Administration With Other Vaccines
CDC general recommendations advise that recombinant and adjuvanted vaccines, such as Shingrix, can be administered concomitantly, at different anatomic sites, with other adult vaccines, including COVID-19 vaccines. Concomitant administration of Shingrix with Fluarix Quadrivalent , 23-valent pneumococcal polysaccharide vaccine and Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine, Adsorbed , and 13-valent pneumococcal conjugate vaccine has been studied, and there was no evidence for interference in the immune response to either vaccine or safety concerns. Coadministration of Shingrix with adjuvanted influenza vaccine and COVID-19 vaccines is being studied.
Shingrix and pneumococcal vaccine can be administered at the same visit if the person is eligible for both. When both pneumococcal conjugate vaccine PCV13 and PPSV23 are recommended for an adult, PCV13 should always be administered first and can be administered concomitantly with Shingrix.
What Are The Main Differences Between Shingrix And Zostavax
Shingrix is a recombinant, adjuvanted zoster vaccine that was first FDA-approved in 2017. It contains a certain protein called the varicella-zoster glycoprotein E antigen to produce an immune response in the body. Shingrix also contains an adjuvant, or added ingredient, to help boost the bodys immune response to the virus. The adjuvant suspension in Shingrix contains an extract from the Quillaja saponaria tree, known to modulate immune activity. Because Shingrix is an inactivated or non-live 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 between the first and second doses. The second dose is necessary to ensure long-term effectiveness. Immunocompromised or immunodeficient individuals may require a shorter vaccine schedule and can get the booster one to two months after the first shot.
Shingrix is currently the preferred shingles vaccine, according to the Centers for Disease Control and Prevention .
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, Zostavax is not recommended for those who are immunocompromised. Otherwise, the vaccine may cause a symptomatic infection, even weeks following vaccination.
Who Should Not Get The Vaccine
It is safe for most people to get two doses of Shingrix. However, you should talk to your healthcare provider before getting the shingles vaccine if:
- You are pregnant
- You have severe allergies to any of the Shingrix ingredients
- You have ever experienced a severe allergic reaction to Shingrix
If you have a mild sickness, such as a cold, its usually safe to get the shingles vaccine. If you are moderately or severely ill, you should wait until you feel better to get your next dose of Shingrix.
You should still get the shingles vaccine if you dont remember having the chickenpox virus in the past and if youve had shingles previously. Shingrix can protect you against developing shingles again in the future.
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Does Delay Of Second Shingrix Dose Warrant A Third Shot
DEAR DR. ROACH: Three years ago, I turned 60 and received my first dose of Shingrix. I had a highly unpleasant reaction, with fever and flulike symptoms. I did not return for the second dose until last week, so although I have had two doses, they are three years apart. Do I need to get another dose in a short window of my most recent vaccination or will I be considered protected since I have had two doses, just significantly spaced apart? By the way, no reaction this round other than a sore arm! K.B.S.
ANSWER: The new two-dose shingles subunit vaccine is a highly effective treatment to prevent shingles and its complications. It is recommended you get the second dose two to six months after the first dose. According to the Centers for Disease Control and Prevention:
The vaccine series need not be restarted if more than 6 months have elapsed since the first dose however, the efficacy of alternative dosing regimens has not been evaluated, data regarding the safety of alternative regimens are limited, and individuals might remain at risk for herpes zoster during a longer than recommended interval between doses 1 and 2.
Despite that somewhat reassuring statement, three years seems to be pushing it to me, and I would really consider getting a third dose two to six months after the dose you just took. You may get a reaction, but you would be surer about having protection against shingles.
What Does The Shingles Vaccine Do
The shingles vaccine can prevent shingles. Every year, about 1 million people in the United States get shingles. Anyone whos had chickenpox can get shingles. Thats because the varicella-zoster virus lives silently in your nervous system after youve had chickenpox. The virus can reactivate later in your life if your immune system is weakened. Your risk of getting shingles goes up as you get older. In the United States, 1 in 3 people will get shingles in their lifetime.
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Coverage And Cost Comparison Of Shingrix Vs Zostavax
For adults aged 50 years and older, only plans with Medicare Part D coverage will cover the Shingrix vaccine. However, there may still be a copay even with Medicare Part D coverage. The average cash price for one Shingrix dose is $167, though you may be able to use a prescription discount card to lower this cost. Check with your local pharmacy to see if you can use a Shingrix SingleCare card. Like Shingrix, Zostavax is primarily covered by Medicare Part D plans or Medicare Advantage plans with Medicare Part D coverage. The copay for Zostavax with insurance can vary. With an average cash price of $278, Zostavax can be expensive with or without insurance. Using a prescription discount card for Zostavax may be able to reduce this cost.
