Herpes Zoster Vaccine: Canadian Immunization Guide
For health professionals
Last complete revision:
July 2018 This chapter was revised to reflect NACI’s Updated Recommendations on the Use of Herpes Zoster Vaccines. Most sections were revised to include information and practice recommendations for the new recombinant zoster vaccine which is now available in Canada. Changes include:
- Recommendations for use in different populations.
- Contraindications and precautions.
- Administration of the HZ vaccines: Table 1 was added to summarize key information.
- Considerations on the efficacy, effectiveness and immunogenicity of HZ vaccines: Table 2 was added to summarize key information.
- Vaccine safety and adverse events.
Side Effects And Counseling For Reactogenicity
In eight 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. Also, 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.
Healthcare providers should counsel patients about expected reactogenicity before administering Shingrix.
What to tell patients about the side effects of Shingrix:
Most people have a sore arm after they get Shingrix. Many people have redness and swelling on their arm spanning several inches where they got the shot. Many people also felt tired or experienced muscle pain, a headache, shivering, fever, stomach pain, or nausea. About 1 out of 6 people had symptoms severe enough to prevent them from doing regular activities. You should plan to avoid strenuous activities, such as yardwork or swimming, for a few days after vaccination. Remember that the pain from shingles can last a lifetime, and these side effects should only last 2 to 3 days.
The impact of prophylactic analgesics in conjunction with Shingrix has not been studied. However, you may suggest patients take over-the-counter ibuprofen or acetaminophen to ease discomfort from side effects.
What Else To Know About The Shingles Vaccine
Ready to get vaccinated? This is the essential info on how the shots are given, what to expect with side effects, and more.
You need two doses of Shingrix to get full protection from shingles. You should get your second dose 2 to 6 months after the first. Your doctor or pharmacist will inject the vaccine into the muscle of your upper arm, so wear clothes that give easy access to that area.
If it has been more than 6 months since you got your first dose, go ahead and get your second dose. You dont need to start over, Dooling says.
Continued
Because Shingrix is so new, experts arent sure whether youll eventually need another shot, or a booster, years down the road.
The CDC is actively following how protected people remain after the two-dose series, she says. We know that after 4 years, protection remains above 85%. Only time will tell how durable that protection is.
You have to wait 2 weeks between Shingrix and COVID-19 vaccination. The COVID-19 vaccines are so new that the CDC isnt sure how theyll interact with Shingrix. If youve gotten either Shingrix or a COVID-19 vaccine in the last 14 days, youll need to reach the 2-week mark before you get the other one.
Side effects are fairly common. You may have heard that people sometimes have unpleasant side effects soon after they get the shingles vaccine.
Shingrix tends to have has more side effects than some vaccines, like those for the seasonal flu, says Kistler. The shingles vaccine may cause:
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Routine Vaccination Of People 60 Years Old And Older
CDC recommends a single dose of Zostavax® for people 60 years old or older, whether or not the person reported a prior episode of herpes zoster . People with chronic medical conditions may be vaccinated unless a contraindication or precaution exists for their condition. Zostavax is a live virus vaccine. It can be administered concurrently with all other live and inactivated vaccines, including those routinely recommended for people 60 years old and older, such as influenza and pneumococcal vaccines.
When vaccinating people 60 years old or older, there is no need to screen for a history of varicella infection or to conduct laboratory testing for serologic evidence of prior varicella infection. Even if a person reports that they have not had varicella, they can still receive the herpes zoster vaccine. The Zostavax®zoster vaccine package insert pdf iconexternal icon makes no reference to varicella history, and almost all people 60 years old or older are immune to varicella. The Advisory Committee on Immunization Practices states that people born in the United States prior to 1980 are considered immune to varicella. If serologic evidence of varicella susceptibility becomes available to the healthcare provider, the patient should be offered varicella vaccine not herpes zoster vaccine.
The general guideline for any vaccine is to wait until the acute stage of the illness is over and symptoms abate.
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.
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Is There Anyone Who Should Not Get The Shingles Vaccine
The shingles vaccine is a live virus and, therefore, should not be given to anyone with a weakened immune system. This includes individuals who are being treated with radiation or chemotherapy or who are on steroid medications. The vaccine also should not be given to anyone who has had a life-threatening reaction to the ingredients in the vaccine, so talk to your doctor about your specific health situation.
Mrna Vaccine Makers Set Sights On Shingles And The Epstein
More advances on the mRNA vaccine front this week as both Pfizer and Moderna move forward on new viral targets for future vaccines. Pfizer is turning its focus to shingles while Moderna has begun human trials for a mRNA vaccine against the Epstein-Barr Virus.
Shingles is a painful viral disease caused by the herpes zoster virus, the same virus responsible for chickenpox. After one is initially infected with the virus it often remains dormant and can reactivate decades later. Around one in three people will experience shingles in their lifetime.
In a new announcement Pfizer will again join forces with mRNA developer BioNTech, this time focusing on the development of a mRNA shingles vaccine. Pfizer notably joined up with BioNTech in early 2020 to accelerate development of BioNTech’s mRNA COVID-19 vaccine, which subsequently became the first vaccine of its type to reach the general public.
Pfizer and BioNTech co-developed the worlds first mRNA vaccine, providing a well-tolerated and effective tool to help address COVID-19 the most devastating pandemic in a century and demonstrating consistent, agile and high-quality manufacturing on an unprecedented scale, explains Pfizers chief scientific officer, Mikael Dolsten. With this agreement, we continue on our journey of discovery together, by advancing mRNA technology to tackle another health challenge ripe for scientific innovation, supported by our world-class manufacturing network.
