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
How Common Is Shingles
Shingles affects 1 out of every 3 people in the United States. More than 1 million cases of shingles are diagnosed every year. The risk of shingles increases as you get older, with about half the cases occurring in people over the age of 50. Shingles develops in about 10% of people who have had chickenpox at an earlier time in their life.
When Should You Call Your Doctor
If you think you have shingles, see a doctor as soon as possible. Early treatment with antiviral medicines may help reduce pain and prevent complications of shingles, such as disseminated zoster or post-herpetic neuralgia.
A rash or blisters on your face, especially near an eye or on the tip of your nose, can be a warning of eye problems. Treatment can help prevent permanent eye damage.
If you still feel intense pain for more than 1 month after the skin heals, see your doctor to find out whether you have post-herpetic neuralgia . Getting your pain under control right away may prevent nerve damage that may cause pain that lasts for months or years.
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Signs And Symptoms Of Shingles
In two out of three people whove had chickenpox, the slumbering virus never wakes up again. But in that third person, it does, manifesting as herpes zoster, or shingles. It starts as pain, itching, burning, or tingling in a narrow band on one side of the face and scalp, on one side of the neck and shoulder, or on either side of your body across your ribs or waist.
After one to five days, a painful rash and weeping blisters develop there. People with weakened immune systems may have an all-over rash similar to chickenpox instead. Other shingles symptoms include fever, chills, headache, and nausea. The blisters scab over in seven to 10 days, and the whole thing finally clears up in about two weeks.
What If I Wait Too Long To Take The Second Dose Will I Need To Restart The Vaccination Process
The Centers for Disease Control and Prevention states that if more than six 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 four weeks after the first dose, it should not be counted. You should get the follow-up dose at least two months after the first dose.
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Dr Roach: How Long After Shingles Can A Person Get Vaccinated
Dear Dr. Roach: I am 81 years old and was diagnosed with shingles at the end of October 2020. After taking famciclovir, I am healing, but still have a scaly rash and shooting pains on the right side of my head where the shingles occurred. I was told that the pain could last for a year or more. Is this true? The initial outbreak was on my scalp, forehead, brow and eye area. I did see my ophthalmologist and was fortunate that the shingles did not get into my eye, just on my eyelid.
I also saw my physician, who recommended I get the shingles vaccine in February 2021. My eye doctor disagrees and said to wait six to nine months. What is the recommended time span between the onset of shingles and getting the vaccine? How long does the vaccine protect someone? Once you have the vaccine, can you ever get shingles again?
L.H.
Dear L.H.: Both your doctors are right. Your regular doctor who recommended a four-month time span is correct, but your eye doctor, who said six to nine months, is right also. In fact, the vaccine may be given at any time after the shingles lesions are healed . Getting shingles again within a year is very unlikely, so it is fine to wait up to a year after the bout of shingles.
The length of protection seems to be long. But this is still a new vaccine, and it is unclear how long the protection will last.
Anon.
Is What My Internist Said Correct Should I Get The Shingles Vaccine And If So How Long Is The Vaccine Good For
No, you still need the vaccine, especially if they didnt prove it was shingles. Most people have no side effects from the shot, so unless you have another medical condition that compromises your immune system or have had a bad reaction in the past, there is no reason the side effects should scare you off. You should get the vaccine, definitely, if you are over 60.
Since the shingles vaccine is relatively new, how long the vaccine lasts is a question that’s still being studied. At this point we know the vaccine provides 5 years of protection at the very least, but it’s possible that you would only need to get it once in your life . By the time you would need a follow-up shot, the research will be much further along!
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Who Shouldnt Get The Shingles Vaccine
There are a few situations in which shingles vaccination may not be right for you. You should not get Shingrix if youve ever had a severe reaction to a vaccine. This means you had trouble breathing or swelling in your mouth or airway, a life-threatening condition called anaphylaxis.
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You should also skip Shingrix if:
- You have allergies to any parts of the vaccine. These include gelatin and the antibiotic neomycin. If you have other allergies, tell your doctor or pharmacist about them before you get Shingrix.
- You currently have shingles or another illness. You can get the vaccine when youre well.
- You are pregnant or breastfeeding. You should wait until youve stopped breastfeeding to get vaccinated.
