[robot_jesus]

I'm in my 40s with genetic predisposition for Alzheimer's. Been seriously considering the past year or two paying out of pocket for Shingrix. I think it would be ~$500 total for two doses.

Sure, I could wait 7 or 8 years until I qualify via insurance, but is that really worth the risk for what is an easily absorbed cost to me? Especially when I have a friend in her late 30s who just went through a very rough bout of shingles?

It makes sense to have targets like age 50 for population-wide public health recommendations. But it can and does infect people of much earlier ages.

Recent articles like this make me think I'll go ahead.

[reenorap]

This finding of shingles and dementia is likely due to “healthy vaccinee” bias as per the link someone else posted below:

https://youtu.be/qlTnnQytOJ0?is=XJ0c5pWVV6Lg0IMs

As per one of the slides around 7 minutes in, there are many vaccines that show a 20-40% reduction in mortality and dementia.

The talk above basically says that “observational studies” may show great results, like the so-called protective action of the shingles vaccine against dementia. However when brought to a well designed RCT all those benefits don’t actually show up. And the speaker shows later on that the shingles vaccines shows a marked benefit for shingles but nothing for dementia.

[gdudeman]

This really isn't the case in the Shingles vaccine unless the UK study is flawed a way that isn't clear to me.

The study looked at the effect of being eligible for a vaccine and the results were clear. (see chart below the fold here: https://erictopol.substack.com/p/the-shingles-vaccine-and-re...)

There was a hard age cutoff in the UK study. Above a certain age, you weren't eligible. Below it, you were. People who were born in the "can get the vaccine" group have markedly lower rates of dementia. People in the "too old" group have higher rates. It's one of those studies where you don't even need to look at the p-value to see the difference.

I'm very open to being wrong about this!

[hn_throwaway_99]

Thanks very much for linking that substack, very informative.

But in your summary:

> People who were born in the "can get the vaccine" group have markedly lower rates of dementia. People in the "too old" group have higher rates.

I would change "people" to "women". I thought it was very interesting that the benefit of the Shingles vaccine eligibility for Alzheimer's was largely confined to women - men showed no such benefit per the graph in that substack article.

[reenorap]

The video explains why the analysis is wrong and gives a very clear graph of how when you look at the proper data, there’s no benefit from the shingles vaccine for dementia. The signal is clear as day.

FWIW Eric Topol is an extremely unreliable source. He has “fame” but most of his stories end up being wrong because of his poor analysis like the review above. I subscribed to him during the pandemic when he migrated to substack but ended my subscription after countless bad articles.

[warshinder]

Right. And RCTs not showing things than can be seen in larger observational studies seems plausibly related to the problems with RCTs, for instance statistical power being generally lower because n sizes are lower, attrition is an issue, etc… I want to believe the research though, especially since I like most smart people are going to get the Shingrix shot anyway.

[reenorap]

It’s the opposite. Observational studies are very biased by the selection process and the only way to get signal from them is rct.

[warshinder]

So you have a 30 person RCT, half the treatment bails midway through, you include the assigned but not treated (ITT) in the analysis. That’s going to give you the power to make a definitive statement while a large scale longitudinal with n=50,000 will not?

[timanderson]

Great video, thanks for the link.

[mlyle]

I got shingles at 45 and it was -not fun-. My arm is slightly disfigured.

I think the age 50 target is dated. With reduced childhood incidence of chicken pox, we're all exposed to varicella zoster less, and it seems like the ages of incidence of shingles is falling. Public health recommendations are slow to catch up with research (especially for vaccinations, these days).

[iambenm]

I got it around 36, and coincidentally a friend 5-6 years younger than me in a different part of the country got it at the same time.

My research at the time led me to the same conclusion: Since we've basically eradicated chickenpox, we're not exposed to the varicella zoster virus as much as previous generations (via children that have chickenpox). Without exposure our antibodies / resistance fade out.

Since we had chickenpox, the virus is already in us and dormant. When it wakes up and decides to do its thing, our bodies have forgotten how to fight it effectively compared to previous generations - and as a result, the incidence of shingles is increasing in younger populations compared to previous generations.

My doctor said vaccination for under 50 is only indicated after multiple occurrences of shingles... so here's to hoping I'm good til the guidelines change.

[zahlman]

> Japan was among the first countries to vaccinate for chickenpox. The vaccine developed by Hilleman was first licensed in the United States in 1995.[17][60]

People (well, Americans and Canadians at least) in their 40s now generally didn't get vaccinated as children, as their parents didn't have the option. It will be different for the next generation.

