Shingles vaccination in adults, Shingles Can Increase Stroke Risk

Shingles vaccination: Shingles (herpes zoster), like chickenpox (varicella), is caused by varicella zoster viruses. Most adults over the age of 50 have had chickenpox in their lives. Viruses nest in the body in the nerve cells. If the immune system weakens – for example in old age – the viruses can become active again and cause a painful rash, shingles (zoster). The painful nerve inflammation can persist for a long time even after the rash has subsided (postherpetic neuralgia). Shingles most often affects older adults and people with a weakened immune system.

Shingles: infection and course of the disease


Shingles is caused by viruses that are already present in the body after an earlier chickenpox disease. Chickenpox can become active again after years and cause shingles.

Chickenpox is very contagious. Almost every person who has not yet had chickenpox becomes sick when it comes into contact with a person with chickenpox. The varicella zoster virus is usually transmitted through coughing and sneezing (droplet infection). But the liquid in the chickenpox vesicles is also contagious, which can lead to smear infections. The viruses can survive for several days. You can therefore also on surfaces such. B. door handles are transmitted.

Shingles is less contagious. Only the fluid in the vesicles of the rash is infectious. People who have not had chickenpox or have been vaccinated against chickenpox can become infected. An infection then causes chickenpox.

With chickenpox, the sufferers are contagious 1 to 2 days before the rash begins. The ability to infect both chickenpox and shingles ends with the complete crusting of the blisters about 5 to 7 days after the start of the rash.


In shingles, the chickenpox pathogens (varicella zoster virus) that are dormant in the nerve cells are reactivated.

As a rule, a burning pain first occurs with shingles. Liquid-filled vesicles form that spread into a belt-like (band-like) rash – usually on the trunk or head and usually only on one half of the body. In some people, even after the rash has healed, the pain in the affected area remains for months or years (postherpetic neuralgia).

The highest risk of developing shingles is in the elderly or people with an immune deficiency.

Shingles: vaccination

STIKO recommends vaccination against shingles (herpes zoster) with a dead vaccine to prevent shingles and prolonged nerve pain (post-herpetic neuralgia):

  • Persons over 60 years.
  • all people aged 50 and over whose immune system is weakened (e.g. due to illness, after bone marrow or organ transplantation, with immunosuppressive therapy).
  • all people aged 50 and over with a severe basic illness (e.g. chronic diseases of the lungs (COPD), kidneys or intestines, rheumatoid arthritis, systemic lupus erythematosus).

The double vaccination with the dead vaccine can effectively protect people from 50 years of age against shingles and post-herpetic neuralgia: 92 percent of those vaccinated were not ill within four years of the vaccination; 82 percent were protected from nerve pain caused by shingles (post-herpetic neuralgia).

The vaccine against shingles is approved for people aged 50 and over and is vaccinated twice at intervals of at least 2 and a maximum of 6 months.


If the vaccination is recommended due to one of the basic diseases mentioned, the vaccination and the best time for vaccination (especially in the case of therapy that suppresses the immune system) should be discussed with the treating doctor.

For the above-mentioned population groups, the statutory health insurance companies cover the costs of vaccination with the dead vaccine. As a rule, most private health insurance companies also pay for the vaccination.

Shingles vaccine
Shingles vaccination in adults, Shingles Can Increase Stroke Risk

Vaccination must not be carried out if there is intolerance to any ingredient of the vaccine.

side effects

After vaccination against shingles, stimulation of the body’s own defense often causes redness or swelling at the injection site, which can also be painful. General symptoms such as headache, fatigue, fever or muscle pain may also appear in the first three days after vaccination. Itching often occurs at the puncture site. Occasionally lymph nodes swell or joints hurt. Such vaccination reactions are usually short-lived and subside after one to three days.

Tiredness and discomfort may affect your ability to drive or use machines for 2 to 3 days after vaccination.

Shingles: Frequently asked questions and answers (FAQs)

Is the shingles vaccination paid for by the health insurance?

The Standing Vaccination Commission (STIKO) has recommended vaccination against shingles with a so-called dead vaccine since mid-December 2018 for everyone from the age of 60 and for people with an increased health risk from the age of 50, for example due to a weakened immune system or one other basic suffering.

Since May 1, 2019, this vaccination has been a compulsory benefit of the statutory health insurance companies, i.e. the health insurance companies are obliged to cover the costs of the vaccination for the groups of people mentioned. As a rule, most private health insurance companies also pay for the vaccination. Vaccination recommendations and cost coverage do not apply to the live vaccine, which is also available.

I don’t know if I already had chickenpox. Can I still be vaccinated against shingles?

