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 .
For Patients Who Previously Received Zostavax
Zostavax is no longer available for use in the United States, as of November 18, 2020. Consider the patients age and when he or she received Zostavax to determine when to vaccinate with Shingrix. Studies examined the safety of Shingrix vaccination 5 or more years after Zostavax vaccination. Shorter intervals were not studied, but there are no theoretical or data concerns to indicate that Shingrix would be less safe or effective if administered less than 5 years after a patient received Zostavax.
You may consider an interval shorter than 5 years between Zostavax and Shingrix based on the age at which the patient received Zostavax. Differences in efficacy between Shingrix and Zostavax are most pronounced among older patients. Studies have shown that the effectiveness of Zostavax wanes substantially over time, leaving recipients with reduced protection against herpes zoster. For example, the vaccine efficacy among adults aged 70 to 79 years and adults aged 80 years and older is 41% and 18%, respectively, on average during the first 3 years following Zostavax vaccination.
You should wait at least 8 weeks after a patient received Zostavax to administer Shingrix.
Can You Describe The Vaccine How Long Has It Been Around Is There A New Brand On The Market Thats Showing Better Efficacy
One shingles vaccine, Shingrix, is available in the United States. It was licensed by the FDA in 2017. The manufacturer of a previous vaccine, Zostavax, discontinued making this vaccine in 2020.* In clinical trials, Shingrix was 97% effective at preventing shingles in adults ages 50-69 and 91% for adults 70 years and older. Shingrix is not a live vaccine.
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How Is Shingles Diagnosed
A doctor will examine the rash on your skin and ask you about your symptoms. This is usually how healthcare professionals diagnose shingles.
A healthcare professional may remove some fluid from a blister for testing, but typically this is not necessary.
recommends:
- two doses of chickenpox vaccine regardless of age
- two doses of Shingrix for adults over age 50 and adults with weakened immune systems
According to the , you should get the vaccine even if, in the past, you:
- received Zostavax, another vaccine that is no longer on the market
- received the varicella vaccine
Creating and maintaining healthy lifestyle habits such as stress management, a healthy diet, regular exercise, and getting plenty of sleep can also help prevent or lessen flare-ups.
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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How Is Shingles Spread
A person must have already had chickenpox in the past to develop shingles. A person cannot get shingles from a person that has shingles. However, the virus that causes chickenpox and shingles can be spread from a person with active shingles to a person who has never had chickenpox or had the chickenpox vaccine. The person exposed to the virus would develop chickenpox, not shingles. A person with shingles can spread the virus when the rash is in the blister-phase. The blister fluid is filled with virus particles. The virus is spread through direct contact with the rash or through breathing in virus particles that get mixed in the air. Once the rash has developed crusts, the person is no longer contagious. A person is not infectious before blisters appear or if pain persists after the rash is gone .
Whats The Outlook For People Who Have Shingles
Shingles can be painful but the blisters often begin to heal within a week. Your skin usually clears up within a month.
People who develop PHN can have it for months or years afterward, but not everyone who has shingles will develop PHN.
Healthcare professionals can help treat shingles and shorten its duration with prescription antiviral drugs. These can also reduce your likelihood of having PHN.
Most people only get shingles once, though it is possible to get it again.
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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.
Some people with shingles also experience additional symptoms including fever, headache, chills or upset stomach.
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.
Who Should Get The Shingles Vaccine
The CDC recommends all healthy adults ages 50 years and older get two doses of the shingles vaccine to prevent shingles and problems that can develop after youve had the disease. The two doses should be separated by two to six months. You should get the shingles vaccine even if you:
- Have had shingles: If youve had shingles in the past, you should get the shingles vaccine to help prevent getting the disease again. You should wait until the shingles rash is gone before getting the vaccine.
- Arent sure if youve had chickenpox: Studies show more than 99% of Americans ages 40 and older have had chickenpox at some point in their lives. You should get the shingles vaccine whether or not you remember having chickenpox because theyre caused by the same virus.
- Received the old shingles vaccine : Before November 18, 2020, people were vaccinated with a shingles vaccine called Zostavax. You cant get Zostavax in the United States anymore. If you were vaccinated with Zostavax, you should get vaccinated with the new shingles vaccine, Shingrix.
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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 might 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. Some 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.
Guillain-Barré syndrome , a serious nervous system disorder, has been reported very rarely after Shingrix. There is also a very small increased risk of GBS after having shingles.
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.
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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Who Is At Risk For Shingles
Anyone who has had chickenpox is at risk for getting shingles. But this risk goes up as you get older shingles is most common in people over age 50.
People with weakened immune systems are at higher risk of getting shingles. This includes those who:
- Have certain cancers
- Take immunosuppressive drugs after an organ transplant
Your immune system may be weaker when you have an infection or are stressed. This can raise your risk of shingles.
It is rare, but possible, to get shingles more than once.
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What Are The Side Effects
The shingles vaccines are very safe.
Common side effects to the vaccines include headache as well as soreness, redness and swelling where the vaccine was given. Itching and a rash may also occur after getting Zostavax® II. Other reactions that may occur after getting Shingrix® include fever, muscle soreness, fatigue, shivering, nausea, vomiting and diarrhea.