[pkaye]

Interestingly UK took a different approach and only started offering chicken pox vaccines for children this year.

https://www.gov.uk/government/news/free-chickenpox-vaccinati...

[mlyle]

Which, if chickenpox is really the cause of a lot of dementia (as this article implies) might have been a pretty grave mistake.

[jyounker]

Yeah, I came here to say the same thing. I got it around 46. The horrible looking stuff on the outside is also on the inside, and it weakens your internal tissues. I know this because I tore one of the muscles in my lower back, and it still causes problems.

[scrollop]

There were a few studies around 2022 showing the influenza vaccines and pneumoccocal vaccines reduce alzheimers (influenza by up to a whopping 40%!).

I tell me patients this to increase uptake, so we can reduce alzheimer's prevalence.

(I'm a doctor)

[hn_throwaway_99]

Do you have a link to these studies? I ask because, as another commenter mentioned, I think it would be very difficult to tease out cause and effect and I think the "healthy vaccinee" hypothesis could easily explain why so often you see the association between any vaccine (just here we have shingles, influenza and pneumococcal) and Alzheimer's risk reduction.

To be clear, I would get those vaccines regardless for their stated effectiveness, it just feels like so many observational conclusions ("moderate red wine is good for you!") have been proven to be non-causitive correlations when examined more closely.

Edit: Actually, the youtube link posted above talks about tons of vaccines where observational studies show reduced Alzheimer's risk: https://youtu.be/qlTnnQytOJ0?t=340

[gdudeman]

I believe that there are studies that show that merely getting very sick increases your chance of dementia - essentially it ages you faster or brings chronic disease forward. If that's the case, vaccines for things like the flu - a disease you're likely to get - are probably good overall.

They also activate the immune system in generaly, which could probably go either way in terms of longevity.

In general I don't think vaccines are preventing so much as delaying dementia, but if they stop chronic infection they might be.

[emceestork]

https://www.neurology.org/doi/10.1212/WNL.0000000000214782

edit: Sorry this is the follow up study but the 40% study is linked within

[js2]

On the topic of vaccines, if you were vaccinated against measles before it switched to the two-dose schedule (1989 in the US), you might want to have your titers measured.

I was vaccinated in the early 70s when it was a single dose. With measles in the news recently, I asked my doc to add a measles antibodies test to my blood draw. Came back negative. No immunity. I went to the local pharmacy and got an MMR booster the next day.

https://www.health.harvard.edu/diseases-and-conditions/some-...

[daft_pink]

If you were vaccinated on the normal schedule, what year would you generally be born to be vaccinated with the single dose?

[js2]

In the U.S., the second dose was added in 1989 so around then. You might've also gotten a booster in the U.S. if you were born earlier but lived in a college dormitory.

If you're not sure, get tested. It's a simple blood draw.

[andy99]

I read before that iirc because of waning protection it’s better not to get it too early. It’s not clear to me why you can’t get it twice, but what I read (and it was some online discussion so could be wrong) was that someone had been specifically told by their doctor to wait to 50 as the best spot to get it. I’d like to know more, I’m in my 40s and would be happy to get it now too but not if it was going to be worse overall for some reason.

[anonym29]

The antibodies you develop to fight the virus fade over time. I just had it fairly recently (young 30s, vaccinated with the attenuated chickenpox virus, never had chickenpox, so this was likely the vaccine strain¹). Did a lot of reading and research during and after. The antibodies seem to offer good protection for 5-10 years following either vaccination or infection according to the literature I was reading.

¹ The vaccine strain tends to be much more mild than the wild strain, and indeed it was quite unpleasant, but not extremely painful for me. The wild strain is considerably more painful and linked to a greater incidence rate of complications. Please do not skip chickenpox vaccinations for your kids, the minor risk of latent infection from attenuated vaccine is far less harmful than the consequences of not vaccinating. Most important of all, if you have a cluster of blisters or rash on one side of your body that keep popping up, make sure to see a doctor and get on antivirals within the first 72 hours for best results.

[chasil]

As I understand it, antibodies only last a month within the blood before they degrade.

It is the memory B cells that produce them that last years.

https://en.wikipedia.org/wiki/Memory_B_cell

https://www.quora.com/What-is-the-lifespan-of-an-antibody-in...

[jimbob45]

You had Shingles after never having chicken pox except the vaccine?

[anonym29]

Yes. In my case, the virus became active after severe and chronic sleep deprivation one summer where I tried experimenting with going from a 16/8 sleep schedule to a 24/12 sleep schedule, on a now-resoundingly-disproven hypothesis that the ratio of waking hours to sleeping hours was more important than the absolute number of each for healthy functioning.

