Persons With Chronic Diseases
Autoimmune disease
Although definitive data are lacking, individuals with autoimmune disease not being treated with immunosuppressive drugs are not considered significantly immunocompromised. Individuals 50 years of age without contraindications should receive RZV.
For more information, refer to Immunization of Immunocompromised Persons, and Immunization of Persons with Chronic Diseases in Part 3.
New Shingles Vaccine Changes Recommendations For Adults
The pain associated with shingles can be unbearable. It can last for months and be so debilitating that even routine tasks become too difficult to bear. The single dose Zostavax® vaccine had been recommended since 2006, and it is about 50 percent effective at protecting against a shingles rash and about 75-80 percent effective at protecting against pain.
Fortunately, a new shingles vaccine, called Shingrix®, offers improved protection not only from developing the disease, but also against the severe pain associated with shingles. Shingrix is 95 percent effective at protecting against both the rash and associated pain. It is given as two doses separated by two to six months.
In this video, Dr. Offit discusses the differences between the two shingles vaccines and updated recommendations for adults. These include getting the vaccine at 50 years of age instead of 60 and being revaccinated if youve previously received the older version .
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.
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How Do You Get The Vaccine And Should You Get It
Youll have to get a prescription from your physician, pick up the vaccine, then return for the injection.
But should you consider getting it? While thats something youll need to discuss with your doctor, according to Quach, one thing is clear. The older you are, the more benefit youre going to derive from this vaccine.
Debbie Airhart will certainly be looking into the new shot, both for herself, and her parents. I would definitely consider it, she says. I wouldnt wish shingles on anybody.
Shingrix Vaccine Efficacy And Duration Of Protection
Among immunocompetent adults 50 years and older, the efficacy of two doses of Shingrix for the prevention of herpes zoster was high among all age groups. In a clinical trial of more than 30,000 participants, vaccine efficacy was 96.6% in adults aged 50 to 59 years, 97.4% in adults aged 60 to 69 years, and 91.3% in adults aged 70 years and older.
The efficacy of two doses of Shingrix for the prevention of postherpetic neuralgia was high: 91.2% in adults aged 50 years and older, and 88.8% in adults aged 70 years and older.
Vaccine efficacy was estimated among several immunocompromised groups:
- 68.2% among adult autologous hematopoietic cell transplant recipients.
- 87.2% in a post hoc efficacy analysis of adult patients with hematologic malignancies.
- 90.5% in a post hoc efficacy analysis of adult patients with immune-mediated diseases who were not taking immunosuppressive medication.
In immunocompetent adults 70 years and older, vaccine efficacy remained high, at or above 84% in all 7 years after vaccination.
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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?
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.
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What Does The Shingles Vaccine Do
The shingles vaccine can prevent shingles. Every year, about 1 million people in the United States get shingles. Anyone whos had chickenpox can get shingles. Thats because the varicella-zoster virus lives silently in your nervous system after you’ve had chickenpox. The virus can reactivate later in your life if your immune system is weakened. Your risk of getting shingles goes up as you get older. In the United States, 1 in 3 people will get shingles in their lifetime.
What Are The Benefits Of The Shingles Vaccine
The shingles vaccines are the best way to protect you from getting shingles. The vaccines have been shown to reduce the risk of getting shingles by 50% for Zostavax® II, and to more than 90% for Shingrix®.
For those who still get shingles after being immunized, the vaccines can reduce pain, including the type of pain that lasts after shingles.
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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?
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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How Long After Ive Received The Shingles Vaccine Am I Contagious
With the currently authorized shingles vaccine, Shingrix, you wont be contagious. The old vaccine, Zostavax, used a weakened form of the live varicella-zoster virus. Therefore, people worried about spreading the disease to the people around them.
Shingrix doesnt use a live version of the varicella-zoster virus. It is inactivated, which means it uses a dead version of the virus. Therefore, you have no risk of transmitting the disease to anyone.
