I Feel Healthy Am I Really At Risk For Shingles
If youre one of the 99% of adults 50 years and older who have had chickenpox, the virus that causes shingles is inside your body and can reactivate at any time. 1 in every 3 people in the US will get shingles in their lifetime. No matter how healthy you feel, your immune system declines as you age, and that puts you at an increased risk for shingles.
Simultaneous Administration With Other Vaccines
RZV and LZV may be administered concomitantly with other live vaccines given by the parenteral, oral, or intranasal routes. For concomitant parenteral injections, different injection sites and separate needles and syringes should be used.
In general, inactivated vaccines including RZV may be administered concomitantly with, or at any time before or after, other inactivated vaccines or live vaccines protecting against a different disease.
LZV may be given at any time before or after live oral or intranasal vaccines. If two live parenteral vaccines are not administered concomitantly, there should be a period of at least 4 weeks before the second live parenteral vaccine is given.
Concomitant administration of pneumococcal 23-valent polysaccharide vaccine and LZV has not resulted in decreased efficacy and so the two vaccines can be given concomitantly.
For more information, refer to Timing of Vaccine Administration in Part 1.
Shingrix Vaccine Side Effects
The most common side effects of the shingles vaccine include:
- Pain, redness, or swelling at the injection site
- Muscle aches
- Fever
- Upset stomach
Some research has shown that there might be an increased risk of Guillain-Barre syndrome, a rare disorder in which the immune system attacks the nerves, in adults age 65 and older who receive the shingles vaccine. One study showed that the risk occurred during 42 days of follow-up after vaccination. However, other safety studies have not been conducted to reaffirm this information.
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Is There Anyone Who Should Not Have The Shingles Vaccination
There are 2 shingles vaccines available in the UK:
- Zostavax, a live vaccine given as 1 dose
- Shingrix, a non-live vaccine given as 2 doses
If Zostavax is not suitable for you, a GP or practice nurse will decide whether to offer you Shingrix instead.
You should not have the shingles vaccine if you’ve had a serious allergic reaction in the past to a previous dose of the shingles vaccine, or to any of the ingredients in the vaccine, or to a previous dose of varicella vaccine.
If you have a weakened immune system a GP or practice nurse will assess which vaccine is suitable for you. Discuss any health concerns with the GP or practice nurse before you have the vaccine.
Zostavax is not suitable for people who have a weakened immune system due to a condition, treatment or medicine.
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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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.
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.
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First Could You Describe Briefly What Shingles Is
Shingles is a viral infection that causes a painful rash. Shingles is caused by the varicella zoster virus which is the same virus that causes chicken pox. After you have had chicken pox, the virus lies inactive in nerve tissue and years later can reactivate, causing a painful rash that looks like blisters. Most often the rash appears in a line around the right or left side of your torso, but can affect any part of the body including the face and eyes. Individuals have a 20-30% chance of getting shingles during their lifetime, and it is more likely to occur when you get older. The most common complication of shingles is post herpetic neuralgia, which causes persistent pain long after the blisters have disappeared and can last for months.
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.
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Shingles Vaccine And Insurance
Private health insurance plans often cover vaccination costs. Still, a patient might have a charge depending on the specific insurance plan.
Medicaid may or may not cover the vaccine cost. Medicare Part D plans cover the shingles vaccine, but there may be a cost to the patient depending on the plan. Usually, the fees are less than $50 per dose.
Medicare Part B does not cover the shingles vaccine.
Who Should Not Get Vaccinated
- Patients with a history of severe allergic reaction to any component of the vaccine or after a previous dose of Shingrix.
- Patients who tested negative for immunity to the varicella zoster virus. If you test negative, you should get the chicken pox vaccine.
- Patients who currently have shingles.
- Patients who are currently pregnant or breastfeeding. Women who are pregnant or breastfeeding should wait to get Shingrix.
