Shingles Vaccine: Expert Q& a
Never Too Late to Seek Protection Against ‘Debilitating’ Virus
Shingles can make everyday tasks — from getting dressed to getting into bed — a painful proposition. The culprit behind this agonizing rash, which is especially common in older people, is the same virus responsible for another common but debilitating condition: chicken pox.
“Most of us never get rid of the chicken pox virus,” William Schaffner, MD, president of the National Foundation for Infectious Diseases, tells WebMD. “It lies dormant like a bear in a cave during winter. When a person gets shingles, the virus has reawakened.”
Fortunately, a vaccine is available that greatly reduces the risk of shingles. Schaffner, who is also a professor in Vanderbilt University School of Medicine’s infectious diseases division and chair of the schoolâs department of preventive medicine, spoke with WebMD about getting protected.
Does The Vaccine Work
In December 2017 Public Health England published an evaluation of the first three years of the shingles vaccination programme in England . This showed that the shingles vaccine was 62% effective against shingles and 70 to 88% effective against post-herpetic neuralgia in this period. Public Health England estimates that there were 17000 fewer GP consultations for shingles than expected in this 3-year period.
In the early 2000s researchers carried out a very large study of Zostavax, the shingles vaccine used in the UK, involving over 38,000 adults aged 60 or older. The results showed that:
- In adults aged between 60 and 70, the vaccine reduced the number of cases of shingles by 51.3%
- In adults aged over 70, the vaccine reduced the number of cases of shingles by 38%
- The vaccine reduced the incidence of post-herpetic neuralgia by over 66% in all age groups
- For those who did get shingles, the vaccine reduced the severity of the disease.
Read the abstract of this study , published in 2005 by Oxman et al.
Adults aged 80 or over are not offered the shingles vaccine. This is because the effectiveness of the vaccine declines with age in older age groups.
How Many Doses Of The Vaccine Do I Need
In most cases, the shingles vaccine is given as one dose.
If you have a severely weakened immune system you will be offered a second dose of the vaccine at least 8 weeks after your first dose.
Speak to a healthcare professional about getting other vaccines at the same time so they can advise what’s best for your individual circumstances.
You should ideally wait seven days between the coronavirus vaccination and shingles vaccination.
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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 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.
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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.
Can You Get Chickenpox If Youve Been Vaccinated
Yes. About 15% 20% of people who have received one dose of varicella vaccine do still get chickenpox if they are exposed, but their disease is usually mild. Vaccinated persons who get chickenpox generally have fewer than 50 spots or bumps, which may resemble bug bites more than typical, fluid-filled chickenpox blisters. In 2006, the Advisory Committee on Immunization Practices voted to recommend routine two-dose varicella vaccination for children. In one study, children who received two doses of varicella vaccine were three times less likely to get chickenpox than individuals who have had only one dose.
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Know Your Risk Of Getting Shingles And Complications
About 1 out of every 3 people in the United States will develop shingles during their lifetime.
If youve had chickenpox, you are at risk for shingles. More than 99% of Americans born before 1980 have had chickenpox, even if they dont remember it.
Your risk of getting shingles and having serious complications increases as you get older.
About 1 in 10 people who get shingles develop nerve pain that lasts for months or years after the rash goes away. This is called postherpetic neuralgia and is the most common complication of shingles.
Shingles may lead to other serious complications involving the eye, including blindness. Very rarely, it can also lead to pneumonia, hearing problems, brain inflammation or death.
More Information On Side Effects
Reactions listed under possible side effects or adverse events on vaccine product information sheets may not all be directly linked to the vaccine. See Vaccine side effects and adverse reactions for more information on why this is the case.
If you are concerned about any reactions that occur after vaccination, consult your doctor. In the UK you can report suspected vaccine side effects to the Medicines and Healthcare products Regulatory Agency through the Yellow Card Scheme . See more information on the Yellow Card scheme and monitoring of vaccine safety.
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Where In The Body The Vaccination Is Given And How Many You Will Need
Like most vaccinations, the vaccine will be given in your upper arm. You will only have the vaccination once.
