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 .
How Is The Shingles Vaccine Made
The shingles vaccine available in the U.S., Shingrix®, contains a single protein from the surface of herpes zoster virus as well as two adjuvants: QS21 and monophosphoryl lipid A. QS21 is a soap-based molecule isolated from the bark of the Quillaja saponaria tree. Monophosphoryl lipid A is a detoxified form of lipopolysaccharide, a potent adjuvant taken from the surface of common bacteria.
The first shingles vaccine, called Zostavax®, is no longer available in the U.S. However, this version contained a more concentrated version of the same live, weakened virus as the current chickenpox vaccine. It contained about 14 times the amount of weakened chickenpox virus than the vaccine for children. This amount of virus was necessary to obtain a protective response in the aging immune systems of older adults. The introduction of Shingrix vaccine was important because adjuvants in the vaccine improved immune responses in older adults and decreased the need to use large quantities of the live, weakened virus also necessary to make chickenpox vaccine. For these two reasons Zostavax is no longer available in the U.S.
Make A Plan To Get 2 Doses
- You can get Shingrix at your doctors office or pharmacy. Talk to your doctor or pharmacist about getting Shingrix.
- Plan to get your second dose of Shingrix 2 to 6 months after your first dose.
Five years later, I still take prescription medication for pain. My shingles rash quickly developed into open, oozing sores that in only a few days required me to be hospitalized. I could not eat, sleep, or perform even the most minor tasks. It was totally debilitating. The pain still limits my activity levels to this day.
A 63-year-old harpist who was unable to continue playing due to shingles
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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.
Why Do We Need A Shingles Shot
As you might remember from your childhood, the rash from chickenpox is itchy but usually doesnt hurt. In most cases, chickenpox is a mild illness that doesnt cause long-term problems.
After you got over a case of chickenpox, the virus stays in your body but goes dormant, meaning its not active. However, it can reactivate later in your life. If it does, youll get shingles.
Unlike chickenpox, a shingles rash can be extremely painful. Fever, headache, fatigue, and sensitivity to light are also common shingles symptoms.
There are also potentially serious health consequences of the infection. For example, if you get a shingles rash close to your eye, it can affect your vision and potentially cause blindness.A case of shingles generally lasts between two and six weeks. The pain usually goes away when the rash does, but some people have pain that lingers for months or even years .
Shingles can be treated with antiviral medications such as acyclovir or valacyclovir, which reduce the length of the outbreak. However, anyone who has had shingles will likely tell you to do whatever you can to avoid getting it in the first place. Thats where Shingrix comes in.
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Does The Shingles Vaccine Contain Thimerosal
You may be concerned about additives to the shingles vaccine, like thimerosal.
Thimerosal is a preservative that contains mercury. Its added to some vaccines to prevent bacteria and other germs from growing in them. The shingles vaccine contains thimerosal.
The worry about thimerosal arose when early research linked it to autism. This connection has since been found to be untrue.
Does Shingrix Require Two Shots
Shingrix is approved as a two-dose vaccine. It is not recommended to skip the second dose of Shingrix. Typically, the second Shingrix dose is administered two to six months after the first dose in adults aged 50 years and older. However, in people who are immunocompromised, the second dose can be given one to two months after the first dose.
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What Is The Shingles Vaccine
The shingles vaccine can protect you against shingles and postherpetic neuralgia , which is the most common complication of shingles. Shingles is a painful rash caused by the varicella-zoster virus, the same virus that causes chickenpox. The rash usually develops on one side of your body or face. It starts with red bumps and then the bumps turn into fluid-filled blisters.
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
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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.
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, more effective shingles vaccine.
Conditions Treated By Shingrix And Zostavax
Shingrix and Zostavax are FDA-approved to prevent shingles . Both vaccines are indicated to prevent shingles in adults aged 50 years and older. However, unlike Zostavax, Shingrix is also approved to prevent shingles in immunocompromised or immunodeficient adults aged 18 years and older.
Shingrix and Zostavax are approved for preventative purposes only. They are not approved to treat shingles. In addition, they are not used to prevent primary varicella infection, also known as chickenpox.
Postherpetic neuralgia is a common type of nerve pain that arises with shingles. Because Shingrix and Zostavax can prevent shingles, they can also prevent postherpetic neuralgia and other painful complications from shingles. However, these vaccines are not labeled to treat PHN.
