Contraindications And Precautions For Herpes Zoster Vaccination
Shingrix should not be administered to:
- A person with a history of severe allergic reaction, such as anaphylaxis, to any component of this vaccine.
- A person experiencing an acute episode of herpes zoster. Shingrix is not a treatment for herpes zoster or postherpetic neuralgia . The general guidance for any vaccine is to wait until the acute stage of the illness is over and symptoms abate.
There is currently no CDC recommendation for Shingrix use in pregnancy therefore, providers should consider delaying vaccination until after pregnancy. There is no recommendation for pregnancy testing before vaccination with Shingrix. Recombinant vaccines such as Shingrix pose no known risk to people who are breastfeeding or to their infants. Providers may consider vaccination without regard to breastfeeding status if Shingrix is otherwise indicated.
Adults with a minor acute illness, such as a cold, can receive Shingrix. Adults with a moderate or severe acute illness should usually wait until they recover before getting the vaccine.
To learn more, see Contraindications and Precautions, General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices .
Who Needs A Shingles Vaccine
Shingrix is recommended for adults aged 50 or older. You should still get the vaccine even if youve had shingles in the past, as it is possible to get it again.
You can also get Shingrix if you received Zostavax in the past. This is important because studies have shown that the efficacy of Zostavax over time.
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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.
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Transmission Of Vaccine Virus
It is rare for vaccinated people to spread varicella vaccine virus, especially if they do not have rash. Worldwide, since the varicella vaccine programs started, only 11 healthy vaccinated people have been documented as spreading vaccine virus to others. All of these vaccinated people had rash after vaccination. As a result, 13 people, including household members and people in long-term care facilities, got infected with vaccine virus varicella. One additional case had a mechanism other than direct transmission from a vaccine recipient, possibly exposure to vaccine aerosol during preparation of the vaccine for administration.
There has not been any documented transmission of varicella from vaccinated healthcare personnel.
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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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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:
What Shingles Vaccines Are Available
According to the Centers for Disease Control and Prevention , there are 2 vaccines licensed and recommended to prevent shingles in the U.S.: Shingrix and Zostavax.2 The CDC recommends that healthy adults 50 years and older get 2 doses of Shingrix, separated by 2 to 6 months, to prevent shingles and the complications from the disease.3
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Skipping The Second Dose Of The Shingles Vaccine Might Mean You Have Less Protection Against This Painful Rash
Medically reviewed in March 2021
Shingles is a painful condition, and the effects of it can last for months or even years in some cases. Although there is no cure for shingles once you have it, there is a vaccine that prevents shingles in the first place.
The Centers for Disease Control and Prevention recommends that healthy adults over the age of 50 get the shingles vaccine. This is true even if youve had shingles in the past, or if you were previously vaccinated with the older shingles vaccine.
The shingles vaccine is administered in two separate dosesonce you receive the first dose, the second should be given 2 to 6 months later. After the second dose, the vaccine is more than 90 percent effective at preventing shingles, according to the CDC.
Why the second dose matters The shingles vaccine is designed to be given as two doses, not as one. Despite the effectiveness of the vaccine, some people skip their second dose. Some simply forget to follow up and lose track of the appointment date. Others may skip the second dose due to costdepending on your insurance plan, you may be responsible for a co-pay or deductible fee, or you may need to pay for the second dose out of pocket.
Getting the second dose gives you the full protection the vaccine offers. Below are some ways to make sure you get your second dose.
Shingrix Dosage And Schedule
Shingrix should be administered to immunocompetent adults aged 50 years and older and adults aged 19 years who are or will be immunodeficient or immunosuppressed because of disease or therapy as a two-dose series , 2 to 6 months apart . 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. See more detailed clinical guidance.
If more than 6 months have elapsed since the first dose of Shingrix, you should administer the second dose as soon as possible. However, you do not need to restart the vaccine series.
If the second dose is given less than 4 weeks after the first dose, the second dose should be considered invalid. A valid second dose should be administered 2 months after the invalid dose .
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Who Should Get It
The CDC recommends that adults ages 50 and up get the shingles vaccine. As mentioned above, its part of a two-dose series. And if youre an older adult that hasnt gotten the shingles vaccine yet, its never too late. There isnât a maximum age limit to get it.
You can also get the vaccine if youre at least 19 years old and have a weakened immune system. In this case, you can receive a second dose 1 to 2 months after the first. Talk to your healthcare provider if you think this may apply to you.
Even if youâve already had shingles or received a different shingles vaccine, you should still get Shingrix if eligible. But you shouldnt get it if youre allergic to any of the vaccine ingredients, currently have shingles, or are pregnant.
Is The Shingles Shot Covered By Medicare
Original Medicare does not pay for the shingles vaccine. However, if youre enrolled in a Medicare prescription drug plan or have a Medicare Advantage plan that includes drug coverage, your shot may be covered. For vaccines covered under Part D , it is not recommended to get the shot through your providers office, as you may have issues with Part D billing.*
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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.
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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.
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Key Points To Remember
- Shingles can be very painful.
- Adults ages 50 and older and adults 19 and older who have a weakened immune system can get the vaccine. You need two doses, whether or not you’ve had shingles before.
- The vaccine greatly lowers your chances of getting shingles. If you get shingles anyway, you are less likely to have the long-term pain that can occur after shingles than if you hadn’t had the vaccine.
- If you’ve already had shingles, you are not likely to get it again. But some people do.
What Questions Should I Ask My Healthcare Provider
Its normal to have questions before you get a vaccine. Some common questions you may want to discuss with your healthcare provider include:
- When should I get the shingles vaccine?
- What side effects should I expect?
- How does the shingles vaccine work?
- When should I schedule each dose of the shingles vaccine?
- How effective is the shingles vaccine?
