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?
Shingrix For Prevention Of Shingles
Shingrix is a vaccine thats used to prevent shingles . Its approved for use in people:
- ages 50 years and older
- ages 18 years and older who have an increased risk of shingles
People with an increased risk of shingles include those with a weakened immune system, such as people with HIV.
Shingrix is not meant for use in preventing chickenpox .
Effectiveness for prevention of shingles
Shingrix has been found to be effective in helping to prevent shingles. For details on how the drug performed in clinical studies, see Shingrixs
state that Shingrix is the preferred vaccine for shingles. They recommend it for:
- all adults ages 50 years and older
- adults ages 18 to 50 years with a weakened immune system
How Effective Is The Shingles Vaccine In Preventing Shingles
The shingles vaccine can provide strong protection against shingles and postherpetic neuralgia , the most commonly occurring shingles complication.
The shingles vaccine is 97% effective in preventing shingles in people ages 50 to 69 years old. Its 91% effective in people ages 70 years and older.
In addition, the shingles vaccine is 91% effective in preventing PHN in people ages 50 to 69 years old. Its 89% effective in people ages 70 years and older.
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Is Shingrix Or Zostavax More Effective
Shingrix and Zostavax have both been proven to prevent shingles. However, Shingrix is a newer vaccine that is considered more effective than Zostavax. Shingrix is even recommended for those who have already received the Zostavax vaccine in the past.
Clinical trials have shown that Shingrix is 97% effective at preventing shingles in adults aged 50 to 69 years old. Shingrix is also effective in preventing shingles in older adultsadults over the age of 70, Shingrix is 91% effective.
Zostavax has a 70% efficacy rate in preventing shingles in adults aged 50 to 69 years old, according to the Zoster Efficacy and Safety Trial . Results from the Shingles Prevention Study showed that Zostavax is 51% effective against shingles. Compared to Shingrix, the effectiveness of Zostavax decreases in older age groups. Based on the SPS results, Zostavax is 64% effective in adults aged 60 to 69 years old 41% effective in adults aged 70 to 79 years old and 18% effective in adults aged 80 years and older.
Your healthcare provider will most likely recommend Shingrix over Zostavax. Shingrix is especially recommended for immunocompromised patients since it is a non-live vaccine. Ask your doctor or pharmacist about which shingles vaccine is right for you.
What If I Wait Too Long To Take The Second Shingrix Dose
The Centers for Disease Control and Prevention state that if more than 6 months have passed since you received your first dose, you should get the second dose as soon as possible. You dont have to start the doses all over again.
Also, if you get the second dose within 4 weeks after the first dose, it should not be counted. You should get your follow-up dose at least 1 to 2 months after the first dose, per your doctors recommendation.
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When They Start How Long They Last
The shingles vaccine is given in a two-shot series. You may experience side effects after the first, second, or both shots. Most of the time, these symptoms are mild and occur immediately following vaccination. They typically only last for two or three days.
Side effects of the shingles vaccine are more common in younger people, and might interrupt your normal daily activities for a few days.
This may seem like a downside of the shingles vaccine, but remember that these symptoms are a result of the creation of a strong shingles defense within your body.
It is OK to take Tylenol or Advil after a shingles vaccine to relieve symptoms. Rest and plenty of fluids may help, too.
What Is Mrna And What Is An Mrna Vaccine
Messenger RNA is a bit of genetic code that teaches the bodys immune system how to make antigens, which are proteins that prompt an immune system response.
Messenger RNA vaccines carry this code inside a fatty covering that is injected into muscle tissue. If you contract the virus later, your body will already know how to fight it.
BioNTech co-founder Özlem Türeci told The Atlantic that mRNA vaccines were like showing our immune system a wanted poster of a foe and instructing the immune system to target that outlaw for destruction.
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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.
Can I Get Shingrix If Ive Never Had Chickenpox
If youve never had chickenpox , the CDC recommends that you get the chickenpox vaccine instead of Shingrix. Researchers havent studied Shingrix in people who have never had chickenpox. And Shingrix is not approved for preventing chickenpox.
If you cant recall whether youve had chickenpox, you may need to be screened for it. But this will depend on your age.
Its assumed that people born in the United States and elsewhere before 1980 have been exposed to chickenpox. Therefore, you may be able to receive Shingrix. You should check with your doctor first to make sure.
