New Shingles Vaccine Changes Recommendations For Adults
The pain associated with shingles can be unbearable. It can last for months and be so debilitating that even routine tasks become too difficult to bear. The single dose Zostavax® vaccine had been recommended since 2006, and it is about 50 percent effective at protecting against a shingles rash and about 75-80 percent effective at protecting against pain.
Fortunately, a new shingles vaccine, called Shingrix®, offers improved protection not only from developing the disease, but also against the severe pain associated with shingles. Shingrix is 95 percent effective at protecting against both the rash and associated pain. It is given as two doses separated by two to six months.
In this video, Dr. Offit discusses the differences between the two shingles vaccines and updated recommendations for adults. These include getting the vaccine at 50 years of age instead of 60 and being revaccinated if youve previously received the older version .
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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.
How To Pay For Shingrix
Commercial insurance covers about 96% of insured people for the Shingrix vaccine. Most people with private insurance will pay under $5 for each dose.
Programs like Medicaid cover Shingrix in certain states. Medicare Parts A and B do not cover the shingles vaccine. But individuals covered under Medicare prescription drug plans, or Part D, will have their vaccines covered.
For people who do not have access to insurance, there are a number of vaccine assistance programs and affordable health coverage options available. Many of these programs provide vaccines at little or no cost.
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How Does The Shingles Vaccine Work
The vaccine recommended for most people is a live vaccine called Zostavax. It contains a weakened chickenpox virus . It’s similar, but not identical, to the chickenpox vaccine.
People with a weakened immune system cannot have live vaccines. They will be offered a non-live vaccine called Shingrix. It activates the immune system but also contains an ingredient called an adjuvant, which helps to boost the response to the vaccine.
Very occasionally, people develop chickenpox following shingles vaccination . Talk to a GP if this happens to you.
Shingrix And Other Medications
Below are medications that can interact with Shingrix. These are not all the drugs that may interact with Shingrix.
Before taking Shingrix, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.
If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.
Immunosuppressive drugs such as prednisone
Taking Shingrix with drugs that suppress your immune system can cause problems with the way your body responds to Shingrix. Examples of immunosuppressive medications include:
- corticosteroids, such as:
Here are answers to some frequently asked questions about Shingrix.
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New Shingles Vaccine Is Cost Effective
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The new shingles vaccine is expensive, but worth it, according to a new analysis in JAMA Internal Medicine.
Shingles is a painful and sometimes debilitating nerve inflammation and blistering skin rash caused by the same virus that causes chickenpox. Anyone who has had chickenpox is susceptible to it many years later.
The old vaccine, Zostavax, is about 50 percent effective. The new one, Shingrix, provides 90 percent protection. It is given in two shots at $140 each, and it is recommended for people 50 and older. It will probably soon be covered by Medicare Part D and other insurers.
Using data from randomized trials, researchers calculated that using the new vaccine would save money over the long term, based on statistical measures that quantify the cost effectiveness of health care measures.
Our findings are subject to the proposed price $280, said the lead author, Phuc Le, an assistant professor at the Cleveland Clinic. Any price change in the future may change the calculation.
The age of the recipient and failure to get the second shot could change the cost effectiveness. But even allowing for such variables, if the new vaccine cost $350 for two doses, it would still be more cost effective than the old one.
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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Is Shingrix Or Zostavax Better
Shingrix is more effective than Zostavax. Shingrix is 97% effective at preventing shingles in adults aged 50 to 69 years old whereas Zostavax is only 70% effective at preventing shingles in the same age group. Shingrix consistently prevents shingles in older adults while the effectiveness of Zostavax decreases with increasing age. However, Shingrix has more systemic side effects than Zostavax.
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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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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Obstacles To Getting Vaccinated
Despite the fact that the small, but vocal, group of individuals who oppose vaccinations remains strong, Jain says she hasnt encountered much opposition to getting vaccinated among her patients.
A lot of patients will actually come to me asking how they can get the shingles vaccination, so I actually have experienced the opposite, she said. Theres a very small percentage of patients, Id say under 10 percent, that are very averse to getting vaccinations, though.
Jain said that with these patients, their concerns often center around possible adverse effects from the vaccination, fears that theyll contract shingles by getting the vaccination, or the belief that since theyve never had the illness, they dont need the vaccine.
Another big concern that patients have is cost, Jain told Healthline in March 2018. Zostavax cost $213, and Shingrix costs about $280 out of pocket.
Prices have fluctuated slightly in 2019, with Shingrix at $185 per injection (.
She explained that even insurance or Medicare coverage doesnt solve the problem.
The issue is that Medicare Part B is not covering it, Medicare Part D is covering part of it, and Medicaid may or may not cover it it really depends on the insurer and the insurance plan, she said. So, I think cost is also a big barrier for patients as well.
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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:
The Problem With Medical Records Tracking Vaccine Schedules
Another obstacle is the fact that it can be difficult for family physicians to know exactly what vaccinations a patient has received. Unlike pediatric patients, who typically have accessible records of their vaccination schedule, it can be trickier for adults.
