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 germ, such as protein, sugar, or capsid .
Zostavax is a different shingles vaccine that is live. If youre unsure about which vaccine may be right for you, ask your doctor or pharmacist.
Shingles Can Strike Twice Will The Shingles Vaccine Help
- By Urmila Parlikar, Associate Director, Digital Health Products, Harvard Health Publishing
No one who has experienced the burning, stabbing, painful misery of shingles wants to think about it again. But they should. Why? Because shingles can strike twice, or rarely, even a third time. A shingles vaccine can reduce the chances of a recurrence.
Theres some disagreement about how often recurrence occurs. In one study, researchers examined medical records of nearly 1,700 patients who had a documented case of shingles between 1996 and 2001. They found that more than 5% of these patients were treated for a second episode within an average of eight years. Thats about as likely as getting shingles in the first place if youre age 60 or older. Other studies have shown the recurrence rate to be much lower.
But the bottom line is the same: having shingles once doesnt protect you from ever having it again.
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.50,51
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
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Household Contacts Of People Who Are Immunocompromised
People aged 50 years who are household contacts of a person who is immunocompromised are recommended to receive zoster vaccine
People 50 years of age who are household contacts of a person who is, or is expected to become, immunocompromised are recommended to receive zoster vaccine. This indirectly protects the immunocompromised household member from exposure to varicella-zoster virus . However, because the efficacy of zoster vaccine is around 4065%, the vaccinated household member may still develop herpes zoster from wild-type VZV.
The rate of VZV-like rashes from the vaccine virus is very low. It is unlikely that vaccine-associated virus would be transmitted from a recently vaccinated person to a susceptible immunocompromised contact.1
If a vaccinated person develops a varicella- or zoster-like rash, they should:
- cover the rash
People 50 years of age who have had a previous episode of herpes zoster can receive zoster vaccine at the recommended age.
The risk of a repeat episode of zoster is about 5% in immunocompetent people.10-12 In addition, a history of previous zoster may be inaccurate or a mistaken diagnosis.
An episode of herpes zoster boosts cellular and humoral immunity above baseline levels in most people. Studies suggest that this boost persists for at least 1 year and up to 3 years.13
What Everyone Should Know About The Shingles Vaccine
Shingles vaccination is the only way to protect against shingles and postherpetic neuralgia , the most common complication from shingles. CDC recommends that healthy adults 50 years and older get two doses of the shingles vaccine called Shingrix , separated by 2 to 6 months, to prevent shingles and the complications from the disease. Your doctor or pharmacist can give you Shingrix as a shot in your upper arm.
Shingrix provides strong protection against shingles and PHN. Two doses of Shingrix is more than 90% effective at preventing shingles and PHN. Protection stays above 85% for at least the first four years after you get vaccinated.
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What The Research Says
What we do know is that when your immune system is compromised or distracted fighting off another virus, it tends to give the herpes zoster virus a chance to reactivate.
Past research has established that immune-suppressing medications like chemotherapy and corticosteroids as well as health conditions that attack your immune system like Crohns disease, HIV, and lupus increase your risk for a shingles outbreak.
Researchers are currently trying to understand whether COVID-19 may do the same thing.
Preliminary data suggests that this could be the case, but we do not know yet.
A small 2021 study involving 491 vaccinated people in Israel showed that six participants experienced shingles for the first time after getting their first dose of COVID-19 vaccine. All six individuals had pre-existing conditions that lowered their natural immune response, and all six fully recovered after developing shingles.
This study prompted researchers to advocate for more studies on COVID-19 vaccines as possible triggers for the shingles virus.
Data gathered in Brazil also showed an increase of 10.7 cases of shingles per million inhabitants during the time of the pandemic.
Its impossible to know exactly how and to what extent the effect of increased stress of the pandemic and other factors played into these numbers increasing during that span of time. Stress has long been suspected to be a possible factor in developing shingles.
Drug Interactions Of Shingrix Vs Zostavax
Immunosuppressive drugs such as cyclosporine and tacrolimus can decrease the effectiveness of vaccines. Steroids, like prednisone, and chemotherapy can also have immunosuppressive effects that can alter how vaccines work.
Those who are on immunosuppressive therapy should avoid Zostavax altogether Zostavax contains the live virus, which could result in an infection.