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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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
New Shingles Vaccine: What You Need To Know
Nov. 13, 2019 — Unlike some vaccines, thereâs been so much demand for the new shingles vaccineShingrix that itâs not always easy to find. It was approved in 2017, and the CDC recommends the vaccine for adults 50 and older to prevent this painful, blistering illness. It is being used in place of the previous vaccine, Zostavax.
More than a year later, doctors say they are learning more about how it works, its safety risks, and how it compares to Zostavax.
How effective is Shingrix?
âIt’s just remarkable,” says Wilbur Chen, MD, an associate professor of medicine at the Center for Vaccine Development and Global Health, University of Maryland School of Medicine. “It has performed better than I expected.”
In studies, Shingrix was more than 97% effective at preventing shingles in people 50 and older. It works just as well in older adults, who are at greater risk for a painful shingles complication called postherpetic neuralgia . “When 70- and 80-year-olds get shingles, it can be extremely debilitating,” Chen says.
By contrast, Zostavax cuts the risk of shingles by only 51% and PHN by 67%. It’s only about 38% effective in people over age 70.
How safe is Shingrix?
“So far so good,” Schaffner says. The main side effect is soreness in the arm where you get the shot.
Other side effects are mild and usually last for 2 to 3 days, including:
Who shouldn’t get Shingrix?
Can I get the Shingrix vaccine now?
What do doctors still need to learn about Shingrix?
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Can My Grandfather With Shingles Give My Baby Daughter Chickenpox
Yes, although people with shingles cannot pass shingles to someone else, they can pass chickenpox virus to others through direct contact with the rash. If your baby has not yet had chickenpox or the chickenpox vaccine, she could become infected with the virus and develop chickenpox.
Unlike chickenpox that can be passed to others through coughs or sneezes, people with shingles can only pass the virus to others through direct contact with the rash. If the rash has yet to develop or has crusted, the patient cannot transmit the virus. Similarly, people who still have pain without the rash are no longer able to transmit the virus.
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.
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A Look At Each Vaccine: Shingles Vaccine
View the full-size infographic. A shingles vaccine is available for adults 50 years of age and older in the United States. The vaccine prevents much of the pain and suffering caused by shingles when the virus that causes chickenpox reawakens in those with aging or compromised immune systems.
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.
How Long Between Shingles Attack And Recurrence
The time between an initial shingles case and its relapse can vary a great deal, and there is no established figure. However, researchers have noted most of these flare-ups arise in the four- to eight-year window following an initial attack. Recurrence within three years is much rarer.
Factors such as overall health status and the presence of other diseases can spur attacks, and there are preventative medications and approaches.
Is Treating Relapse The Same
The approaches to treating shingles and any relapse are the same. In the latter case, healthcare providers may become particularly interested in isolating the cause of the weakened immunity thats causing the recurrence. That said, there is no outright cure for this disease, so treatment focuses on managing symptoms.
These approaches include:
- Antiviral medications, such as Zovirax , Famvir , and Valtrex , can help, especially if given within 72 hours of symptom onset.
- Over-the-counter drugs like Tylenol or Motrin or Advil can also help manage discomfort and pain.
- Compresses and creams are among other approaches that help relieve itching these include applying wet compresses, using calamine lotion, and taking colloidal oatmeal baths.
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How Does The Shingrix Work
The shingles vaccine contains inactivated pieces of the virus, allowing the body to build immunity to the disease. In addition, it stimulates the bodys immune system to produce more antibodies without causing illness.
The presence of more antibodies helps the body confront the virus and keep the infection at bay. The vaccine also contains molecules that improve the bodys immune response to be stronger and last longer.
This process helps the body build immunity against the virus and lowers the risk of shingles-related complications such as PHN.
Dose Route Of Administration And Schedule
Live attenuated zoster vaccine
Each dose is 0.65 mL .
Route of administration
Each dose is 0.5 mL .
Route of administration
Intramuscular, into the deltoid region of the upper arm.
Administration of the RZV as a subcutaneous injection is a vaccine administration error and should be avoided. However, if Shingrix is inadvertently administered subcutaneously, that dose will be considered as valid in the vaccine series. The second dose will be given as per vaccine schedule.
For more information, refer to Vaccine Administration Practices in Part 1.
2 doses, 2 to 6 months apart. A 0,12 months schedule may be considered for improved adherence to the 2nd dose .
Providers should consider different strategies to promote adherence to the two dose schedule for RZV .
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