Stress and sleep deprivation are known triggers for the virus, which lies dormant in the nervous system for life after initial infection, and can be dormant for decades at a time between reactivations.

[jghn]

My primary care suggested I hold off to mid-late 50s instead of right at 50 for this reason. Between not wanting shingles, and some of the newer research into neuroprotective angles I'm not sure I'm going to do this however.

[goosejuice]

Hmm but as I understand it, dementia begins in your 30s. It's just that we don't see the signs of it until much later. So if it is protective, waiting doesn't seem wise (on the dementia side of it).

[InsideOutSanta]

You absolutely can get it twice. It's currently not officially recommended, but that's probably just because Shingrix is relatively new, so booster shots aren't that relevant yet.

[raverbashing]

Yeah

And you can absolutely get Shingles before 50 (in some cases)

[AnotherGoodName]

But surely you can do a booster shot?

[giardini]

I've had two shingles shots: Zostavax and Shingrix. There's no reason you couldn't take either shot again. You might have to pay but no big deal.

I know people who've had shingles and it is not only a major PITA but can be life-threatening, can blind you, etc., just bad stuff. Don't delay taking advised precautions, including injections.

[tptacek]

So far as I know there's no standard booster protocol for Shingrix.

[golem14]

That just tells you it hasn’t been fully researched, not that it wouldn’t be useful.

[unsupp0rted]

You could just get one more dose, right?

[tptacek]

Wait, you can just pay for the shingles vaccine, before you're 50? Where do I do that?

I had shingles in my 30s. It was the sickest I've ever been.

[Aurornis]

You can get basically any medication or vaccination you want in the US as long as you can find a doctor to write the prescription.

We even have anabolic steroids that were approved for muscle wasting in cancer patients, but if you can find a doctor willing to write the prescription and a pharmacy that won’t question it, anyone can have pharmacy grade Anavar for the gym, completely legal. In theory the doctor writing the prescription is putting their license at risk, but enforcement is so lax that there are “anti-aging” clinics all over that will prescribe testosterone and Anavar to anyone with a credit card.

So with a documented history of shingles you should have no problem getting a prescription written. It would be worth a quick check with your insurance company because it might even be covered if your doctor will fill out the form and attach evidence of the past diagnosis.

[dataflow]

> You can get basically any medication or vaccination you want in the US as long as you can find a doctor to write the prescription.

Is that not usually true in other countries?

[dboreham]

I doubt you need a prescription for most vaccines. Typically there's some sort of guidelines that might say normally given to over 55 years old, but there will be some wiggle room due to other hard to prove preconditions such as family history of xxx or sensitivity to yyy. You say you have one of those things and Costco or the public health dept. will give you the vaccine no questions asked. For example when the COVID-19 vaccine was rolled out it was supposed to be for older people, but also people with various other (not easy to test for) preconditions such as asthma. So everyone who wasn't an anti-vaxxer developed asthma.

Medications are different. Need prescription for that, although $$ and a zoom call can solve that problem.

[jandrewrogers]

There is a large industry in the US that specializes in catering to people that want medications, vaccines, diagnostics, and treatments that are outside the recommended standard of care that medical insurance or public health systems cover. You have to pay for these services directly but the market is competitive so the cost is quite reasonable.

A doctor must sign off on these but that step is mostly performative outside of some narrow exceptions. My impression is that this type of medical care is much more accessible in the US than most other developed countries.

[Aurornis]

That's it.

Some countries are even more open. You can walk up to pharmacies in some countries and ask for most medications without a prescription. Up until 10-20 years ago you could walk into pharmacies in some countries and get abusable drugs, too, but that became enough of a problem that they cracked down on it.

The unique thing about the US is that we have access to almost everything first, and you can find a doctor willing to prescribe it to you if you look hard enough. In many other countries doctors don't want to stray far from the government prescribing guidelines. You may also not be allowed certain treatments unless your doctor can prove you meet the government requirements.

In the US, the enforcement is on the backend, if at all. There have been many cases of doctors getting the bright idea of turning their prescription pad into a money printer and writing prescriptions for scheduled medications to anyone willing to pay cash. Some of them make millions before the DEA catches up and goes after them. The smarter ones have moved into spaces where the enforcement brings less attention. Prescribing opioids is out, but I can't even turn on the radio without getting ads for doctors who will write me a prescription for testosterone to "get an edge in the gym".

[InsideOutSanta]

Yes, it is. In my experience, in most cases, your regular doctor will prescribe things if they are not dangerous even if they aren't recommended.

