Rate Of Complications From Herpes Zoster
Overall, 1326% of patients with herpes zoster develop complications. Complications occur more often in older people and people who are immunocompromised.51,52
Post-herpetic neuralgia is the most common complication of herpes zoster, but it occurs very infrequently in children and young adults. PHN occurs in approximately 1 in 5 herpes zoster cases in people aged > 80 years, compared with approximately 1 in 10 cases in people aged 5059 years.4,5,9 The population-based incidence of PHN is 3 times higher in people 7079 years of age than in people 5059 years of age .4
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 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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Transporting Storing And Handling Vaccines
Transport according to National vaccine storage guidelines: Strive for 5.60 Store at +2°C to +8°C. Do not freeze. Protect from light.
Zostavax must be reconstituted. Add the entire contents of the diluent container to the vial and shake until the powder completely dissolves. Reconstitute immediately after taking the vaccine out of the refrigerator. Use the reconstituted vaccine within 30 minutes.
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.
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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.
Herpes Zoster In People Who Are Immunocompromised
People who are immunocompromised have an increased risk of herpes zoster compared with non-immunocompromised people. Rates of herpes zoster are up to 15 times higher in people who are immunocompromised due to HIV. In the 1st year after haematopoietic stem cell transplantation, up to 30% of patients may develop herpes zoster.25,37
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Mild Side Effects Of Shingles Vaccine:
- Redness, soreness, swelling, or itching at the site of the injection .
It is safe to be around infants and young children, pregnant women, or people with weakened immune systems after you get the shingles vaccine. There is no documentation of a person getting chickenpox from someone who has received the shingles vaccine .
Some people who get the shingles vaccine will develop a chickenpox-like rash near the place where they were vaccinated. As a precaution, this rash should be covered until it disappears.
Like all vaccines, shingles vaccine is being closely monitored for unusual or severe problems by CDC and FDA.
Signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and weakness. These would start a few minutes to a few hours after the vaccination. If you have a severe allergic reaction or other emergency that cant wait, call 9-1-1 or get the person to the nearest hospital. Otherwise, call your doctor.
Afterward, the reaction should be reported to the Vaccine Adverse Event Reporting System . Your doctor might file this report, or you can do it yourself through the VAERS website, or by calling 1-800-822-7967.
The shingles vaccine does not contain thimerosal .
This information was taken directly from the Shingles Vaccine Information Statement dated 10/06/2009.
For more information on possible side effects from vaccination, visit CDCs Possible Side Effects from Vaccines page.
Who Should Not Get The Shingles Vaccine
Some people shouldnt get the shingles vaccine. These people include those:
- Who currently have shingles.
- Who have had a severe allergic reaction to the shingles vaccine in the past.
- Who have tested negative for immunity to the varicella-zoster virus, meaning youve never had chickenpox. If youve never had chickenpox, you should get the chickenpox vaccine.
- Who are ill. You should wait until your illness has passed before receiving the shingles vaccine.
- Who are pregnant or breastfeeding.
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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.
Prevent Shingles Or Another Shingles Outbreak:
- A vaccine may be given to help prevent shingles. You can get the vaccine even if you already had shingles. The vaccine comes in 2 forms. A 2-dose vaccine is usually given to adults 50 years or older. A 1-dose vaccine may be given to adults 60 years or older.
- The vaccine can help prevent a future outbreak. If you do get shingles again, the vaccine can keep it from becoming severe. Ask your healthcare provider about other vaccines you may need.
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Vaccinate To Decrease Your Shingles Risk
Your chances of getting shingles increase as you get older. The U.S. Centers for Disease Control and Prevention recommends that adults age 50 and older get vaccinated against shingles.
Two vaccines, recombinant zoster vaccine and zoster vaccine live are available in the United States to prevent shingles. Shingrix is the preferred vaccine.
The CDC recommends Shingrix for adults 50 years and older, whether or not they have already had shingles or previously received the Zostavaxvaccine, which has been used since 2006. You should get two doses of Shingrix, two to six months apart. Two doses of Shingrix are more than 90% effective at preventing shingles. Shingrix is also 90% effective in helping to prevent PHN in those who get shingles despite being vaccinated.
While Zostavax is still available, studies show it is less effective than Shingrix.Zostavax may be used in some healthy adults 60 years and older, for example, in those who are allergic to Shingrix.
There is no specific time that you must wait after having shingles before receiving the shingles vaccine. But its probably best to hold off until the shingles rash has disappeared before getting vaccinated.
About the Author
Urmila Parlikar, Associate Director, Digital Health Products, Harvard Health Publishing
Is The Vaccine Safe
The vaccine can be given to people with a previous history of shingles infection. It should not be given to anyone who currently has shingles. As stated above, the vaccine should not be given to people who are clinically immunosuppressed because the vaccine strain could replicate too much and cause a serious infection. For more information see the MHRA’s Drug Safety Update .
In clinical trials of the vaccine, there have been no reports of someone who was vaccinated passing the virus on to anyone else. However, because the shingles vaccine is a live vaccine, it is thought that this may be possible in rare cases.
There is thought to be a very small risk that someone who has been vaccinated could pass on the virus to someone who is not immune to chickenpox. This is only thought to be a risk if the person who has been vaccinated develops a shingles type rash at the injection site or elsewhere on the body.
The shingles vaccine is not recommended for pregnant women as a matter of caution. However, studies have been carried out on pregnant women who have accidentally received chickenpox or shingles vaccines. These have not shown any link between the weakened virus in the vaccine and any specific problems in babies born to these women. See this Public Health England statement for more information.
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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.
