Recombinant Subunit Zoster Vaccine
There is a new herpes zoster recombinant subunit adjuvanted vaccine . It is not a live vaccine and requires a two-dose schedule with approximately 26 months between doses. The vaccine was registered in Australia in 2017 for people aged 50 years and above. However, it is not yet available for use. There is reportedly a limited global supply.
In 2018, an application by the manufacturer to include the HZ/su vaccine on the National Immunisation Program was unsuccessful due to uncertainty regarding cost-effectiveness. This vaccine is registered and used in some other countries, including the USA where the Centres for Disease Control and Prevention recommend it in preference to the live attenuated vaccine.33
The recombinant vaccine is more efficacious and more reactogenic than the live vaccine. In clinical trials, it provided 97% protection against herpes zoster for 5059 year olds and 91% for those aged over 70 years.34,35 Similar levels of protection were observed against postherpetic neuralgia over more than three years. Overall in those aged over 70 years, more people vaccinated with the recombinant vaccine than with placebo reported adverse events that prevented normal everyday activity in the week following vaccination .34 Monitoring during the first eight months of its use in the USA has found the vaccines safety profile to be consistent with pre-licensure trials.36
Hsv Pathogenesis And Replication
Replication is a multi-step process. Post-infection, HSV glycoproteins interact with and attach to the cell. The viral envelope then fuses with the cell membrane, releasing its contents into the cell. DNA is uncoated and transported into the nucleus when nucleocapsid fuses with the viral envelope . Here, immediate-early genes are transcribed . Primary herpes infection involves replication within epithelial cells, with an incubation period of 46 days. Mature virions are then transported to the cell membrane, where they are released, causing cell lysis and local inflammation. Replication continues until host immune responses contain the initial infection .
Herpesvirus ascends peripheral sensory nerves to spread to the trigeminal ganglion, where latent infection develops. Latent virus can be induced to reactivate. Reactivation has been associated with various stimuli including stress, infections, and UV light exposure. However, from a molecular standpoint, reactivation is a phenomenon that continues to be studied and is not clearly understood. Clinical manifestations of reactivation vary widely in terms of presentation and severity .
A Closer Look At The Safety Data
Both Shingrix and Zostavax shingles vaccines have been shown to be safe and well tolerated. Common side effects, such as soreness and redness at the injection site, are usually mild to moderate in intensity and resolve quickly on their own.
Shingrix
In 8 clinical trials of more than 10,000 participants:
- Grade 3 reactions were common after patients received Shingrix.
- About 1 out of 10 adults who received Shingrix reported grade 3 injection-site symptoms such as pain, redness, and swelling.
- About 1 out of 10 reported grade 3 systemic reactions such as myalgia , fatigue , headache, shivering, fever, and gastrointestinal illness.
- Most people who got Shingrix reported at least some pain at the injection site.
Zostavax
- A 2013 study showed that patients with a history of a previous shingles rash had the same side effects after Zostavax as those with no history of shingles. See Safety of zoster vaccine in elderly adults following documented herpes zoster.
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Can You Get Chickenpox If You’ve Been Vaccinated
Yes. About 15% 20% of people who have received one dose of varicella vaccine do still get chickenpox if they are exposed, but their disease is usually mild. Vaccinated persons who get chickenpox generally have fewer than 50 spots or bumps, which may resemble bug bites more than typical, fluid-filled chickenpox blisters. In 2006, the Advisory Committee on Immunization Practices voted to recommend routine two-dose varicella vaccination for children. In one study, children who received two doses of varicella vaccine were three times less likely to get chickenpox than individuals who have had only one dose.
Simultaneous Administration With Other Vaccines
RZV and LZV may be administered concomitantly with other live vaccines given by the parenteral, oral, or intranasal routes. For concomitant parenteral injections, different injection sites and separate needles and syringes should be used.
In general, inactivated vaccines including RZV may be administered concomitantly with, or at any time before or after, other inactivated vaccines or live vaccines protecting against a different disease.
LZV may be given at any time before or after live oral or intranasal vaccines. If two live parenteral vaccines are not administered concomitantly, there should be a period of at least 4 weeks before the second live parenteral vaccine is given.
Concomitant administration of pneumococcal 23-valent polysaccharide vaccine and LZV has not resulted in decreased efficacy and so the two vaccines can be given concomitantly.
For more information, refer to Timing of Vaccine Administration in Part 1.
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Why Is The Shingles Vaccine Important
Shingles causes a painful rash and blisters and it can lead to serious complications. The most common complication is post-herpetic neuralgia , a condition that causes burning pain that can last long after the shingles rash and blisters go away. The older you are when you get shingles, the more likely you are to develop PHN.
Getting vaccinated is the best way to prevent shingles and PHN.
Shingles is caused by the same virus that causes chickenpox. After you have chickenpox, the chickenpox virus stays dormant in your body. The virus can activate years later and cause shingles.