[nicoburns]

In some countries, getting that prescription is much harder (unless you have the medical condition the medicine is intended/licensed for)

[bink]

Not exactly. My doctor wanted to start me on a medicine that would make me more likely to develop shingles so he asked me to get the vaccine series before he'd prescribe the medicine. I guess there's no such thing as a prescription for a vaccine, so I just went to my local pharmacy. I made the mistake of writing on the form that I had no health issues. The pharmacist came out and said because I wasn't 50 and had no health issues they weren't allowed to administer the vaccine. Even after I explained my condition and the doctor's request they still refused. They wouldn't even let me fill out a new form. I had to go to a different pharmacy which conveniently didn't ask about my current health status.

It's stupid too, because the question I answered "wrong" wasn't clear. It basically sounded like they were asking me if I currently had a cold or covid.

[jakestein]

I'm in my 40s and asked my GP for it since I similar had a bad experience with it a few years ago. After warning me 3 times that it might not get covered by insurance, they gave it to me. I tried to get the second dose at a pharmacy, and they would not do it since I'm under 50. I got the second dose at my GP again a few months later.

[kaikai]

You can just ask for vaccines at the pharmacy. I got a potentially missed childhood vaccination as an adult and they asked a few questions about why I wanted it, but were happy to give it to me. If it’s something odd you might need to go to a travel clinic.

[tptacek]

Not this one you can't.

[toomuchtodo]

I told my local Walgreens I am immunocompromised and they did not ask for proof (early 40s).

https://www.cdc.gov/shingles/hcp/vaccine-considerations/inde...

[tptacek]

See this is the information I'm looking for. :)

[toomuchtodo]

Happy to help!

[warshinder]

Safeway pharmacy staff dgaf about anything from my personal experience.

[eclipticplane]

I got mine at a tiny off-chain pharmacy. I just lied about my age. They didn't even check my ID. I did it in my early 30s, definitely did not look 50. Very happy I did so, have seen a few younger friends go through shingles and it _sucks_.

[giardini]

Sorry Tom, but you definitely look older than your age!8-))

[SoftTalker]

If you just want to pay out of pocket or with an HSA, etc. you can get many vaccines at a pharmacy. Might need to check if there are limited hours for that service or appointments needed. Not sure if Shingrix is one of them.

[tptacek]

I've tried to get the shingles vaccine at Walgreens before and been turned down because I wasn't old enough.

[SoftTalker]

Huh. Well maybe not then. Did you make it clear you'd pay out of pocket and not insurance?

[tptacek]

Yes. I really want this vaccine.

[sarchertech]

Have you tried asking your PCP?

[InsideOutSanta]

Most age recommendations do not prevent you from access, but determine whether the insurance will pay. I got both the shingles and HPV vaccines despite being outside the age bracket.

[Jolter]

If you have already had shingles as an adult, aren’t you fairly well protected for the next ten years or so, at least? I’d wager that you are one of the people least at risk since your immune system is already primed and readying suppress the virus that’s latently infecting you.

[tptacek]

You are more likely to have a recurrence of shingles after once having it before. At any rate, I had mine more than 10 years ago.

[DANmode]

Yep! You rarely kill off all of the bugs.

Usually just most, except some in your organs where your immune response is different, out of necessity.

Then, if your immune functionality drops below a certain threshold that they can replicate inhibited, and leave the fort, you’re dealing with a systemic infection again.

[OutOfHere]

Most people, especially those under the vaccination age of 50, with a weak immune system don't supplement a correct dose of basic immune boosting supplements like vitamin D3 (4-6 KIU), zinc (15-25 mg), selenium (200 mcg), and beta glucan, which typically is why they have a weak immune system in the first place. Safely boosting your immune system's baseline will protect you not just against opportunistic shingles but various other things too.

[zeckalpha]

My understanding is that they're not sure if the vaccine will last in your system for more than 30 years, and that subsequent doses may be less effective, so getting it early may weaken you later.

But I am with you. My personal bet is we'll know more about this by the time that becomes an issue.

The earliest cohorts of vaccinated children are approaching their 30s, so we should learn about long term efficacy this decade.

[robot_jesus]

It's a fair callout, but for me (and increased propensity for Alzheimer's) the calculus is a bit different. Making to to my mid-70s with full mental faculties would easily be worth the tradeoff of an increasing likelihood of shingles at that point. And besides, I would presume I would be able take the vaccine again?

[warshinder]

They have donanimab now, and apoe4 testing may qualify you if you have any prodromal (easily faked frankly) symptoms and a decent insurer.

[dualvariable]

> they're not sure if the vaccine will last in your system for more than 30 years

Vaccines don't really last in your system more than a few days (although some cells get dragged off to the lymph nodes and get harshly interrogated for longer than that). It is the T-cell and B-cell responses that are persistent for years.

