Vaccination Of Immunocompromised Adults 19 Years And Older
CDC recommends two doses of RZV for the prevention of shingles and related complications in adults aged 19 years who are or will be immunodeficient or immunosuppressed because of disease or therapy. The second dose of RZV should typically be given 26 months after the first. However, for persons who are or will be immunodeficient or immunosuppressed and who would benefit from completing the series in a shorter period, the second dose can be administered 12 months after the first. For more detailed clinical guidance see .
Uncommon Rare And Very Rare Adverse Events
Uncommon adverse events occur in 0.1% to less than 1% of vaccinees. Rare and very rare adverse events occur, respectively, in 0.01% to less than 0.1% and less than 0.01% of vaccinees.
Both HZ vaccines are safe with serious adverse events reported very rarely in immunocompetent individuals.
Recurrence or exacerbation of herpes zoster ophthalmicus following LZV vaccination has been reported very rarely, involving several cases world-wide following LZV immunization. Following a causality assessment of seven cases of HZO which were temporally associated with the administration of LZV, NACI concluded that there was insufficient evidence to recommend for or against the administration of LZV in individuals with a history of HZO. More evidence is required for further assessment of risk related to HZO recurrence in LZV recipients. At this time, there is insufficient evidence to assess the risk related to HZO recurrence following RZV recipients.
See Contraindications and Precautions if considering vaccinating a person with previous HZO.
For more information, refer to Adverse Events Following Immunization in Part 2 and the product monograph in Health Canada’s Drug Product Database.
Very Common And Common Adverse Events
Very common adverse events occur in 10% or more of vaccinees. Common adverse events occur in 1% to less than 10% of vaccinees.
Injection site reactions are very commonly reported for both LZV and RZV. For LZV recipients the frequency is slightly higher in adults aged < 60 years. For all ages, the majority of these events were rated mild or moderate in intensity and lasted less than 2 days.
Due to the adjuvant in RZV, which induces a high cellular immune response and helps address the natural age-related decline in immunity, RZV is more reactogenic than LZV.
Injection site AEs are very commonly reported by recipients of RZV. Approximately 80% report injection-site pain and approximately 30% report redness at the site of injection.
Systemic adverse events, primarily fatigue and myalgia are common in LZV recipients and very common in RZV recipients . For RZV, they include headache .
Local and systemic reactions that were severe enough to interfere with normal activities have been more frequently reported following the receipt of RZV than LZV. However, these reactions have been temporary . Patient education on the short-term reactogenicity of the RZV is recommended prior to vaccine administration to promote adherence to the second dose.
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Where In The Body The Vaccination Is Given And How Many You Will Need
Like most vaccinations, the vaccine will be given in your upper arm. You will only have the vaccination once.
If you have the Zostavax vaccine, you will just need one injection. If you are not eligible for the live vaccine, you will need 2 doses of the Shingrix vaccine 2 months apart to give you the best protection. Once your course is completed, you will not need any more shingles vaccines.
Should I Get A Vaccine
Doctors say most healthy people over 50 should get Shingrix, as well as anyone 19 or older who are immunocompromised. Itâs available at pharmacies as well as doctorsâ offices. Most people have been exposed to the chickenpox even if they didnât actually develop symptoms.
You should get the Shingrix vaccine unless:
- You are allergic to any part of the vaccine
- Had a blood test that proves you never had chicken pox
- Have shingles now
- Are breastfeeding or nursing.
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Is The Shingles Vaccine Covered By Insurance
The shingles vaccine may be covered by insurance depending upon the insurance program:
- Medicare: Medicare Part D covers shingles vaccine expenses, but it depends on the plan. You may need to pay either in part or full and then get it reimbursed. Medicare part B does not cover the vaccine.
- Medicaid: Medicaid may or may not cover the vaccine. You can find out by contacting your insurer.
- Private health insurance: Most private health insurance programs cover the shingles vaccine, but you may need to pay some part of the expenses depending on your plan.
- Vaccine assistance program: Check with the Shingrix manufacturer, GlaxoSmithKline, if they have a Shingrix vaccine assistance program. Through vaccine assistance programs, people who cannot afford the vaccine can get help in the form of free vaccination.
Know Your Risk Of Getting Shingles And Complications
About 1 out of every 3 people in the United States will develop shingles during their lifetime.
If youve had chickenpox, you are at risk for shingles. More than 99% of Americans born before 1980 have had chickenpox, even if they dont remember it.
Your risk of getting shingles and having serious complications increases as you get older.
About 1 in 10 people who get shingles develop nerve pain that lasts for months or years after the rash goes away. This is called postherpetic neuralgia and is the most common complication of shingles.
Shingles may lead to other serious complications involving the eye, including blindness. Very rarely, it can also lead to pneumonia, hearing problems, brain inflammation or death.