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Uncommon Rare And Very Rare Adverse Events
Uncommon adverse events occur in 0.1% to less than 1% of vaccinees. Rare and very rare adverse events occur, respectively, in 0.01% to less than 0.1% and less than 0.01% of vaccinees.
Both HZ vaccines are safe with serious adverse events reported very rarely in immunocompetent individuals.
Recurrence or exacerbation of herpes zoster ophthalmicus following LZV vaccination has been reported very rarely, involving several cases world-wide following LZV immunization. Following a causality assessment of seven cases of HZO which were temporally associated with the administration of LZV, NACI concluded that there was insufficient evidence to recommend for or against the administration of LZV in individuals with a history of HZO. More evidence is required for further assessment of risk related to HZO recurrence in LZV recipients. At this time, there is insufficient evidence to assess the risk related to HZO recurrence following RZV recipients.
How Can I Get The Shingles Vaccine
You can buy the shingles vaccine at most pharmacies and travel clinics. Shingrix® is given as a series of 2 doses, 2 to 6 months apart, and costs about $150/dose. Zostavax® II is given as 1 dose and costs about $200. Some health insurance plans may cover the cost of the vaccine check with your provider.
If you buy the vaccine at a travel clinic, a doctor or nurse on site will be able to immunize you. Most pharmacists in B.C. are also able to immunize.
If you want to be immunized by your doctor, find out if they have a supply of the shingles vaccine.
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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.
Coadministration With Other Vaccines
Recombinant and adjuvanted vaccines, such as RZV, can be administered concomitantly at different anatomic sites with other adult vaccines, including COVID-19 vaccines .
- Concomitant administration of RZV with Fluarix Quadrivalent , 23-valent pneumococcal polysaccharide vaccine , tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine , and 13-valent pneumococcal conjugate vaccine has been studied, and there was no evidence for interference in the immune response to either vaccine or safety concerns .
- Coadministration of RZV with adjuvanted influenza vaccine and COVID-19 vaccines is being studied.
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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.
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:
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Dosage For Shingles Prevention
Shingrix is given as two 0.5-mL injections in your upper arm. Youll receive two doses of this vaccine.
Over time, some vaccines protection begins to fade, so may you need booster doses. They help keep the vaccine working. But you dont need a booster dose after getting the two doses of Shingrix.
Shingrix dosing schedule for people ages 50 years and older
For people ages 50 years and older taking Shingrix, the second dose is given 2 to 6 months after the first dose.
Shingrix dosing schedule for people ages 18 years and older with an increased risk of shingles
For people ages 18 years and older with an increased risk of shingles who are taking Shingrix, the second dose may be given 1 to 2 months after the first dose.
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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New More Effective Shingles Vaccine Offers Greater Protection
A vaccine against shingles has been available for several years, but a new vaccine promises to offer greater protection and significantly limit the suffering from shingles. Approved by the Food and Drug Administration last October, the Shingrix vaccine provides a 90 percent protection rate for older adults, compared with 50 percent for the previously available Zostavax vaccine. And unlike its predecessor, Shingrix can safely be given to those with compromised immune systems.Close to one-in-three Americans will develop shingles, a rash of itchy blisters similar but more painful than chicken pox. Usually appearing in a swath on the side of the face or torso, shingles feels, as one sufferer described it, like being pressed against a cactus.
The old vaccine is a live vaccine, says Daniel Z. Uslan, MD, an infectious diseases physician and director of the UCLA Antimicrobial Stewardship Program. It makes your body immune by exposing it to a live but weakened shingles virus. The new vaccine is an inactivated recombinant vaccine, meaning there is no live virus in it. Its a much safer vaccine that we can use in patients with weaker immune systems. And those are the people who need the vaccine because theyre most likely to get shingles and have complications from shingles.
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.
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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 .
How Does The New Vaccine Work
Shingrix contains broken-down parts of the virus which then allow the body to build up immunity to the virus. When the body confronts the actual virus in the future, it mounts a response to keep the infection at bay. The vaccine also contains molecules that make the bodys immune response stronger and last longer.
For these reasons, Shingrix provides better and longer-lasting protection against both shingles and PHN than the older vaccine, Zostavax.
Protection from the older vaccine wore off after approximately eight years, but we believe Shingrix to last much longer.
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