It is important to stay in the clinic for 15 minutes after getting any vaccine because there is an extremely rare possibility of anaphylaxis, which is a life-threatening allergic reaction. This may include hives, difficulty breathing, or swelling of the throat, tongue, or lips. The chance of true anaphylaxis is about 1 in 1 million vaccine doses. Should this reaction occur, your health care provider is prepared to treat it. Emergency treatment includes administration of epinephrine and transfer by ambulance to the nearest emergency department. If symptoms develop after you leave the clinic, call 9-1-1 or the local emergency number. Learn more about anaphylaxis on our vaccine side effects page.
It is important to always report serious or unexpected reactions to your health care provider.
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How Long Does Shingles Last
Most cases of shingles last three to five weeks.
- The first sign is often burning or tingling pain sometimes it includes numbness or itching on one side of the body.
- Somewhere between one and five days after the tingling or burning feeling on the skin, a red rash will appear.
- A few days later, the rash will turn into fluid-filled blisters.
- About one week to 10 days after that, the blisters dry up and crust over.
- A couple of weeks later, the scabs clear up.
Main Symptoms Of Shingles
The first sign of shingles you may notice is a burning, tingling feeling on one side of your body. Then a rash may appear in the same area afterward.
You may also notice red patches on the skin, fluid-filled blisters, a raised rash, fever and chills, stomach ache, light sensitivity, headache, and exhaustion.
If shingles affect a nerve in your face, you may also experience:
- Difficulty moving your facial muscles
The signs and symptoms associated with shingles will usually take three to five weeks to disappear completely. For some people, symptoms appear without rashes. If you suspect you have shingles symptoms, consider talking to your doctor.
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Who Should Not Get Zostavax
Some people should not get shingles vaccine :
The Shingles Prevention Study involved individuals age 60 years and older and found that Zostavax significantly reduced disease in this age group. The vaccine is currently recommended for persons 60 years of age and older.
- A person who has ever had a life-threatening or severe allergic reaction to gelatin, the antibiotic neomycin, or any other component of shingles vaccine. Tell your doctor if you have any severe allergies.
- A person who has a weakened immune system because of:
- HIV/AIDS or another disease that affects the immune system,
- treatment with drugs that affect the immune system, such as steroids,
- cancer treatment such as radiation or chemotherapy, or
- cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma.
Someone with a minor acute illness, such as a cold, may be vaccinated. But anyone with a moderate or severe acute illness should usually wait until they recover before getting the vaccine. This includes anyone with a temperature of 101.3°F or higher.
This information was taken from the Shingles Vaccine Information Statement dated 10/06/2009.
How Do You Get Immunised Against Shingles
You can only get the shingles vaccine on its own, not as a combination vaccine. It is given as a needle.
Shingles vaccines include:
Note the Zostavax vaccine contains a small amount of the live virus. Some people may not be able to receive a live vaccine for medical reasons, please discuss with your doctor or immunisation provider for further information.
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Is The Shingles Vaccine Safe
The FDA have approved the use of both shingles vaccines in healthy adults over the age of 50.
However, there are some instances in which a person should not get either vaccine â if they are pregnant or breastfeeding, allergic to any ingredient in the vaccine, or have a weakened immune system, for example.
Who Should Not Get Shingrix
You should not get Shingrix if you:
- Have ever had a severe allergic reaction to any component of the vaccine or after a dose of Shingrix.
- Currently have shingles.
- Currently are pregnant. Women who are pregnant should wait to get Shingrix.
If you have a minor illness, such as a cold, you may get Shingrix. But if you have a moderate or severe illness, with or without fever, you should usually wait until you recover before getting the vaccine.
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How You Get Shingles
You dont catch shingles. Chickenpox virus caught earlier in your life reactivates later to cause shingles. You cant catch shingles from someone who has chickenpox.
However, if you have shingles blisters, the virus in the fluid can infect someone who has not had chickenpox and they may develop chickenpox.
When Should You Get Immunised Against Shingles
Anyone aged 60 years and over who wants to protect themselves against shingles can talk to their doctor about getting immunised.
Shingles immunisation is recommended for:
- adults aged 60 years and over who have not previously received zoster vaccine
- adults aged 70 years to 79 years, for free under the National Immunisation Program
- adults aged 50 or over who live in the same household as someone who has a weakened immune system.
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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.
Available Vaccines And Vaccination Campaigns
Since 2008, the U.S. Advisory Committee on Immunization Practices has recommended most Americans aged 60 and older get the shingles vaccine. A newer recommendation was issued in 2018 with the licensure of a new vaccine: .
In adults 50-69 years old, Shingrix reduces the risk of shingles by more than 96%. For those 70 and older, the vaccine is 91.3% effective at preventing shingles. It similarly reduces the risk of post-herpetic neuralgia. Modeling studies project that protection will wane to 0 by 19 years after immunization. Study of the expected duration of protection is ongoing.
The antigen in Shingrix is a surface protein of the varicella zoster virus produced by culturing genetically engineered Chinese hamster ovary cells. Vaccination consists of two doses of vaccine, given at months 0 and 2-6.
The older shingles vaccine is a live, attenuated vaccine. It was licensed in 2006. The generic name of the vaccine is Zoster Vaccine, Live . It is still available, although Shingrix is recommended over Zostavax because of its superior effectiveness and duration of protection.
People who have previously been vaccinated with Zostavax are recommended to vaccinate with Shingrix.
Most Medicare drug plans cover the cost of the shingle vaccine and its administration, minus any copayments, for people 65 and older. Most private insurance plans provide coverage for the vaccination for people 50 and older.
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