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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.
Who Should Not Get The Shingles Vaccine
The shingle vaccine is a live vaccine. This means that it contains weakened viruses that cannot cause infection but makes your body produce the antibodies it needs in case you are exposed to or get the infection later in life.Live vaccines, like the shingles vaccine, can cause an infection in people with very weakened immune systems and should not be used in people with leukaemia, lymphoma, other conditions affecting your bone marrow, tuberculosis or in people having immunosuppressive therapy such as chemotherapy. Check with your doctor if you are unsure if you are in this group. It should also not be given to children and pregnant women.
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How Do You Catch Shingles
You do not “catch” shingles it comes on when there’s a reactivation of chickenpox virus that’s already in your body.
After you’ve recovered from chickenpox, the varicella-zoster virus lies dormant in your nerve cells and can reactivate at a later stage when your immune system is weakened.
Anyone who has had chickenpox can get shingles.
How Do I Protect Myself From Shingles
The best protection from shingles is vaccination. People can still get shingles after receiving the varicella vaccine but they are 4 to 12 times less likely to do so than if they haven’t been immunized. The vaccine is recommended for most people 60 and older.
Some people should not receive the vaccine for example, those with certain allergies or who are taking certain medications. A health professional can advise who should not be vaccinated due to contraindications to the vaccine.
People between 50 and 59 years can request the vaccine from their health professional.
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Why Is Vaccination Against Shingles Recommended
While shingles can get better on its own, having the shingles vaccine can prevent you from getting shingles at all. If you do get shingles, vaccination can prevent you from getting the complications of shingles and prevent you from getting shingles again. The most common complication from the shingles infection is pain after the infection has gone and 1 in 5 people experience it. The pain can carry on for months to years after the infection, and is described as burning, sharp and jabbing, or deep and aching. This is called postherpetic neuralgia .
Other complications from shingles infection include glaucoma, vision loss, facial weakness and hearing loss.
Will There Be Any Side Effects From The Shingles Vaccination
There are 2 shingles vaccines: Zostavax and Shingrix .
With both vaccines it’s quite common to get redness and discomfort at the vaccination site, headaches and fatigue, but these side effects should not last more than a few days. See a GP if you have side effects that last longer than a few days, or if you develop a rash after having the shingles vaccination.
Read more about the shingles vaccine side effects.
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What Are The Risks Associated With Shingles
Some people experience pain around the rash site for a month or morepain that is severe enough to interfere with daily activities.
Scratching the rash can also cause a secondary infection if harmful bacteria get into the sores.
Shingles on the face can involve the eyes, which is serious because it can cause scarring and blindness.
The occurrence and severity of shingles and its complications increase with age.
What Are The Possible Side Effects Of Shingrix
Studies show that Shingrix is safe. The vaccine helps your body create a strong defense against shingles. As a result, you are likely to have temporary side effects from getting the shots. The side effects may affect your ability to do normal daily activities for 2 to 3 days.
Most people got a sore arm with mild or moderate pain after getting Shingrix, and some also had redness and swelling where they got the shot. Some people 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. Symptoms went away on their own in about 2 to 3 days. Side effects were more common in younger people.
You might have a reaction to the first or second dose of Shingrix, or both doses. If you experience side effects, you may choose to take over-the-counter pain medicine such as ibuprofen or acetaminophen.
If you experience side effects from Shingrix, you should report them to the Vaccine Adverse Event Reporting System . Your doctor might file this report, or you can do it yourself through the VAERS websiteexternal icon, or by calling 1-800-822-7967.
If you have any questions about side effects from Shingrix, talk with your doctor.
The shingles vaccine does not contain thimerosal .
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Considerations For Patients Who Previously Received Zostavax
Studies have not examined the safety and immunogenicity of Shingrix administered less than 5 years following Zostavax® vaccination. However, there are no data or theoretical concerns to indicate that Shingrix would be less safe or less effective when given at an interval shorter than 5 years following Zostavax. Since the risk of herpes zoster increases with age, providers should weigh a patients risk of herpes zoster with the age-specific protection expected from Zostavax to determine when to vaccinate with Shingrix.
- Shingles=Herpes Zoster or Zoster
- VZV=varicella zoster virus
What Are The Side Effects
Because the vaccine helps your body create a strong defense against shingles, you are likely to have temporary side effects from getting the shots. You may experience side effects after either dose or after both doses, which may include:
- Redness, soreness, swelling at the site of the vaccination.
- Tiredness, muscle pain, headache, shivering, fever, stomach pain or nausea.
About one out of six people who got Shingrix experienced side effects that prevented them from doing regular activities. Symptoms usually went away on their own in about two to three days.3
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The Biology Behind That Blistering Rash
During the initial exposure to chickenpox, some of the virus particles settle into the nerve cells around the spinal cord and brain. When the virus reactivates sometimes decades later, as a result of things like stress it travels down those nerve fibers to the skin. As the virus multiplies, the telltale rash erupts.
What Is The Brand Name Of The Shingles Vaccine
There are 2 shingles vaccines used in the UK:
- Zostavax, a live vaccine given as 1 dose
- Shingrix, a non-live vaccine given as 2 doses, 2 months apart
Most people will have the Zostavax vaccine. The Shingrix vaccine is recommended if Zostavax is not suitable for you, for example if you have a condition that affects your immune system.
You can read more about the shingles vaccines in the patient information leaflets:
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