A note from Cleveland Clinic
No one likes to get shots, especially for something youve already been vaccinated for. But the newer version of the shingles vaccine is one youll want to offer up your arm for. The Shingrix vaccine is more than 90% effective at helping you prevent shingles. Since most of us have had chickenpox in the past, the shingles vaccine is an easy way to prevent the dormant chickenpox virus from creeping up and hitting you again with shingles.
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.
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Does Shingrix Require 2 Shots
Shingrix is an intramuscular injection requiring 2 injections, with the second dose given 2 to 6 months after the first. In those who are immunodeficient or immunosuppressed and require a shorter vaccination schedule, the second dose can be administered 1 to 2 months after the first dose.
Temporary injection site pain was reported in 78% of those receiving Shingrix, as expected with an intramuscular injection.
Related: FDA Requires a Warning about Guillain-Barré Syndrome for Shingrix
This is not all the information you need to know about Shingrix or Zostavax for safe and effective use and does not take the place of talking to your doctor about your treatment. Review the full product information, and discuss this information and any questions you have with your doctor or other health care provider.
Who Should And Shouldnt Get The Vaccine
Shingrix is approved for all adults with normal immune systems who are 50 years old or older. This is 10 years younger than the recommendation for the older vaccine Zostavax, which marks a major change in vaccination practices and provides added protection against shingles earlier in life.
If you have already been vaccinated against shingles with Zostavax, dont worry we recommend you be revaccinated with the new Shingrix vaccine to give you added protection. There should be at least two months between the time you received Zostavax and the time you receive Shingrix.
If you have already had shingles, you arent immune from getting it again! Shingles can occur more than once in a lifetime and already having the infection does not protect you against future infections. We recommend you also be vaccinated with Shingrix if you have a healthy immune system. If you recently recovered from shingles, we recommend you wait until your rash and symptoms have resolved before getting the vaccine.
If you do not have a normal immune system , then we recommend you speak with your primary care provider to see if the shingles vaccination is right for you. If you are one of the rare few adults who has never had chicken pox, then we recommend you talk with your provider about getting the varicella vaccination instead.
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Before Taking This Medicine
You should not receive Shingrix if you have ever had a life-threatening allergic reaction to inactivated zoster virus vaccine.
Tell your doctor if:
-
you have ever had an allergic reaction to any vaccine or
-
you have fainted after receiving an injection.
Tell your doctor if you are pregnant or breastfeeding.
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.
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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.
When Should You Get Immunised Against Shingles
Anyone aged 60 years and over who wants to protect themselves against shingles can talk to their doctor about getting immunised.
Shingles immunisation is recommended for:
- adults aged 60 years and over who have not previously received zoster vaccine
- adults aged 70 years to 79 years, for free under the National Immunisation Program
- adults aged 50 or over who live in the same household as someone who has a weakened immune system.
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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 shingles vaccine.
Shingrix And Other Medications
Below are medications that can interact with Shingrix. These are not all the drugs that may interact with Shingrix.
Before taking Shingrix, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.
If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.
Immunosuppressive drugs such as prednisone
Taking Shingrix with drugs that suppress your immune system can cause problems with the way your body responds to Shingrix. Examples of immunosuppressive medications include:
- corticosteroids, such as:
Here are answers to some frequently asked questions about Shingrix.
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Shingrix Is Not A Live Vaccine
A live vaccine is one that contains a weakened form of a germ. Shingrix is not a live vaccine. Its an inactive vaccine, which is a vaccine thats made from a germ thats been killed.
Because Shingrix is inactive, more people can receive it. This includes people with a weakened immune system .
People with weakened immune systems are typically advised against receiving live vaccines. This is because on very rare occasions, live vaccines can mutate back to the full-strength germ that causes a disease.
If this happens, people with weakened immune systems would have a much higher risk for developing the disease that the vaccine is meant to prevent.
Shingrix is also a recombinant vaccine. This means that its made of parts of the shingles virus, such as protein, sugar, or capsid .
There used to be an alternative shingles vaccine to Shingrix. This other vaccine was called Zostavax.
Like Shingrix, it was approved to prevent shingles . However, Zostavax is
Below, we briefly describe the similarities and differences between these two vaccines.