For adults, it becomes quite challenging, especially when they switch providers, because often times you have to track down records to find out if theyve been vaccinated, said Jain.
She said it can be complicated to try and decipher which vaccines patients have received and which ones they should get without clear records.
For adults over the age of 65, you want to find out if theyve gotten the two pneumonia vaccinations that are recommended, so it becomes a challenge to find out if theyve gotten both, or just one, she said.
Same thing goes now for the shingles vaccination. Youre kind of tracking down records, and when you dont have them, you have to make a clinical judgment.
Despite these challenges, Jain says the fact that Shingrix is a newly minted vaccination may make things a bit more straightforward.
The nice thing about Shingrix is that its so new, most patients have not gotten it, she said. Even if theyve had Zostavax, its recommended that they get Shingrix in addition to it, so thats a little bit less of a challenge with a new vaccination.
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Are Shingrix And Zostavax The Same
Both Shingrix and Zostavax can decrease the risk of shingles. However, they differ in effectiveness, administration, and side effects. Shingrix is a recombinant zoster vaccine and Zostavax is a live vaccine. Meaning, Shingrix contains an inactivated form of the varicella-zoster virus and Zostavax contains a live, weakened form of the virus. Another difference is that Shingrix is injected into the muscle while Zostavax is injected underneath the skin. Compared to Zostavax, Shingrix is a newer shingles vaccine.
Do I Need To Pay For Shingles Immunisation
Vaccines covered by the NIP are free for people who are eligible. See the NIP Schedule to find out which vaccines you or your family are eligible to receive.
Eligible people get the vaccine for free, but your health care provider may charge a consultation fee for the visit. You can check this when you make your appointment.
If you are not eligible for free vaccine, you may need to pay for it. The cost depends on the type of vaccine, the formula and where you buy it from. Your immunisation provider can give you more information.
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Shingrix Vs Zostavax: How Do Various Shingles Vaccines Stack Up
Its important to understand what shingles is. Shingles is essentially a reactivation of chickenpox. Chickenpox is a bit of a misnomer. The pox ending refers to its blistering rash. For much of human history it was thought to be similar to smallpox . However, the two infections are entirely unrelated.
Why it was called chicken-pox is not entirely clear since the disease has nothing to do with chickens. A few theories have been put forward. One is that chicken-pox is a linguistic corruption of child-pox since the disease generally affects children. But the real reason is likely lost to history. In any case, we are better off referring to chickenpox by its scientific name of varicella.
Varicella is caused by the aptly named Varicella-zoster virus . Varicella is not a benign illness and it can be fatal, but most people survive the initial infection. However, even though the characteristic rash eventually disappears, the virus is never entirely cleared from the human body. It remains dormant in the dorsal root ganglia, a cluster of nerve cells that run parallel to the spine. Your immune system normally keeps the virus in check. But as we age, immunity can wane. By age 55, 30-40% of people have lost the specific immunity they had to the varicella-zoster virus and the virus can re-awaken.
How Long After Ive Received The Shingles Vaccine Am I Contagious
With the currently authorized shingles vaccine, Shingrix, you wont be contagious. The old vaccine, Zostavax, used a weakened form of the live varicella-zoster virus. Therefore, people worried about spreading the disease to the people around them.
Shingrix doesnt use a live version of the varicella-zoster virus. It is inactivated, which means it uses a dead version of the virus. Therefore, you have no risk of transmitting the disease to anyone.
A note from Cleveland Clinic
No one likes to get shots, especially for something youve already been vaccinated for. But the newer version of the shingles vaccine is one youll want to offer up your arm for. The Shingrix vaccine is more than 90% effective at helping you prevent shingles. Since most of us have had chickenpox in the past, the shingles vaccine is an easy way to prevent the dormant chickenpox virus from creeping up and hitting you again with shingles.
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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.
Who’s Most At Risk Of Shingles
People tend to get shingles more often as they get older, especially over the age of 70. And the older you are, the worse it can be. The shingles rash can be extremely painful, such that sufferers cannot even bear the feeling of their clothes touching the affected skin.
The pain of shingles can also linger long after the rash has disappeared, even for many years. This lingering pain is called post-herpetic neuralgia .
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What Can I Expect After Getting The Vaccine
Shingrix is a two-part vaccine with the second dose given 2-6 months after the first. If you miss this timeframe, then you do not have to repeat the series. The vaccine is given into the muscle, much like an influenza, pneumonia or tetanus vaccine.
Once you get the vaccine, you are more likely to experience fatigue, achy muscles, fever, shivering or upset stomach compared to the older vaccine. Approximately 11 percent of people who get the vaccine reported these flu-like symptoms and another nine percent reported mild pain, redness, and swelling at the site of the injection. These symptoms are more likely to occur after the second dose and typically resolve in a few days.
Shingrix represents a real opportunity to protect ourselves against a debilitating disease with remarkable and long-lasting effectiveness. Speak with your Methodist Physicians Clinic primary care provider about being vaccinated.