*not reportedFrequency is not based on data from a head-to-head trial. This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.Source: DailyMed , DailyMed
Shingrix Vs Zostavax: Differences Similarities And Which Is Better For You
In March 2021, the FDA approved a safety labeling change for Shingrix. The label now contains a warning about a possible increased risk of Guillain-Barré Syndrome with Shingrix. However, the FDA affirms the benefits of the vaccine continue to outweigh the risks. Read more about the FDA warning here.
In addition, Zostavax has been discontinued in the U.S. as of November 2020. The original post has been preserved for informational purposes only.
Shingrix and Zostavax are vaccines that can be given to prevent herpes zoster, more commonly known as shingles. A shingles vaccine is recommended for adults once they turn 50, and it can help prevent the rash and other complications associated with shingles.
Most people have been infected with the varicella-zoster virus if theyve ever had chickenpox. After chickenpox resolves, the varicella-zoster virus lies dormant in the body for years, if not forever. Later in life, the virus can reactivate as shingles and cause a painful rash that usually wraps around the face or torso.
Although Shingrix and Zostavax work in similar ways to prevent shingles, there are some important differences between the two.
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Shingrix For Prevention Of Shingles
Shingrix is a vaccine thats used to prevent shingles . Its approved for use in people:
- ages 50 years and older
- ages 18 years and older who have an increased risk of shingles
People with an increased risk of shingles include those with a weakened immune system, such as people with HIV.
Shingrix is not meant for use in preventing chickenpox .
Effectiveness for prevention of shingles
Shingrix has been found to be effective in helping to prevent shingles. For details on how the drug performed in clinical studies, see Shingrixs
state that Shingrix is the preferred vaccine for shingles. They recommend it for:
- all adults ages 50 years and older
- adults ages 18 to 50 years with a weakened immune system
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.
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What Are The Advantages Of Getting The Shingles Vaccine
The shingles vaccine reduces your risk of getting shingles. Shingles causes a painful rash that usually develops on one side of your body or face. Some people describe the pain as an intense burning or shooting sensation. The rash is often a single strip that wraps around one side of your body or is on one side of your face. It consists of blisters that normally crust over in seven to 10 days. The rash generally clears up within a month.
For some people, the pain from the rash can last for months or even years after the rash goes away. This long-term pain is called postherpetic neuralgia , and it is the most common complication of shingles.
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Swelling Around The Injection Site
Swelling around the injection site is another common side effect of Shingrix. Like pain and redness, minor swelling can usually result from a localized immune system response, which isnt necessarily dangerous.
You can apply hydrocortisone cream on or around the injection site to reduce redness and swelling. However, if you experience severe swelling that doesnt go away, or the swelling accompanies other symptoms of an allergic reaction, seek medical attention right away.
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Who Can Give The Vaccine
There is not much you need to do to prepare to get a shingles vaccine. You dont even necessarily need an appointment.
A doctor can schedule a time to give you the vaccine, but licensed pharmacists are also allowed to administer it. Some pharmacies offer shingles vaccines on a walk-in basis. Check with your healthcare professional or pharmacy to be sure.
Whether youve made an appointment or walked into a pharmacy for vaccination, the next steps are simple.
Who Shouldnt Get The Shingles Vaccine
There are a few situations in which shingles vaccination may not be right for you. You should not get Shingrix if youâve ever had a severe reaction to a vaccine. This means you had trouble breathing or swelling in your mouth or airway, a life-threatening condition called anaphylaxis.
You should also skip Shingrix if:
- You have allergies to any parts of the vaccine. These include gelatin and the antibiotic neomycin. If you have other allergies, tell your doctor or pharmacist about them before you get Shingrix.
- You currently have shingles or another illness. You can get the vaccine when youâre well.
- You are pregnant or breastfeeding. You should wait until youâve stopped breastfeeding to get vaccinated.
- You happened to test negative for VZV, the virus that causes chickenpox. If youâre older than 50, you probably had chickenpox even if you donât remember it. The CDC does not recommend testing for this. However, if a blood test shows youâve never had the childhood illness, you should get the chickenpox vaccine instead.
If you have a disease or take medications that affect your immune system, talk to your doctor about the pros and cons of Shingrix.
âItâs an individualized decision based on factors such as the specific medications and conditions of the person sitting in front of you,â Kistler says. She often consults with her patientsâ specialist doctors to make decisions about Shingrix.