If you have the Zostavax vaccine, you will just need one injection. If you are not eligible for the live vaccine, you will need 2 doses of the Shingrix vaccine 2 months apart to give you the best protection. Once your course is completed, you will not need any more shingles vaccines.
Why Is The Shingles Vaccine Important
Shingles causes a painful rash and blisters and it can lead to serious complications. The most common complication is post-herpetic neuralgia , a condition that causes burning pain that can last long after the shingles rash and blisters go away. The older you are when you get shingles, the more likely you are to develop PHN.
Getting vaccinated is the best way to prevent shingles and PHN.
Shingles is caused by the same virus that causes chickenpox. After you have chickenpox, the chickenpox virus stays dormant in your body. The virus can activate years later and cause shingles.
Symptoms of shingles include:
Shingles cant spread from person to person like chickenpox. But if you have shingles, you can spread the virus to someone who isnt immune to chickenpox meaning someone who hasnt had chickenpox and isnt vaccinated against it. If that happened, the person might get chickenpox but not shingles. Learn more about shingles.
- Adults age 50 and older
- Adults 19 years and older who have a weakened immune system because of disease or treatments
You need to get 2 doses of Shingrix. Youll need the second dose 2 to 6 months after the first dose. You need to get Shingrix even if you:
- Have already had shingles
- Have been vaccinated against shingles with Zostavax
- Are not sure if youve had chickenpox
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Research Into Mrna Vaccines For Shingles
Several companies are researching the potential use of mRNA vaccines for shingles. Pfizer and BioNTech are partnering on an mRNA shingles vaccine just as they did with vaccines for the flu and COVID-19.
A major advantage to the technology is the ability to develop new vaccines quickly. The fact that mRNA vaccines are synthetic and dont rely on actual virus particles also means they can be quickly produced in large numbers.
While the Shingrix vaccination is considered safe, the FDA has confirmed a link between Shingrix and Guillain-Barre Syndrome. Phasing out the old vaccine with the introduction of a new one, as the FDA did when Shingrix replaced Zostavax, might eliminate this potential issue.
Pfizer and BioNTech hope to begin clinical trials later this year.
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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Why More Adults Arent Getting The Super
Despite such impressive results, only about 35 percent of adults 60 and older reported receiving the shingles vaccine in 2018. Whats behind the hesitation? A couple of things. First, says Kristin Christensen, M.D., an internal medicine specialist affiliated with Penn Medicine, in Radnor, Pennsylvania, some of us dont take shingles as seriously as we should: People think, If its not going to kill me I dont need it, without realizing that singles can be incapacitating, causing severe pain that can really limit peoples functioning.
Whats more, difficulty in getting the vaccine may have discouraged those who sought out the vaccine earlier on. The company that makes the vaccine couldnt keep up with the initial demand, resulting in long waiting lists at pharmacies that dispensed the vaccines.
Then theres the hit to your wallet. Shingrix costs on average about $195 per injection, and two injections are required. But unlike the flu and pneumonia vaccines, which are fully covered as preventive services under Medicare Part B, the shingles shot falls under the prescription drug plan under Medicare Part D. Depending on your plan, even after youve met your annual deductible youll likely end up shelling out money for it. If youre between the ages of 50 and 65, and covered by a private health insurance, ask your doctor about getting your vaccine now, while youve got good coverage, Schaffner suggests.
What Are The Possible Side Effects Of Shingles Immunisation
All medicines and vaccines can have side effects. Sometimes they are serious, most of the time theyre not.
For most people, the chance of having a serious side effect from a vaccine is much lower than the chance of serious harm if you caught the disease.
Talk to your doctor about possible side effects of shingles vaccines, or if you have possible side effects that worry you.
Common side effects of shingles vaccines include:
- pain, redness, swelling or itching where the needle went in
Serious reactions to immunisation are rare. With Zostavax® vaccination, very rarely a generalised chickenpox-like rash may occur around 24 weeks after vaccination. This may be associated with fever and feeling unwell. This rash may be a sign of a serious reaction to the virus in the vaccine. Seek medical attention and inform of recent Zostavax vaccination if you experience this reaction.
The Consumer Medicine Information links in How do you get immunised against shingles? list the side effects of each vaccine.
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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.
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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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.
Schedule
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 .
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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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.