Dear Doctor: The shingles outbreak is caused by a failure of the immune system, not exposure.

DEAR DR. GARDON: I am 70 years old. I was vaccinated against shingles in 2018. I took two doses of the Shingrix vaccine. I was invited to dinner at someone’s house where someone had just gotten shingles. Am I still protected? –SC

ANSWER: About 99% of North Americans are immune to the varicella-zoster virus that causes chickenpox and shingles, either because they had it as children or because they were vaccinated. Exposure to the virus, whether from chickenpox or shingles, can cause chickenpox in a non-immune person.

Shingles, on the other hand, does not occur because of exposure, but because of the inability of a person’s immune system to keep the virus (which stays in the body forever) under control. This usually happens as we age, in times of high stress, or if something happens to our immune system (like chemotherapy). Shingles usually causes a rash on one side of the body and in a particular location, such as a scratch on the chest or part of an arm or leg.

The chickenpox you had as a child protects you from getting infected again, while the shingles vaccine you received in 2018 reduces your risk of getting shingles and getting the virus again. I recommend the shingles vaccine to anyone over the age of 50 who has not already received this two-dose vaccine, even if they received the older vaccine and previously had shingles.

DEAR DR. ROACH: I was treated for high cholesterol and triglycerides with a statin. But I developed red skin and severe muscle pain, so I had to stop taking it. I read that people of Finnish origin cannot take statins.

My doctor says it is possible to take an injection at home every two weeks. Is there any evidence that I would be able to tolerate this medication? He says I have a 16% chance of having a stroke or heart attack as it stands. Is it a different medicine or the same medicine in a different form? –RG

ANSWER: I have not found any information to suggest that people of Finnish origin are at higher risk of an adverse reaction from a statin. Muscle pain is common with statins; they often go away, but it can definitely prevent some people from taking statins. One to two percent of people are unable to take statins because of muscle pain in randomized trials, but the rate is much higher among ordinary people who take their prescribed statins – largely because the people expect it.

A rash is not a common side effect of statins, but it may be a reason not to take them. However, with a 16% risk of heart attack, stroke or cardiac death over the next 10 years, treatment to reduce this risk deserves special attention.

Your doctor recommends a medication called a PCSK-9 inhibitor, which is not related to a statin at all. They are very effective in lowering LDL cholesterol and reducing the risk of heart disease, but they are quite expensive and, as you say, require an injection.

Another option is bempedoic acid, which works similarly to statins, but it does not carry an increased risk of muscle pain and is chemically unrelated to statins. So, if your red skin was due to an allergy, your risk would be low with this medication.