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People Who Got Herpes Zoster Vaccine Instead Of Varicella Vaccine
A dose of recombinant herpes zoster vaccine administered instead of varicella vaccine does not count as a dose of varicella vaccine.
People who got the recombinant herpes zoster vaccine should be monitored for any serious adverse reactions. Adverse reactions and vaccine administration errors should be reported online to the Vaccine Adverse Event Reporting System external icon. If you need further assistance with reporting to VAERS, please email info@VAERS.org or call 1-800-822-7967.
What Are The Side Effects
Shingrix can make the area where you get the shot swell or feel sore. Other effects include:
- Many people who get the vaccine have muscle aches, headaches, or feel tired.
- About 1 in 4 people have a fever or an upset stomach.
Younger people are more likely to have these side effects, and they typically last 2 or 3 days.
Itâs also possible to have an allergic reaction to an ingredient in the vaccine. If you have problems breathing, feel your face or throat swelling, or feel weak or dizzy after the shot, call 911 and get medical help right away.
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How Well Does Shingrix Work
Two doses of Shingrix provide strong protection against shingles and postherpetic neuralgia , the most common complication of shingles.
- In adults 50 to 69 years old with healthy immune systems, Shingrix was 97% effective in preventing shingles in adults 70 years and older, Shingrix was 91% effective.
- In adults 50 years and older, Shingrix was 91% effective in preventing PHN in adults 70 years and older, Shingrix was 89% effective.
- In adults with weakened immune systems, Shingrix was between 68% and 91% effective in preventing shingles, depending on their underlying immunocompromising condition.
In people 70 years and older who had healthy immune systems, Shingrix immunity remained high throughout 7 years following vaccination.
What Are The Main Differences Between Shingrix And Zostavax
Shingrix is a recombinant, adjuvanted zoster vaccine that was first FDA-approved in 2017. It uses the varicella-zoster glycoprotein E antigen to produce an immune response in the body. An adjuvant, or added ingredient, helps boost the bodys immune response to the virus. Because Shingrix is an inactivated vaccine, it can be used in immunocompromised patients or those with a weakened immune system.
Shingrix is administered as an injection into the muscle . It is given in two separate doses with a period of two to six months in between. The second dose is necessary to ensure long-term effectiveness.
Zostavax, approved in 2006, is a live attenuated herpes zoster vaccine. In other words, Zostavax contains a weakened version of the actual virus to produce an immune response. For this reason, it is not recommended for those who are immunocompromised. Or else, the vaccine itself could cause an infection.
Zostavax is administered as a single injection underneath the skin . It comes in a frozen version and a refrigerator-stable version. The frozen version must be kept frozen during transport and storage to ensure its effectiveness while the refrigerator-stable Zostavax can be kept in a refrigerator until it needs to be used.
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What Vaccines Can Help Prevent Shingles
There is currently one vaccine available in the U.S. to prevent shingles. Shingrix was approved in 2017 and it is more than 90% effective in preventing shingles. With Shingrix, you get two shots between 2 and 6 months apart and protection lasts an estimated 4-5 years. Doctors recommend it for healthy people over 50 as well as those 19 years of age and older who are or will be immunodeficient or immunosuppressed due to disease or therapy..
An earlier vaccine called Zostavax was removed from the market in 2020. That vaccine used a weak form of the chickenpox virus to send your bodyâs immune system into action to fight the disease. Shingrix does not. If you received the Zostavax vaccine, it is recommended that you also receive Shingrix.
Who Shouldnt Get The Shingles Vaccine
You shouldnt receive the shingles vaccine if:
- Youve had a previous severe allergic reaction to Shingrix or any of its ingredients.
- Youre pregnant or breastfeeding.
- You have no immunity to chickenpox, which means you should get the chickenpox vaccine instead.
Having a mild illness like a cold isnt a reason to not get your shingles vaccine.
However, if you have a moderate to severe illness or a fever of 101.3 or higher, you should recover before getting your shingles vaccine.
state that the COVID-19 vaccine may be given without regard to the timing of other vaccines.
This means you dont have to wait to receive your COVID-19 and shingles vaccinations.
In fact, you can get your COVID-19 vaccine and shingles vaccine at the same time. If you choose to do this, make sure to receive your injections at two different sites.
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Contraindications And Precautions For Herpes Zoster Vaccination
Shingrix should not be administered to:
- A person with a history of severe allergic reaction, such as anaphylaxis, to any component of this vaccine.
- A person experiencing an acute episode of herpes zoster. Shingrix is not a treatment for herpes zoster or postherpetic neuralgia . The general guidance for any vaccine is to wait until the acute stage of the illness is over and symptoms abate.