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When To See A Healthcare Provider
For most people, the effects of Shingrix are mild and short-term. In very rare cases, Shingrix can cause more serious side effects.
Seek urgent medical care if you experience signs of a severe allergic reaction a few minutes or hours after your second dose of Shingrix, such as:
- Rapid heartbeat
- Facial swelling
- Swelling in the throat or mouth
You should also let your healthcare provider know if your Shingrix side effects are severe or arent going away on their own.
Drug Interactions Of Shingrix Vs Zostavax
Immunosuppressive drugs, such as cyclosporine and tacrolimus, may decrease the effectiveness of vaccines. Steroids, like prednisone, and chemotherapy can also have immunosuppressive effects that can alter how well vaccines work.
People who are on immunosuppressive therapy should avoid Zostavax altogether Zostavax contains the live varicella-zoster virus, which could result in an infection. The risk of a vaccine-related infection may be increased if the bodys immune system is suppressed.
Antiviral drugs, such as acyclovir and famciclovir, may interfere with the effects of the Zostavax vaccine. The Advisory Committee on Immunization Practices recommends that people who are on antiviral drugs stop taking antiviral medications 24 hours before getting a Zostavax vaccine. Treatment with antiviral drugs should not be resumed for at least 14 days after vaccination with Zostavax. Clinical studies have found that getting both the Zostavax and Pneumovax vaccine at the same time may lead to a reduced immune response to Zostavax. The administration of Zostavax and Pneumovax should be separated by at least four weeks.
Consult a healthcare professional for other possible drug interactions
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Who Is A Candidate For The Shingles Vaccine
Healthy adults aged 50 years and older are candidates for the shingles vaccine Shingrix. There is no age limit, and you can get the Shingrix vaccine even if you have already had shingles, have had the Zostavax vaccine, or do not remember whether you have had chickenpox in the past.
If you have already had shingles, getting the Shingrix can help protect you from the disease coming back. Studies have reported that almost every American aged 40 years and older have more than a 99% chance of having had chickenpox, and people who have had chickenpox are more likely to develop shingles in the future because both are caused by the same virusthe varicella-zoster virus.
After having shingles, there is no duration that you need to wait before getting vaccinated, although you should wait until the rash has completely disappeared. Shringrix is given in 2 doses 2-6 months apart.
Side effects are usually mild and may last for two to three days. No severe side effects for Shingrix have been reported so far.
Who Shouldnt Receive Shringrix
Although vaccines go through rigorous safety testing to ensure they are safe, they arent suitable for everyone. You shouldnt receive Shingrix if you:
- have an active shingles infection
- have a severe illness or a fever of 101.3°F or higher
- have had a severe allergic reaction to Shingrix or any ingredient in the vaccine
- have no immunity to varicella based on a blood test carried out for other reasons
- are pregnant or breastfeeding
If you currently have shingles, another serious illness, or a fever of 101.3°F , wait until these issues have resolved to receive a Shingrix vaccination.
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Know The Benefits And The Side Effects
Shingrix is more than 90% effective at preventing shingles and long-term nerve pain. You may experience some short-term side effects because Shingrix causes a strong response in your immune system.
After getting Shingrix:
- Most people had a sore arm.
- Many people had redness and swelling where they got the shot .
- Many felt tired, had muscle pain, a headache, shivering, fever, stomach pain, or nausea.
About 1 out of 6 people who got Shingrix experienced side effects that prevented them from doing regular activities like yardwork or swimming. Side effects usually go away after 2 to 3 days. Remember that the pain from shingles can last a lifetime, and these side effects should only last a few days.
Late For The Second Dose
The recommended dosing schedule for Shingrix is as a two-shot series:
- One dose initially followed by a second dose 2 to 6 months later.
The question of what to do if it has been more than 6 months since your first dose comes up often.
First off, if you have had trouble finding a location that has the vaccine in stock and it has been more than 6 months since your first dose, you do not have the start the vaccine series over again.
The two most authoritative resources on the matter, the CDC and Immunization Action Coalition, recommend the following:
- Continue to look for the second dose of the vaccine and get it as soon as possible.
- You should not restart the vaccine series.
- Do not substitute the other herpes vaccine for your second dose.
The following excerpt is from the ‘Ask The Experts’ section on Immunize.org:
If more than 6 months have elapsed since the first dose of RZV , administer the second dose when possible. Do not restart the vaccine series, and do not substitute ZVL for the second dose of RZV . If you are out of RZV and a patient needs a second dose, the Vaccine Finder may be helpful for patients to locate other providers that have RZV in stock. Immunization Action Coalition
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