- Is there any reason I shouldnt get the shingles vaccine?
- What could happen if I dont get the shingles vaccine?
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Very Common And Common Adverse Events
Very common adverse events occur in 10% or more of vaccinees. Common adverse events occur in 1% to less than 10% of vaccinees.
Injection site reactions are very commonly reported for both LZV and RZV. For LZV recipients the frequency is slightly higher in adults aged < 60 years. For all ages, the majority of these events were rated mild or moderate in intensity and lasted less than 2 days.
Due to the adjuvant in RZV, which induces a high cellular immune response and helps address the natural age-related decline in immunity, RZV is more reactogenic than LZV.
Injection site AEs are very commonly reported by recipients of RZV. Approximately 80% report injection-site pain and approximately 30% report redness at the site of injection.
Systemic adverse events, primarily fatigue and myalgia are common in LZV recipients and very common in RZV recipients . For RZV, they include headache .
Local and systemic reactions that were severe enough to interfere with normal activities have been more frequently reported following the receipt of RZV than LZV. However, these reactions have been temporary . Patient education on the short-term reactogenicity of the RZV is recommended prior to vaccine administration to promote adherence to the second dose.
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Other Vaccines On The National Immunisation Schedule
All the vaccines can now be given at the same time or immediately before or after the COVID-19 vaccine. These include measles-mumps-rubella , influenza, human papillomavirus , tetanus and whooping cough vaccine , the Shingrix shingles vaccine, and meningococcal vaccines. Ask your health provider if there are any vaccines that you may have missed or are due to have while you get your COVID-19 vaccine.
Pregnant women are recommended influenza vaccine and COVID-19 vaccine at any stage of pregnancy and whooping cough vaccine from 16 weeks gestation. They can be given at the same time or separately.
Note that most of the dedicated COVID-19 vaccination centres do not have other vaccines available. Please ask your usual health provider if there are any other vaccines you need.
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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
What To Know About The Shingles Vaccine
Who needs it? The CDC recommends that everyone 50 and older get Shingrix, even if they had the earlier recommended vaccine Zostavax, or if theyve already had a bout of shingles. Older adults should also get this vaccine, whether or not they remember having had chickenpox as a child. Why? More than 99 percent of Americans over the age of 40 have been exposed to the varicella-zoster virus, even if they dont recall getting chickenpox.
How often? The CDC recommends that older adults, as described above, get this vaccine, which is given in two doses spaced two to six months apart. The shot is more than 90 percent effective after youve had both shots.
Why you need it: One in 3 people will get painful, occasionally debilitating shingles, usually after age 50, and the risk increases with age. By age 85, half of adults will have experienced at least one outbreak.
An important note: Beginning Jan. 1, 2023, Medicare enrollees with Part D wont have any out-of-pocket costs for vaccines that the CDC Advisory Committee on Immunization Practices recommends for adults, including the shingles vaccine, under the Inflation Reduction Act of 2022.
A COVID connection?
A large observational study, published in the journal Open Forum Infectious Diseases, makes clear how important it is for older adults to get both the COVID-19 vaccine and the shingles vaccine.
However, the researchers stress that people should not use these results as an excuse not to get COVID-19 shots.
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How Well Does The Vaccine Work
The vaccine lowers your chances of getting shingles.
If you get the vaccine and still get shingles, you are likely to have much less pain and for a much shorter time.
The Centers for Disease Control and Prevention recommends two doses of the shingles vaccine for adults ages 50 and older and for adults 19 and older who have a weakened immune system.footnote 1
- Redness, swelling, or soreness at the spot where the needle went in.
- A high fever or serious allergic reaction .
Getting the vaccine has some risks. For example:
- You might get shingles anyway. But it probably won’t be as painful or last as long.
- You may need another vaccine later in life.
You shouldn’t get the vaccine if:
- You are ill with more than a mild cold or you have had an allergic reaction to the first dose.
- You have a test that says you have never had chickenpox.
- You have shingles.
- You are age 50 or older.
- You are 19 or older and have a weakened immune system.
- You have had shingles before.
- You have a chronic condition, such as chronic kidney failure, diabetes, rheumatoid arthritis, or COPD.
- You live in a nursing home or other long-term care facility.
- The vaccine can lower your chances of getting shingles.
- If you get the vaccine and still get shingles, you are likely to have less pain for a shorter time.
Warnings Of Shingrix And Zostavax
Shingrix and Zostavax can cause hypersensitivity, or allergic, reactions in those with allergies to vaccine ingredients. Zostavax may cause severe allergic reactions in those with a known allergy to gelatin or neomycin. Severe allergic reactions can lead to severe rash and trouble breathing .
Zostavax should be avoided in those who take immunosuppressive agents and those who are affected by medical conditions that weaken the immune system.
Ask your doctor or pharmacist about other precautions before getting a shingles vaccine.
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Spacing Of Multiple Doses Of The Same Antigen
Vaccination providers should adhere to recommended vaccination schedules . Administration at recommended ages and in accordance with recommended intervals between doses of multidose antigens provides optimal protection.
Administration of doses of a multidose vaccine using intervals that are shorter than recommended might be necessary in certain circumstances, such as impending international travel or when a person is behind schedule on vaccinations but needs rapid protection. In these situations, an accelerated schedule can be implemented using intervals between doses that are shorter than intervals recommended for routine vaccination . The accelerated or minimum intervals and ages for scheduling catch-up vaccinations. Vaccine doses should not be administered at intervals less than these minimum intervals or at an age that is younger than the minimum age.*
Certain vaccines produce increased rates of local or systemic reactions in certain recipients when administered more frequently than recommended . Careful record keeping, maintenance of patient histories, use of immunization information systems , and adherence to recommended schedules can decrease the incidence of such reactions without adversely affecting immunity.