Symptoms of shingles include:
Shingles cant spread from person to person like chickenpox. But if you have shingles, you can spread the virus to someone who isnt immune to chickenpox meaning someone who hasnt had chickenpox and isnt vaccinated against it. If that happened, the person might get chickenpox but not shingles. Learn more about shingles.
- Adults age 50 and older
- Adults 19 years and older who have a weakened immune system because of disease or treatments
You need to get 2 doses of Shingrix. Youll need the second dose 2 to 6 months after the first dose. You need to get Shingrix even if you:
- Have already had shingles
- Have been vaccinated against shingles with Zostavax
- Are not sure if youve had chickenpox
No Increased Risk Of Shingles After Covid
While the study above noted that there may be an increased risk of getting shingles after receiving a COVID-19 vaccine, a 2021 study had conflicting findings.
This study compared shingles onset within a 28-day period after either receiving an mRNA vaccine or getting a diagnosis for another skin condition. The people in the second group had no known history of receiving a COVID-19 vaccine.
The researchers matched these two groups of individuals 1-to-1 based on factors like age, sex, race or ethnicity, and health history. After this matching, they observed no increased risk of shingles between the two groups.
noted that most cases of shingles happen 1 to 2 weeks after having COVID-19 and have a typical presentation.
Older individuals may be more likely to develop shingles after having COVID-19. In a another 2022 study , researchers examined shingles in people who had experienced COVID-19 and people who had not. All people in the study were ages 50 and older.
Compared with people who hadnt had COVID-19, those that had experienced it had a 15% higher chance of shingles. This chance increased to 21% for individuals who experienced hospitalization for COVID-19.
Similar to getting shingles after a COVID-19 vaccine, the reason why COVID-19 can lead to shingles is unclear. It may happen due to immune dysfunction that occurs from COVID-19.
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Can I Get Shingles If I Received The Chickenpox Vaccine
Yes, you can get shingles if you received the chickenpox vaccine. This is because its a live vaccine, meaning it uses a weakened form of VZV.
However, according to the , shingles in people who have a vaccine against chickenpox is much rarer than it is in people whove had a natural chickenpox infection.
Moderna Starts Clinical Trials For Hiv Vaccine
Moderna is developing a vaccine using mRNA technology to treat the herpes simplex virus . There are two HSV virus types HSV-1, the one I have, that affects the mouth, face and genitals, and HSV-2, which predominantly affects the genitals. However, both viruses can spread to other parts of the body. In the United States, of people aged 14 to 49, 47.8 percent have HSV-1 and 11.9 percent have HSV-2, according to the Centers for Disease Control and Prevention. Many people living with herpes dont know they have it, which means these figures may be far greater. HSV remains latent in the body, staying alive through the lifelong infection of a given person. When reactivated, HSV results in visible outbreaks. The vaccine will protect against HSV-2 and provide cross-protection for HSV-1 as a suppressive antiviral treatment.
The CDC recommends against widespread testing for herpes as, alongside the risk of false positives, the risk of shaming and stigmatizing people outweighs the potential benefits.
Deidre Olsen is an award-nominated writer based in Berlin. She is writing a memoir about self-destruction, healing and resilience.
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Can A Vaccine Prevent Herpes Outbreaks Commentary
Researchers recently reported a successful test of a new vaccine for the herpes virus. Does this mean we will soon be able to use vaccines to eliminate herpes infections just like weve nearly eliminated some other virus infections ?
Not yet, unfortunately.
What is a herpes infection?
Infection with the herpes simplex virus causes recurring episodes of small, painful, fluid-filled blisters on the skin, mouth, lips , eyes, or genitals . Herpes simplex infection causes many problems across the globe. Experts estimate that over 400 million people worldwide are infected. In addition to the discomfort that genital herpes can cause, genital herpes can also cause life-threatening illness such as encephalitis and other serious infections in newborn babies if the virus is passed to a newborn during the birth process. And having herpes simplex virus infection can increase the risk of acquiring HIV infection.
Why do we need a herpes vaccine?
A big problem with the herpes virus is that once people have an infection, the virus stays with them for life. The virus stays dormant in the body and at various times reactivates and causes symptoms. Even when there are no visible blisters and no symptoms, the virus may be present on the genitals and can be spread to sex partners.
Is the new herpes vaccine the solution we want?
- How often they got outbreaks of herpes blisters
- How much herpes virus they were releasing based on test swabs taken from their genitals
When Should I See A Doctor Because Of The Side Effects I Experience From Shingrix
Shingrix causes a strong response in your immune system, so it may produce short-term side effects. These side effects can be uncomfortable, but they are expected and usually go away on their own in 2 or 3 days. You may choose to take over-the-counter pain medicine such as ibuprofen or acetaminophen. Contact your healthcare provider if the symptoms are not improving or if they are getting worse.