Long Term Side Effects
In rare cases, the live shingles vaccine, Zostavax, can cause a skin rash or shingles.
The rash that occurs with shingles can affect any area of the body, but it often appears as a line of blisters that wraps around the torso.
Within a few days the blisters cluster, and they continue to form for several more days. The blisters can take 2â3 weeks to heal, according to the American Academy of Dermatology.
Other common symptoms of shingles include:
two shingles vaccines for adults: the recombinant zoster vaccine and the zoster virus vaccine .
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Shingles Is A Painful Blistering Rash That Often Develops In A Stripe That Wraps Around One Side Of The Body Or Face Besides The Rash Symptoms Include Fever Headache And Chills But Mainly You Hear About The Rash Because It Hurts
If youre over 50, the shingles vaccine Shingrix can help you avoid this super painful condition. And you might be surprised to learn who should get it:
If you already got the one-dose shingles vaccine , its time to upgrade to the newer model, Shingrix.
If you previously couldnt get the shingles shot because you are immunocompromised, you can and should get the new one, Shingrix.
You should also get the shingles vaccine if youve had shingles.
You should also get the shingles vaccine if you dont remember having chickenpox.
The varicella vaccine for children will prevent shingles later in life. This one is often combined with the measles-mumps-rubella vaccine and given around ages 1 and 5.
Symptoms, treatment, & epidemiology
Early shingles symptoms include tingling, burning, itching, or shooting pain in a localized area. Then after 1-14 days, a blistery rash appears. The blisters will scab over after about a week.
Shingles is treated with antiviral medication and with pain relievers. The antivirals are most effective when theyre started early on, so dont wait for it to get better on its own before seeking help.
1 in 3 adults will get shingles at some point in their lives. Some people are hospitalized with shingles, particularly when it attacks the nerves of the eye, ear, brain, or lungs. 10-15% of people who get shingles have nerve pain for weeks, months, or even longer after a shingles attack. This is called postherpetic neuralgia.
Shingles: deep cover agent
Shingles Vaccine: Best Defense Against An Outbreak
About one out of every three people in the United States will develop shingles in their lifetime. Fortunately, the shingles vaccine is a safe and effective way to prevent an outbreak.
If youve had a shingles attack, then you know how painful it can be. However, a shingles attack can have more consequences than just a painful, blistering rash. One of the main complications that can result from a shingles outbreak is postherpetic neuralgia .
PHN causes continuous, chronic pain that lasts even after the skin sores have healed, said Jason Scheid, director of ambulatory pharmacy for OSF HealthCare. It is long-term nerve pain after the rash resolves and can be severe enough to impact your daily life.
Shingles and PHN can be debilitating. Prevention is your best approach.
The older you are when you get shingles, the greater the risk for PHN, Jason said. If the rash presents on your face, there is also a risk of impacting your eye and causing vision problems or even vision loss, so it is essential to be evaluated right away. There is also the potential for rashes and open lesions to become infected.
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For Patients Who Do Not Report A Prior Episode Of Varicella
When vaccinating immunocompetent adults aged 50 years and older, there is no need to screen for a history of varicella or to conduct laboratory testing for serologic evidence of prior varicella. More than 99% of adults aged 50 years and older worldwide have been exposed to varicella-zoster virus, and the Advisory Committee on Immunization Practices considers people born in the United States prior to 1980 immune to varicella. Therefore, even if a person does not recall having chickenpox, serologic testing for varicella immunity is not recommended. It is often a barrier to herpes zoster vaccination, and false negatives are common. However, if serologic evidence of varicella susceptibility becomes available to the healthcare provider, providers should follow ACIP guidelines for varicella vaccination. Shingrix has not been evaluated in persons who are seronegative to varicella, and it is not indicated for the prevention of varicella.
For adults 19 years of age and older who are or will be immunocompromised, see .
Rare Side Effects Of The Shingles Vaccine
In rare cases, a severe allergic reaction called anaphylaxis may occur. This can be a life-threatening emergency and requires immediate medical attention.
Symptoms of anaphylaxis after receiving the shingles vaccine include:
Typically, these side effects appear immediately or within a few minutes of vaccination your vaccination provider may be present. If you experience them after leaving the office, call 911.
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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 .
Who Can Have The Shingles Vaccination
Shingles vaccination is available to everyone aged 70 to 79.
When you’re eligible, you can have the shingles vaccination at any time of year.
The shingles vaccine is not available on the NHS to anyone aged 80 or over because it seems to be less effective in this age group.
Read more about who can have the shingles vaccine.
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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.
Adverse Events In People With Immunocompromising Conditions Or On Immunosuppressive Therapy
Zostavax is contraindicated in severely immunocompromised people. Administering Zostavax to people with severe immunocompromise can result in disseminated disease from the Oka vaccine virus. Without an adequate immune response, the vaccine virus can replicate unchecked.30,31 2 people with chronic lymphocytic leukaemia who were given Zostavax died from disseminated Oka vaccine virus disease.15,30,31 They were not receiving immunosuppressive treatment when they were vaccinated. Another person, who at the time of vaccination was taking prednisolone and had also recently been taking checkpoint inhibitors, died a few weeks after receiving Zostavax.33
People on multiple medications associated with low level immunosuppression may also be at risk. In Australia, 1 person died from infection with the Oka VZV vaccine strain 3 weeks after receiving Zostavax. The person was taking long-term hydroxychloroquine and low-dose prednisolone .32
The TGA and the Australian Technical Advisory Group on Immunisation continue to monitor global evidence on the safety of Zostavax. To date, there have been no other reports of a fatal outcome from vaccine-related VZV infection in people who were either mildly immunocompromised or not known to be immunocompromised.
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