DEAR DR. ROACH: I’m a 75-year-old male who can’t remember whether or not he’s had chickenpox as a child. This is somewhat important, as I’m considering getting the shingles shot to prevent that horrible illness. Which would be a prudent approach: go ahead and get the shingles shot or wait in suspense? — R.B.
ANSWER: Although some of my colleagues do check blood antibody titers to find out for sure, I follow the recommendations of the Centers for Disease Control and Prevention, which are to give the shingles vaccine whether the person recalls having chickenpox or not. Over 99% of people over the age of 40 have had chickenpox, even if they don’t remember having the disease.
Two doses of the newer Shingrix vaccine are more than 90% effective at preventing shingles and its truly horrible complication, post-herpetic neuralgia, a persistent pain that can last for months, years or even a lifetime. The side effects of Shingrix are somewhat more common than for other vaccines, such as the flu vaccine. Most common are sore arm, fever and feeling unwell for a day or so.
DEAR DR. ROACH: I recently got the high-dose flu shot recommended for age 65 and above from my pharmacy. At the same time, I also got the second of two shots for pneumonia. I had absolutely no symptoms after the shots. I had to get up in the middle of that night and suddenly passed out in the bathroom. When I came to, I was crumpled up on the floor and could not stand up. I had to crawl back to bed. The next day I felt very lethargic and “out of it.”
I informed the pharmacy in case they track and report stuff like that. Their reaction was “Sorry about that.” Was this a fluke? Or should I avoid the high-dose flu shot in the future? — R.D.
ANSWER: I can’t say for sure. Most people with reactions to the flu shot have other symptoms, and fainting usually happens immediately after the shot. Nonetheless, the reaction should be reported to the Vaccine Adverse Event Reporting System, which is something you can do yourself at vaers.hhs.gov/reportevent.html. VAERS reports do not prove that the vaccine caused the adverse event, but are helpful for identifying trends.
The high-dose flu shot does have a higher incidence of adverse reactions than the standard dose, and getting more than one shot at the same time is likely to further increase the risk, although the absolute rate remains low.
Next year, I would still probably recommend the high-dose vaccine (you won’t need the pneumonia shot again), but I’d be sure you have an extra glass or two of water that day.
I think it is more likely that you had something called “micturition syncope,” which is a reflex type of fainting. Although it is a relatively benign type of fainting, it’s still worthwhile to have an evaluation from your doctor, including an electrocardiogram, just to be sure there are no surprises. It’s possible that it was the combination of the high-dose vaccine, the pneumonia vaccine, and the getting up in the middle of the night that caused the fainting.
Vaccines have frequent short-term side effects and rare long-term ones; however, the benefits greatly outweigh the risk.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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