Emergency department (ED) visits for shingles fell in the past decade for people aged 60 and older but rose for most younger age groups. The decrease among older people may be due to more of them getting the shingles vaccine, U.S. researchers suggest.

Anyone who has had chicken pox or the chicken pox vaccine can develop shingles, but the risk increases sharply after age 50 and vaccination against the shingles-causing virus is recommended by the US Centers for Disease Control and Prevention starting at age 60.

Vaccination can cut shingles risk by more than half, and the severe pain, known as post-herpetic neuralgia, by two-thirds, senior study author Dr. Arash Mostaghimi of Brigham and Women’s Hospital in Boston told Reuters Health.
Mostaghimi and his colleagues analyzed trends in emergency room visits among various age groups between 2006, when the shingles vaccine first became available in the U.S., to 2013.

More than 1.3 million ED visits were for the shingles-causing virus, they reported in JAMA Dermatology.
Such visits increased by more than 8 percent among 20 to 59-year-olds, but decreased by close to 40 percent among those 60 and older. They also fell by 11 percent in 18 to 19-year-olds, for whom the vaccine against chickenpox – introduced in the U.S. in 1995 – had been recommended.

While the study doesn’t prove that vaccination cut emergency room visits for shingles, Mostaghimi said in an email, “in combination with several other studies, it suggests that, overall, the vaccine is effective in real-life … for reducing the likelihood of getting shingles and the severity of illness if it occurs.”

Expect to pay about $250 on average for the vaccine in the U.S., Mostaghimi said. Medicare Part D covers at least part of the cost, but private health insurance often provides better coverage. Therefore, you may want to talk with your doctor about getting the vaccine before you switch to Medicare, he suggests.

Dr. David Barlas of the department of emergency medicine at NYU Langone Medical Center in New York said that while most shingles cases can be treated by a primary care physician, people often come to the emergency department if they feel a “sudden, acute sharp pain in the part of the body where shingles is erupting.”

But that pain may precede the rash by as much as a few days, making a diagnosis “tricky,” he told Reuters Health by email. “You may think you have a severe stomach ache, chest pain or even a stroke. Often, the pain only responds to the strong pain medications available in the emergency room.”