There is currently no CDC recommendation for Shingrix use in pregnancy therefore, providers should consider delaying vaccination until after pregnancy. There is no recommendation for pregnancy testing before vaccination with Shingrix. Recombinant vaccines such as Shingrix pose no known risk to people who are breastfeeding or to their infants. Providers may consider vaccination without regard to breastfeeding status if Shingrix is otherwise indicated.
Adults with a minor acute illness, such as a cold, can receive Shingrix. Adults with a moderate or severe acute illness should usually wait until they recover before getting the vaccine.
To learn more, see Contraindications and Precautions, General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices .
Is The Shingles Shot Covered By Medicare
Original Medicare does not pay for the shingles vaccine. However, if youre enrolled in a Medicare prescription drug plan or have a Medicare Advantage plan that includes drug coverage, your shot may be covered. For vaccines covered under Part D , it is not recommended to get the shot through your providers office, as you may have issues with Part D billing.*
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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.
Why Do I Need Two Doses Of Shingrix
In addition to a painful rash, shingles can lead to serious health complications like PHN, pneumonia, vision loss, hearing problems, and encephalitis . Research indicates that about 1% to 4% of people with shingles will be hospitalized.
Two doses of Shingrix offer effective protection against shingles and related complications for at least seven years. Among healthy adults ages 50-69, Shingrix is more than 90% effective in preventing PHN when two doses are administered. Among adults ages 70 and older, it is 89% effective.
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People Who Got Varicella Vaccine But Should Not Have
People who got varicella vaccine but should not have because of contraindications should be monitored for adverse reactions. Any adverse reactions should be reported online to the Vaccine Adverse Event Reporting System external icon. If you need further assistance with reporting to VAERS, please email or call 1-800-822-7967.
People who had varicella or a positive serologic test for varicella in the past are less likely to develop serious adverse reactions to the vaccine, unless they have had a prior serious allergic reaction to any ingredient of a vaccine. For more information about potential adverse reactions, see Vaccine Safety.
Pregnant women should not get vaccinated. For more information, see Contraindications and Precautions for Varicella Vaccination or Guidelines for Vaccinating Pregnant Women: Varicella. To report administration of VZV-containing vaccines to a pregnant woman, call the manufacturer at 1-877-888-4231. See Mercks websiteexternal icon for more information. Inadvertent vaccination of pregnant women should also be reported to VAERSexternal icon.
Who Shouldn’t Get A Shingles Vaccine
The CDC says some people shouldn’t 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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Are There Any Restrictions After A Shingles Shot
You should not receive the shingles vaccine if you are pregnant, if you have an active shingles infection, or if you previously had an allergic reaction to any component of the vaccine. If youre eligible for the vaccine and receive the vaccination, there are no restrictions afterward and you can leave the doctors office or pharmacy as soon as the shot is complete.
What Shingles Vaccines Are Available
According to the Centers for Disease Control and Prevention , there are 2 vaccines licensed and recommended to prevent shingles in the U.S.: Shingrix and Zostavax.2 The CDC recommends that healthy adults 50 years and older get 2 doses of Shingrix, separated by 2 to 6 months, to prevent shingles and the complications from the disease.3
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Is Shingrix Or Zostavax More Effective
Shingrix and Zostavax have both been proven to prevent shingles. However, Shingrix is a newer vaccine that is considered more effective than Zostavax. Shingrix is even recommended for those who have already received the Zostavax vaccine in the past.
Clinical trials have shown that Shingrix is 97% effective at preventing shingles in adults aged 50 to 69 years old. Shingrix is also effective in preventing shingles in older adultsadults over the age of 70, Shingrix is 91% effective.
Zostavax has a 70% efficacy rate in preventing shingles in adults aged 50 to 69 years old, according to the Zoster Efficacy and Safety Trial . Results from the Shingles Prevention Study showed that Zostavax is 51% effective against shingles. Compared to Shingrix, the effectiveness of Zostavax decreases in older age groups. Based on the SPS results, Zostavax is 64% effective in adults aged 60 to 69 years old 41% effective in adults aged 70 to 79 years old and 18% effective in adults aged 80 years and older.
Your healthcare provider will most likely recommend Shingrix over Zostavax. Shingrix is especially recommended for immunocompromised patients since it is a non-live vaccine. Ask your doctor or pharmacist about which shingles vaccine is right for you.
When To See A Doctor For The Possible Side Effects Of A Shingle Vaccine
Most side effects of the shingles vaccine will resolve on their own within a few days of vaccination or can be treated with over-the-counter medications like acetaminophen or ibuprofen.
In the rare case that you develop a more serious reaction after vaccination, you should call a doctor or go to a health clinic.
Medical emergency
Its rare but possible to have a serious allergic reaction to a shingles vaccine. Call emergency services or go to the nearest emergency room if you experience the following symptoms after a vaccination:
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