Antiviral drugs such as acyclovir and famciclovir can interfere with the effects of the Zostavax vaccine. The Advisory Committee on Immunization Practices recommends that people who are on antiviral drugs stop taking antiviral medications 24 hours before getting a Zostavax vaccine. Treatment with antiviral drugs should not be resumed for at least 14 days after vaccination with Zostavax.
Consult a healthcare professional for other possible drug interactions
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How Well Does Shingrix Work
Two doses of Shingrix provides strong protection against shingles and postherpetic neuralgia , the most common complication of shingles.
- In adults 50 to 69 years old who got two doses, Shingrix was 97% effective in preventing shingles among adults 70 years and older, Shingrix was 91% effective.
- In adults 50 to 69 years old who got two doses, Shingrix was 91% effective in preventing PHN among adults 70 years and older, Shingrix was 89% effective.
Shingrix protection remained high in people 70 years and older throughout the four years following vaccination. Since your risk of shingles and PHN increases as you get older, it is important to have strong protection against shingles in your older years.
Who Should Not Get The Shingles Vaccine
The shingle vaccine is a live vaccine. This means that it can cause an infection in people with very weakened immune systems and should not be used in people with leukaemia, lymphoma, other conditions affecting your bone marrow, tuberculosis or in people having immunosuppressive therapy such as chemotherapy. It should also not be given to children and pregnant women.
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Vaccine Effectiveness And Safety
The vaccine reduces your chance of getting the virus by more than 50%, depending on your age. Vaccine effectiveness is higher among seniors between 65 and 70 years old.
No vaccine is 100% effective. If you get vaccinated, you may still develop shingles. But the infection would likely be less severe and youd be better protected from complications.
The vaccine has been licenced by Health Canada, having met all requirements under the Food and Drugs Act.
Herpes Zoster Vaccine: Canadian Immunization Guide
For health professionals
Last complete revision:
July 2018 This chapter was revised to reflect NACI’s Updated Recommendations on the Use of Herpes Zoster Vaccines. Most sections were revised to include information and practice recommendations for the new recombinant zoster vaccine which is now available in Canada. Changes include:
- Recommendations for use in different populations.
- Contraindications and precautions.
- Administration of the HZ vaccines: Table 1 was added to summarize key information.
- Considerations on the efficacy, effectiveness and immunogenicity of HZ vaccines: Table 2 was added to summarize key information.
- Vaccine safety and adverse events.
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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
- tested negative for immunity to varicella zoster virus. If you test negative, you should get chickenpox vaccine.
- currently have shingles
- currently are pregnant or breastfeeding. Women who are pregnant or breastfeeding should wait to get Shingrix.
If you have a minor acute illness, such as a cold, you may get Shingrix. But if you have a moderate or severe acute illness, you should usually wait until you recover before getting the vaccine. This includes anyone with a temperature of 101.3°F or higher.
The side effects of the Shingrix are temporary, and usually last 2 to 3 days. While you may experience pain for a few days after getting Shingrix, the pain will be less severe than having shingles and the complications from the disease.
Common And Local Adverse Events
Univalent varicella vaccine
Reactions to univalent varicella vaccine are generally mild and include injection site pain, swelling and redness in 10% to 20% of recipients. A low-grade fever has been documented in 10% to 15% of vaccine recipients. A varicella-like rash occurs at the injection site or is generalized in 3% to 5% of vaccine recipients after the first dose. The rash usually appears within 5 to 26 days after immunization. As varicella-like rashes that occur within the first 2 weeks after immunization may be caused by wild-type virus , health care providers should obtain specimens from the vaccine recipient to determine whether or not the rash is due to a natural varicella infection or to the vaccine-derived strain.
The safety profile of a 2 dose regimen is comparable to that of a single dose with slightly higher incidence of injection site reactions observed within 3 days after vaccination and slightly lower incidence of fever and varicella-like rash after dose 2 compared to dose 1.
Varicella zoster immunoglobulin
Reactions to VarIg are rare. The most frequent treatment related adverse events are pain at the injection site , headache , and rash .
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What Vaccines Can Help Prevent Shingles
There is currently one vaccine available in the U.S. to prevent shingles. Shingrix was approved in 2017 and it is more than 90% effective in preventing shingles. With Shingrix, you get two shots between 2 and 6 months apart and protection lasts an estimated 4-5 years. Doctors recommend it for people over 50.