- You happened to test negative for VZV, the virus that causes chickenpox. If youre older than 50, you probably had chickenpox even if you dont remember it. The CDC does not recommend testing for this. However, if a blood test shows youve never had the childhood illness, you should get the chickenpox vaccine instead.
If you have a disease or take medications that affect your immune system, talk to your doctor about the pros and cons of Shingrix.
Its an individualized decision based on factors such as the specific medications and conditions of the person sitting in front of you, Kistler says. She often consults with her patients specialist doctors to make decisions about Shingrix.
Shingles Virus Can Sleep Reactivate
Shingles is caused by the same virus the varicella zoster virus that causes chickenpox. Once you have had chickenpox, the virus that caused it remains inside your nerves. It is inactive, but it can be reactivated later in life. This causes shingles.
When the virus reactivates, the infected nerves, and the skin the nerves go to, become inflamed, causing a burning or stabbing pain. A few days later, when the virus reaches the skin, a rash of blisters appear along the affected nerve. The skin may be very sensitive, unable to tolerate even the lightest touch.
About 1 in 10 adults who get shingles experience long-term pain, even after the rash has healed completely. This condition is called post-herpetic neuralgia . It may last for months, or even years. And it can be debilitating.
After causing shingles, the virus again goes “back to sleep” inside your nerves. But it can still flare up again.
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Transporting Storing And Handling Vaccines
Transport according to National vaccine storage guidelines: Strive for 5.57 Store at +2°C to +8°C. Do not freeze. Protect from light.
Zostavax must be reconstituted. Add the entire contents of the diluent container to the vial and shake until the powder completely dissolves. Reconstitute immediately after taking the vaccine out of the refrigerator. Use the reconstituted vaccine within 30 minutes.
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 a vaccine or after a previous dose of Shingrix
- A person who is known to be seronegative for varicella
- It is not necessary to screen for a history of varicella. However, if a person is known to be varicella-negative via serologic testing, providers should follow ACIP guidelines for varicella vaccination.
Shingrix has not been studied in pregnant women or women who are breastfeeding. Providers should consider delaying Shingrix vaccination for these women.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. This includes anyone with a temperature of 101.3°F or higher.To learn more, see Contraindications and Precautions, General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices .
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Who Should Not Be Vaccinated With Shingrix
You should not receive the Shingrix vaccine if you:
- Have ever had a severe allergy to this vaccine or any ingredient in this vaccine.
- Are breastfeeding or pregnant.
- Are somewhat ill or very ill and have a high fever.
- Have tested negative for immunity to varicella zoster virus .
Ask your healthcare provider if the benefits of getting the vaccine outweigh any potential risks.
What Else To Know About The Shingles Vaccine
Ready to get vaccinated? This is the essential info on how the shots are given, what to expect with side effects, and more.
You need two doses of Shingrix to get full protection from shingles. You should get your second dose 2 to 6 months after the first. Your doctor or pharmacist will inject the vaccine into the muscle of your upper arm, so wear clothes that give easy access to that area.
If it has been more than 6 months since you got your first dose, go ahead and get your second dose. You dont need to start over, Dooling says.
Continued
Because Shingrix is so new, experts arent sure whether youll eventually need another shot, or a booster, years down the road.
The CDC is actively following how protected people remain after the two-dose series, she says. We know that after 4 years, protection remains above 85%. Only time will tell how durable that protection is.
You have to wait 2 weeks between Shingrix and COVID-19 vaccination. The COVID-19 vaccines are so new that the CDC isnt sure how theyll interact with Shingrix. If youve gotten either Shingrix or a COVID-19 vaccine in the last 14 days, youll need to reach the 2-week mark before you get the other one.
Side effects are fairly common. You may have heard that people sometimes have unpleasant side effects soon after they get the shingles vaccine.
Shingrix tends to have has more side effects than some vaccines, like those for the seasonal flu, says Kistler. The shingles vaccine may cause:
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How Do I Get The Shingles Vaccination
Once you become eligible for the shingles vaccination, a GP or practice nurse will offer you the vaccine when you attend the surgery for general reasons.
You can have a shingles vaccine at the same time as most other vaccines. But try to leave 7 days between the shingles vaccine and a coronavirus vaccine, so that if you have any side effects you’ll know which vaccine they were from.