In clinical trials, Shingrix was not associated with serious adverse events. In fact, serious side effects from vaccines are extremely rare. For example, for every 1 million doses of a vaccine given, only one or two people might have a severe allergic reaction. Signs of an allergic reaction happen within minutes or hours after vaccination and include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, or weakness. If you experience these or any other life-threatening symptoms, see a doctor right away.
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How Is Shingles Spread
You do not “catch” shingles it comes on when there’s a reawakening of chickenpox virus that’s already in your body. The virus can be reactivated because of a range of issues, including advancing age, medicine, illness or stress.
Anyone who has had chickenpox can get shingles. It’s estimated that around 1 in 5 people who have had chickenpox go on to develop shingles.
Read more about the causes of shingles.
Why Vaccinate Against Herpes Zoster
Almost all adults in Australia have been infected with the varicella zoster virus and are therefore at risk of developing herpes zoster.9,10 Pain accompanies herpes zoster in about 80% of patients aged over 50 years, and varies from burning to lancinating pain, sometimes with paraesthesia, anaesthesia or allodynia.3
Antiviral therapy given within 72 hours of rash onset can help resolve acute pain and accelerate the healing of skin lesions. However, it is thought to have little or no effect on the likelihood of developing postherpetic neuralgia.11
Postherpetic neuralgia is problematic because it can be refractory to treatment with analgesics, neuroleptics and other drugs, and can last for months and even years.12,13 In older adults it often interferes substantially with activities of daily living and can have a very negative impact on overall wellbeing.14,15
Vaccination protects individuals from herpes zoster and postherpetic neuralgia and reduces associated medical and psychosocial outcomes and costs for the patient.3,13 The limited impact of current treatment for herpes zoster and postherpetic neuralgia makes vaccination a particularly important strategy to spare older Australians this debilitating disease.16
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Im Pregnant And Have Had A Blood Test For Chickenpox What Do The Results Of This Test Show
The blood test can show that you:
- Are immune and have no sign of recent infection. You have nothing further to be concerned about.
- Are not immune and have not yet been infected. You should avoid anyone with chickenpox during your pregnancy.
- Have or recently had an infection. You should discuss what the risks are for your stage of pregnancy with your healthcare provider.
What Illnesses Does Varicella
Chickenpox first occurs as a blister-like skin rash and fever. It takes from 10-21 days after exposure for someone to develop chickenpox. The sores commonly occur in batches with different stages present at the same time. The blisters usually scab over in 5 days. A person with chickenpox is contagious 1-2 days before the rash appears and until all blisters have formed scabs. Children with weakened immune systems may have blisters occurring for a prolonged time period. Adults can develop severe pneumonia and other serious complications.
Shingles occurs when the virus, which has been inactive for some time, becomes active again. Severe pain and numbness along nerve pathways, commonly on the trunk or on the face, are present. Clusters of blisters appear 1 to 5 days later. The blisters are usually on one side of the body and closer together than in chickenpox. Shingles does not spread as shingles from one person to another. If people who have never had chickenpox come in contact with the fluid from shingles blisters, they can develop chickenpox.
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Should You Get A Covid
Some experts recommend that it can be a good idea for people with autoimmune diseases to get the COVID-19 vaccine. This is because people who have autoimmune diseases may have weakened immune systems due to taking immunosuppressant medications to treat their conditions.
People with weakened immune systems may be more likely to get severe COVID-19, according to the . Experts say that the vaccine may be effective against the illness severity. Speak with your doctor to learn more about the COVID-19 vaccine to see if its right for you.
Who Shouldnt Get A Shingles Vaccine
The CDC says some people shouldnt get the shingles vaccine. That includes those who:
- Have ever had a severe allergic reaction to any component of the vaccine or after a dose of Shingrix
- Tested negative for VZV immunity
- Currently have shingles
- Have a severe or moderate acute illness, such as a respiratory infection
Your healthcare provider can answer any questions you have about whether the vaccine is safe for you.
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Open Access License / Drug Dosage / Disclaimer
This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License . Usage and distribution for commercial purposes requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor. The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
Guidance On Reporting Adverse Events Following Immunization
Vaccine providers are asked to report AEFIs through local public health officials and to follow AEFI reporting requirements that are specific to their province or territory. In general, any serious or unexpected adverse event felt to be temporally related to vaccination should be reported.
For LZV the following AEFIs are also of particular interest and should be reported:
- Suspected transmission of vaccine-strain virus to a close household or occupational contact. This phenomenon has been documented following varicella vaccine but it is rare, and transmission has not been documented with LZV.
- Recurrent HZ following immunization of individuals with a history of HZ prior to immunization, noting the area of recurrence.
- Recurrent HZO following immunization of a person who has had a previous episode of HZO. If available, a vitreous fluid specimen should be sent to a laboratory with a request to determine whether the virus is the vaccine strain or wild type virus.
For definitions of serious and unexpected adverse events, refer to Adverse Events Following Immunization in Part 2.
For more information refer to Reporting Adverse Events Following Immunization in Canada.
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