An earlier vaccine called Zostavax was removed from the market in 2020. That vaccine used a weak form of the chickenpox virus to send your bodyâs immune system into action to fight the disease. Shingrix does not. If you received the Zostavax vaccine, it is recommended that you also receive Shingrix.
What Is The Shingles Vaccine
The shingles vaccine prevents herpes zoster, otherwise known as shingles. Shingles is a condition that causes a painful, blistering rash on one side of the face or body. This rash usually appears in a limited area on the skin, sometimes in the form of a stripe or patch. In many cases, the rash shows up after strange sensations, such as tingling or itching, have occurred in the same area. The rash turns into blisters and can be intensely painful. Shingles can also cause:
The most common complication of shingles is postherpetic neuralgia, the lingering nerve pain after the rash goes away . It can be long-lasting and debilitating. Other complications can occur, depending on which part of your body shingles affects. Complications can include:
Vision changes or blindness
The vaccine is not intended to treat shingles or its complications, only to prevent them. It is given as an injection into the upper arm muscle in two doses that are spaced 2 to 6 months apart.
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Answers About Getting The Shingles Vaccine
As COVID-19 vaccines have become available to more and more people across the world, there has been much discussion about the importance of receiving all recommended doses of a vaccineincluding booster shotsto get the most protection against COVID-19.
The public discussion around the COVID-19 vaccines will hopefully encourage more people to consider another vaccine that protects against an illness with the potential for serious long-term side effectsshingles.
The Centers for Disease Control and Prevention recommends the shingles vaccine for people over the age of 50. This includes people who have had shingles in the past and people who have received an older type of shingles vaccine.
The shingles vaccine is given as a two-dose series, spaced 2 to 6 months apart.
Keep reading for answers to common questions about shingles and the shingles vaccine.
What is shingles, exactly? Shingles is a reactivation of the varicella-zoster virus, the same virus that causes chicken pox. Anyone who has had chicken pox in the past is at risk for shinglesstudies show this is roughly 99 percent of Americans over the age of 40 . Roughly 1 in 3 people will have shingles during their lifetime.
Shingles causes a painful blistering rash that takes 3 to 5 weeks to resolve. In most cases, the rash appears on one side of the torso, though it can appear on other areas of the body, including the face. Shingles that affects the eye can cause blindness.
Conditions Treated By Shingrix And Zostavax
Shingrix and Zostavax are FDA approved to prevent shingles . Both vaccines are indicated to prevent shingles in adults aged 50 years and older. Shingrix and Zostavax are not used to prevent primary varicella infection, also known as chickenpox.
Postherpetic neuralgia is a common type of nerve pain that arises with shingles. Because Shingrix and Zostavax can prevent shingles, they can also prevent postherpetic neuralgia and other painful complications from shingles. However, these vaccines are not labeled to treat PHN.
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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.
Adverse Events In People With Immunocompromising Conditions Or On Immunosuppressive Therapy
Zostavax is contraindicated in severely immunocompromised people. Administering zoster vaccine 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 Two people with chronic lymphocytic leukaemia who were given Zostavax died from disseminated Oka vaccine virus disease.18,30,31 They were not receiving immunosuppressive treatment when they were vaccinated.
There has been one report in Australia of death of a patient who was on long-term hydroxychloroquine and a low-dose prednisolone , from infection by the Oka strain varicella-zoster virus 3 weeks after receiving Zostavax vaccine.
There is ongoing monitoring of global evidence on the safety of Zostavax by both the Therapeutic Goods Administration and the Australian Technical Advisory Group on Immunisation . To date, there has not been any other report of fatal outcome from vaccine-related VZV infection in people who were either mildly immunocompromised or not known to be immunocompromised.
Varicella-zoster virus is a DNAvirus of the Herpesviridae family.
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If I’ve Had Shingles Already Can I Still Have The Shingles Vaccine
If you have had shingles before, you can still have the shingles vaccine. Your natural immunity is boosted by having shingles, but it is uncertain how long your immunity will last. If you have had shingles within the past year, your chances of getting shingles again soon is reduced, so it’s recommended that you wait at least 1 year before getting the shingles vaccine.