If you are worried that you may miss out on the shingles vaccination, contact your GP surgery to arrange an appointment to have the vaccine.
How Long After Shingles Can A Person Get Vaccinated
Keith Roach, M.D.
DEAR DR. ROACH: I am 81 years old and was diagnosed with shingles at the end of October 2020. After taking famciclovir, I am healing, but still have a scaly rash and shooting pains on the right side of my head where the shingles occurred. I was told that the pain could last for a year or more. Is this true? The initial outbreak was on my scalp, forehead, brow and eye area. I did see my ophthalmologist and was fortunate that the shingles did not get into my eye, just on my eyelid.
I also saw my physician, who recommended I get the shingles vaccine in February 2021. My eye doctor disagrees and said to wait six to nine months. What is the recommended time span between the onset of shingles and getting the vaccine? How long does the vaccine protect someone? Once you have the vaccine, can you ever get shingles again? L.H.
ANSWER: Both your doctors are right. Your regular doctor who recommended a four-month time span is correct, but your eye doctor, who said six to nine months, is right also. In fact, the vaccine may be given at any time after the shingles lesions are healed . Getting shingles again within a year is very unlikely, so it is fine to wait up to a year after the bout of shingles.
The length of protection seems to be long. But this is still a new vaccine, and it is unclear how long the protection will last.
* * *
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Shingrix And Other Vaccines
Shingrix is generally safe to use with or after administration of certain other vaccines. If you have concerns about whether other vaccines might interact with Shingrix, ask your doctor.
Shingrix after Zostavax
Studies such as this one from 2018 shown that the Zostavax vaccine can wear off over time. Because of this, you can get Shingrix even if youve already received Zostavax. recommends that you wait at least eight weeks after receiving Zostavax before you get Shingrix.
In a of adults ages 65 and older who had received Zostavax at least five years previously, Shingrix was shown to be safe and effective. No studies have tested Shingrix in people who received Zostavax within five years.
Shingrix and the flu shot
There is no evidence showing any negative effects from taking Shingrix together with the flu vaccine. According to a study of adults ages 50 and older, getting both the shingles and flu vaccines at the same time was safe. Also, it didnt make either vaccine less effective.
The Food and Drug Administration approves vaccines such as Shingrix to prevent certain conditions.
Mild Side Effects Of Shingles Vaccine:
- Redness, soreness, swelling, or itching at the site of the injection .
- Headache .
It is safe to be around infants and young children, pregnant women, or people with weakened immune systems after you get the shingles vaccine. There is no documentation of a person getting chickenpox from someone who has received the shingles vaccine .
Some people who get the shingles vaccine will develop a chickenpox-like rash near the place where they were vaccinated. As a precaution, this rash should be covered until it disappears.
Like all vaccines, shingles vaccine is being closely monitored for unusual or severe problems by CDC and FDA.
Signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and weakness. These would start a few minutes to a few hours after the vaccination. If you have a severe allergic reaction or other emergency that cant wait, call 9-1-1 or get the person to the nearest hospital. Otherwise, call your doctor.
Afterward, the reaction should be reported 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.
The shingles vaccine does not contain thimerosal .
This information was taken directly from the Shingles Vaccine Information Statement dated 10/06/2009.
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How Is Shingles Treated
Because the shingles virus is a herpes virus, the mainstay of treatment involves antiviral therapy for a minimum of one to two weeks. Its extremely important to complete the course of therapy even if you are feeling better. It usually takes about 48 to 72 hours to see the impact of the antiviral medication. When initiated quickly after the onset of symptoms, antiviral medication may shorten the severity and duration of the illness and decrease the chance of developing PHN.
Pain is most often treated with non-steroidal anti-inflammatory medications, although sometimes the pain is so severe that narcotic medication is required. If the patient cannot tolerate narcotics, we can also prescribe anticonvulsant drugs.
Itching can be treated with over-the-counter medications such as cortisone, calamine lotion and Benadryl cream. The goal is not to scratch the blisters, which could cause the area to become infected. Topical medications can also be used to protect the skin from infection.
It is possible to get shingles more than once. Patients who suspect they may be experiencing a recurrence of shingles should begin treatment as soon as they observe the new symptoms, since early treatment may prevent these patients from getting the full-blown rash.