Almost all adults who grew up in Germany from the age of 50 had chickenpox at some point. It is therefore not necessary to prove chickenpox before vaccinating against shingles with the dead vaccine.

Only in the case of an upcoming therapy that suppresses the immune system or an organ transplant should a blood test be carried out beforehand to check whether you have already had chickenpox. If there is a current blood test that shows that the person did not have chickenpox, vaccination against chickenpox is useful.

I already had Shingles vaccination. Can I still get vaccinated against it?

Shingles can occur repeatedly. Therefore, vaccination with the recommended vaccine (dead vaccine) also makes sense if someone has already developed shingles. This can reduce the risk of further illnesses.

However, vaccination is not suitable for the treatment of shingles. Therefore, vaccination should only be carried out after the shingles have subsided.

Does the shingles vaccination need to be refreshed?

How long the vaccination protection lasts after vaccination with the dead vaccine is still the subject of research. However, previous results show that vaccination against shingles only decreases slightly after four years (from 98 to 88 percent). Further studies indicate that protection lasts even longer.

Can I be vaccinated against shingles and flu at the same time?

Yes, vaccination against shingles with the recommended dead vaccine can be given simultaneously with an inactivated flu vaccine without an enhancer (adjuvant). To date, no study results are available on the simultaneous vaccination with other vaccines.

Why is only the shingles vaccine recommended?

In Germany there are two different shingles vaccines: a so-called live vaccine with weakened viruses and a dead vaccine that only contains parts of the virus.

The recommended dead vaccine is more effective and provides longer-lasting protection than the live vaccine. In addition, the live vaccine cannot be used in people with a weakened immune system who have a particularly high risk of shingles. For this reason, the Standing Vaccination Committee (STIKO) recommends vaccination with the dead vaccine for all people aged 60 and over and, in certain underlying diseases, for people aged 50 and over.

Shingles vaccination increases the risk of stroke

Patients who have undergone shingles for the first time, within 6 months after this fall into the group at increased risk of stroke. However, antiviral therapy may reduce this risk. The role of vaccination against shingles and chicken pox ( Varicella zoster ) in the prevention of stroke in such patients is also discussed .

Sinead M. Langan and colleagues from the London School of Hygiene and Tropical Medicine, UK, published the results of their new study in the June issue of Clinical Infectious Diseases.

In the course of the study, the authors studied information from the clinical practice database of the United Kingdom Clinical Practice Research Datalink for 1987–2012. (n = 6584). In this case, we used the analysis by the method of a series of cases with the control in the same sample (self-controlled case series) in order to compare the risk of stroke in the same patients in the period after the transferred shingles and in other periods of their lives. After this, the method of stratified analysis was used to study the effect of shingles on the risk of stroke in people who received specific antiviral therapy and those who did not.

Detail report

It was found that the risk of stroke increased by 63% and was as high as possible in the first 4 weeks after shingles (the incidence rate after leveling by age (OZv) 1.63; 95% confidence interval (CI) 1.32–2.02) . This indicator decreased in the period of 5–12 weeks after the episode of shingles to 1.42 (95% CI 1.21–1.68), and in the period 13–26 weeks – to 1.23 (95% CI 1.07– 1.42). After 26 weeks, no relationship was found between herpes virus infection and stroke.

The strongest was the above relationship in patients with ophthalmic form of shingles (damage to the ocular branch of the trigeminal nerve) – in the period of 5-12 weeks in such patients, stroke developed ≥3 times more often.

atherosclerotic plaques and hypercoagulation

Regarding the majority (60%) of participants, it was not possible to obtain information regarding the type of stroke. However, the authors believe that most often it is an ischemic stroke. Presumably, the mechanism of its development is associated with the development of endothelial dysfunction due to herpetic infection. Which led to an intensification of the formation of atherosclerotic plaques and hypercoagulation.

The results of the study also demonstrate the beneficial effect of antiviral therapy in reducing the risk of stroke. Apparently due to a decrease in the intensity of inflammatory processes. Differences did not reach the level of statistical significance in the subgroup of ophthalmic herpes, but the trend is quite obvious.

Shingles vaccination 2020
Shingles vaccination increases the risk of stroke

The effect of antiviral therapy on the effects of herpes infection makes one think about the possible beneficial effect of vaccination against the Varicella zoster virus . Of course, these issues need further careful study.

  • Langan SM, Minassian C., Smeeth L., Thomas SL (2014) Risk of stroke following herpes zoster: a self-controlled case-series study. Clin. Infect. Dis. 58 (11): 1497–1503.
  • Pullen LC (2014) Stroke Risk Highest in 4 Weeks After Acute Zoster. Medscape, May 26 (

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