Why A New Shingles Vaccine
Did we need a new shingles vaccine? To answer that question, it helps to have a bit of background on this infection.
Shingles, which is also called herpes zoster, occurs when the chickenpox virus , which is dormant in those who’ve had the illness, reawakens later in life. Almost all adults older than 40 carry the chickenpox virusand the older we get, the more the risk of getting shingles climbs. According to the CDC, the infection strikes about 1 million people in the U.S. each year and nearly one in three adults will experience a bout of shingles in their lifetime.
The two to four weeks of shingles, marked by symptoms such as a blistery and painful rash on one side of the body, can be difficult enough. But about one in five people with shingles go on to develop postherpetic neuralgia, or PHN, which is nerve pain that can linger for months or even years.
Since 2006, we’ve had Zostavaxapproved for those between 50 and 59 but recommended by the CDC for adults 60 and olderas the sole bulwark against shingles. Zostavax offers 70 percent protection against shingles for people between 50 and 59 but only 18 percent in people 80 and older, according to the Pink Sheet, which reports on the pharmaceutical industry.
When all ages are taken into consideration, Zostavax cuts the chance of shingles by only 51 percent and the risk of PHN by 67 percent.
“Shingles is a big problem with immunocompromised people,” Schaffner says.
Who Should Avoid Getting The Shingrix Vaccine
You should not get Shingrix if you:
- Have ever had a severe allergic reaction to any component of the Shingrix vaccine
- Currently have shingles
- Currently are pregnant or breastfeeding
- Tested negative for immunity to varicella-zoster virus
- Have a moderate or severe illness with a temperature of 101.3º F
- Have gotten Varivax less than eight weeks ago
Skipping The Second Dose Of The Shingles Vaccine Might Mean You Have Less Protection Against This Painful Rash
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.
Set up a reminder system If youve already booked your second dose appointment, simply program a reminder in your smartphone or other place where you keep track of your schedule.
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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 .
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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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 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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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:
- Redness
- Stomach pain
- Nausea
Who shouldn’t get Shingrix?
Can I get the Shingrix vaccine now?
How do I pay for Shingrix?
Which Vaccines Do Older Adults Need
As you get older, a health care provider may recommend vaccinations, also known as shots or immunizations, to help prevent certain illnesses.
Talk with a doctor or pharmacist about which of the following vaccines you need. Make sure to protect yourself as much as possible by keeping your vaccinations up to date.
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How Safe Is Shingrix
studies showed that Shingrix was safe and effective.
There have been concerns about ingredients, such as thimerosal, that may be added to vaccines. Thimerosal is a kind of preservative that contains mercury. Its added then taken out of some vaccines to keep other germs and bacteria from growing. The concern arose when early research connected thimerosal to autism. This link has since been found to be false. Shingrix doesnt contain thimerosal.
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.
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Doses Given At Less Than The Recommended Interval
When providing vaccine doses at less than the recommended interval, it is important to know the minimum interval between doses in which an adequate immune response will be achieved. For example, the recommended interval between each of the first 3 doses of the childhood immunization series of diphtheria, tetanus, acellular pertussis, and inactivated polio -containing vaccine is 8 weeks. However, if needed, the first 3 doses may be administered at minimum intervals of 4 weeks.
Refer to vaccine-specific chapters in Part 4 for additional information on recommended and minimum dose intervals for vaccine administration.
What You Should Know About The Shingrix Vaccine For Shingles Prevention
Contagion
This breakthrough vaccine is quickly becoming an integral part of the adult immunization arsenal.
The adjuvanted zoster vaccine recombinant, Shingrix, was approved for adults 50 years and older for the prevention of herpes zoster in October 2017.1 Shingles, which develops after the reactivation of the varicella-zoster virus , is a painful rash that generally occurs on 1 side of the body, usually the face or torso. Complications may include postherpetic neuralgia , ophthalmic involvement, and bacterial infection. These complications can lead to hospitalization or even death. The risk of shingles and PHN increases with age, and about 1 of every 3 individuals in the United States will develop shingles, leading to about 1 million cases each year.
DOSAGE AND ADMINISTRATION
Shingrix is administered through intramuscular injection as a 2-dose vaccine series.2 The second dose should be administered anytime between 2 and 6 months after the first dose. The vaccine series does not need to be restarted if more than 6 months have passed since the first dose.3
PHARMACOLOGY
Shingrix has been shown to boost VZV-specific immune response with the adjuvant known as ASO1B, which is thought to protect against shingles.2 Additionally, VZV glycoprotein E is essential for viral replication and cell-to-cell spread and is the primary target of VZV-specific immune responses. Shingrix does not contain preservatives.
METHOD OF SUPPLY
STORAGE
DRUG INTERACTIONS AND CONTRAINDICATIONS
References
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Conjugate Vaccine Carrier Proteins
Protein conjugates used in Hib conjugate vaccines produced in the United States include tetanus toxoid which is also used as a component of DTaP and Tdap vaccines . Simultaneous or sequential vaccination with Hib and these tetanus-toxoid containing vaccines is recommended when both are indicated . MCV4 and PCV13 both contain diphtheria-toxoid conjugates. There has been concern about simultaneous administration of vaccines containing like conjugates. One brand of MCV4, MenACWY-D , demonstrates reduced immunogenicity of the antibody response to Streptococcal pneumonia strains when administered simultaneously with PCV13 compared with separate administration. It is recommended to space these vaccines by 28 days in a person with anatomic asplenia . Simultaneous or sequential vaccination of MCV4-CRM , PCV13, and Tdap , all of which contain diphtheria toxoid, is not associated with reduced immunogenicity or increase in local adverse events.
Extra Doses Of Vaccine Antigens
Administering extra antigens contained in a combination vaccine should be avoided in most situations . Using combination vaccines containing certain antigens not indicated at the time of administration to a patient might be justified when 1) the extra antigen is not contraindicated, 2) products that contain only the needed antigens are not readily available, and 3) potential benefits to the patient outweigh the potential risk for adverse events associated with the extra antigens. An extra dose of many live-virus vaccines and Hib or hepatitis B vaccine has not been found to be harmful . However, the risk for an adverse event might increase when extra doses are administered at an earlier time than the recommended interval for certain vaccines .
A vaccination provider might not have vaccines available that contain only the antigens needed as indicated by a childs vaccination history. Alternatively, although the indicated vaccines might be available, the provider might prefer to use a combination vaccine to reduce the required number of injections. In such cases, the benefits and risks of administering the combination vaccine with an unneeded antigen should be carefully considered and discussed with the patient or parent.
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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.
See Contraindications and Precautions if considering vaccinating a person with previous HZO.
For more information, refer to Adverse Events Following Immunization in Part 2 and the product monograph in Health Canada’s Drug Product Database.
Administration With Other Vaccines
CDC general recommendations advise that recombinant and adjuvanted vaccines, such as Shingrix, can be administered concomitantly, at different anatomic sites, with other adult vaccines, including COVID-19 vaccines. Concomitant administration of Shingrix with Fluarix Quadrivalent , 23-valent pneumococcal polysaccharide vaccine and Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine, Adsorbed , 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 Shingrix with adjuvanted influenza vaccine and COVID-19 vaccines is being studied.
Shingrix and pneumococcal vaccine can be administered at the same visit if the person is eligible for both. When both pneumococcal conjugate vaccine PCV13 and PPSV23 are recommended for an adult, PCV13 should always be administered first and can be administered concomitantly with Shingrix.
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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.