> and that subsequent doses may be less effective

They should activate B cells that you already have and produce high-affinity mature antibodies.

[throwaway2037]

If you have any developing countries nearby (holiday, etc.), you can usually get it cheaper at a clinic. I get my vaccines (when on holiday) in Thailand here: https://www.thaitravelclinic.com/vaccine-price-list/

[anarticle]

I feel like we've probably spent more for less! Any interaction with the medical industry for less than 1k feels like a steal to me.

[gdudeman]

People who are immune compromised qualify for this. I'm not sure how much your insurance company would push back on that though.

[greg7mdp]

Got the shingrix vaccine for free at my county health center, even though it was not covered by my insurance. Worth checking.

[copperx]

Shingles terrifies me because it can cause hearing loss. I spoke to my GP and he wouldn't give me a script for it even though I'm 3 years away from qualifying. He mentioned side effects.

[bitwize]

My A1C popped high, so I could get Shingrix 2 years before the nominal minimum age, paid for by insurance, on the technicality of having a T2D diagnosis. My blood sugar is much more under control now, but that's a nice little side benefit I won't hesitate to take advantage of. The most severe side effect for me was long term muscle pain near the injection site (even now 10 months after I got the shot). But it's totally worth it because the pain of shingles is far, far worse as I understand it.

[dr_kiszonka]

"An increased risk of Guillain-Barré syndrome (severe muscle weakness) was observed after vaccination with SHINGRIX"

https://www.shingrix.com/side-effects/

[throwaway2037]

For the record, annual flu vaccines also have this risk, but it doesn't stop 450 million people from getting them.

[jyounker]

That seems like being penny wise and pound foolish.

[subscribed]

Looks like the GP is in the UK.

I tried to go private (also not 50), but everyone just refused. Pharmacy, GP, private GP.

Currently I'm arranging it in the third country because WTAF.

(UK becoming the dirtiest and sickest country of Europe one more time)

[pasc1878]

The age for shingles vaccine in the UK under the NHS (so free) is 65.

Of course I got shingles when I was 64. Caught early and got anti-virals and had no lasting effects.

[jyounker]

I'm glad you got lucky. I got it identified and treated with antivirals early (first 12 hours), a friend of mine turned out to be a research dermatologist who took over treatment in the first 36 hours, and still I ended up with long term effects. (Apparently if I'd gone another 12 hours without significant response, he would have put me on intravenous antivirals.)

I'm glad you didn't have any lasting effects.

[subscribed]

I wanted to pay the full price, but pharmacies (Boots, Lloyds, couple of small ones) refused citing NICE guidance, GP and private GP refused to "prescribe" it.

[Integer]

Weird, I went to a travel vaccination clinic in London and got it no questions asked (the nurse was even familiar with the dementia research). Try calling privatemedicalclinic.com ?

[subscribed]

Thanks a lot!

[copperx]

Close, I'm in the US. I don't need a script to get it, only if I want the insurance to pay for it.

But if I couldn't I could still go to Mexico and buy brand name Shingrix.

[monkey_monkey]

> (UK becoming the dirtiest and sickest country of Europe one more time)

Big Yawn

[subscribed]

Don't let the facts to discourage you from yawning.

> [1] Of the reported 22,289 bathing waters across Europe (EU-27, Albania and Switzerland) in 2025, 84% were rated excellent quality. This share reached 85% at the EU level.

[1] https://www.eea.europa.eu/en/analysis/publications/european-...

> [2] In 2025, 297 bathing waters in England (66.1 per cent) met the Excellent standard

Note the sharply increasing amount of "Poor" waters.

And that's despite the methodology allowing to presence of untreated sewage and human faeces in the "excellent" waters: https://www.theferret.scot/scottish-beaches-excellent-pollut...

[2] https://www.gov.uk/government/statistics/bathing-water-quali...

With treatment waiting times, dental treatment availability and deaths while waiting for the ambulance I don't think I need to get into gory details.

[tptacek]

I think the bigger thing is that the vaccine has a peak response window, and the current medical guidance lines that up with when you're epidemiologically most likely to experience a shingles outbreak (for most people, that's very unlikely when you're young, because your immune system is so jumpy, but that wanes with age). If you get the vaccine early, its effect can be attenuated right when you need it most.

(I don't like this logic and if I had the option of just going to Walgreens and getting vaccinated, I'd do that this afternoon. I'm just saying, there's a logic to it.)

[WalterBright]

When covid struck, I went and got revaccinated for the usual - MMR, Polio, etc.

[cyanydeez]

aside from age ranges being the tested population, your just gambling no other interference pattern is involved.