaccine ⁴

While scientists have not figured out why, the Shingrix vaccine is also linked with a lower risk of dementia. (So is the RSV vaccine). A large study matched 35,938 people who received only the RSV vaccine, 103,798 who received only the Shingrix vaccine, and 78,658 who received both to an equal number of people who got flu shots but not RSV or Shingrix vaccines. Participants who had either the RSV or Shingrix vaccines were 71% less likely to be diagnosed with dementia than those who only had flu shots.

Vaccination with Shingrix can save us from the distress and discomfort of shingles—or perhaps even make them a non-event, like I was lucky enough to experience. And, the vaccine can reduce the chances of months of nerve pain and even protect against dementia. This sure seems like a no-brainer to me.