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Shingrix Shortage: Where Can I Get Shingrix
Shingrix is in high demand. This is good news in terms of keeping shingles at bay, the more people vaccinated the better but the demand has been higher than the manufacturer anticipated, which means there is a shortage. The Centers for Disease Control and Prevention expects the shortage, which began in the summer of 2018, to last through 2019. GSK is working as fast as possible to make more vaccines available. The vaccines take six to nine months to make.
The high demand is partly due to the increased efficacy of Shingrix over Zostavax. Also playing a factor is the increased range of people who are suggested to receive the vaccinepeople over 50 versus Zostavaxs recommendation of people over 60.
Until supply has caught up to demand, pharmacists and physicians are prioritizing people who have received the first dose of Shingrix and need their second dose, and those who are at a higher risk of contracting and/or suffering serious consequences of shingles. Because of the shortage, many people have missed the six-month window the CDC does not currently recommend restarting the series if you miss the second dose timing, but you should get it as soon as possible within a 12-month window from the initial vaccine.
In the meantime, you can try calling different pharmacies to see if they have the vaccine available. As supply begins to go up, more doses should become readily available.
What Are Shingle Vaccine Side Effects
The shingles vaccines are safe and effective, but they can cause side effects. Common side effects include headache, fever, and fatigue. Nausea, vomiting, and diarrhea are other common side effects.
A person may experience soreness, redness, and swelling on the site where the vaccine was given. People who get the Zostavax vaccine may experience a rash and itching on the site.
After you get the vaccine, stay at the clinic for at least 20 minutes. The staff will make sure you’re good to go. They will also make sure you don’t suffer a severe allergic reaction.
A person who experiences a severe allergic reaction to the vaccine will manifest different symptoms. These include hives and swelling of various parts of the body. Shortness of breath is another symptom that can come up.
If the staff determines a person has a severe allergic reaction, they will call 9-1-1. This type of issue is a life-threatening condition that requires immediate treatment. A person who suffers a severe allergic reaction after leaving the clinic should report it to their health care provider.
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Who Shouldn’t Get It
A person should not get Shingrix if:
- They have ever had a severe allergic reaction to any component of the vaccine or the first dose of the vaccine.
- They test negative for immunity to varicella-zoster virus.
- They currently have shingles.
- They are pregnant.
If you are experiencing a moderate to severe illness, with a fever or not, you should consider waiting until you are better before getting the vaccine.
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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Learn More Aboutzostavax Lawsuits
Side effects of the shingles vaccine Zostavax may result in the development of a painful and persistent strain of shingles
The report indicates that 155 reports were submitted to the Vaccine Adverse Event Reporting System during the first four months Shingrix was available, including at least 13 problems with Shingrix administration. According to the findings, nine of those errors were because the drug was administered in a single subcutaneous dose, instead of as a 2-dose intramuscular injection, which is how the vaccine should be given. The single subcutaneous dose is how Zostavax is administered, suggesting confusion among doctors.
All but one of those patients suffered injection site reactions, including pain, erythema, and pruritus.
In two cases, patients were given the vaccine information statement for Zostavax instead of for Shingrix, and not instructed to return for their second dose, which also suggests whoever administered the vaccine thought they were giving the patients Zostavax, or thought that Shingrix worked the same way.
In the other four cases, the patients given the vaccine were younger than the minimum age of 50, for which the vaccine is approved.
What Are The Shingles Vaccines
There are 2 vaccines, Shingrix® and Zostavax® II, that protect against shingles. Shingles is caused by the varicella zoster virus, which also causes chickenpox. Zostavax® II contains a weakened form of the virus while Shingrix® contains only a part of the virus. The vaccines are approved by Health Canada.
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How Do You Get The Shingles Vaccine
So here is the million-dollar question, “How do I get the shingles vaccine?” If you’re looking to get this vaccine, you can start by asking your primary health care provider. A doctor or nurse practitioner can administer the shingles vaccine.
Persons who can get the publicly funded Shingrix vaccine can get it through their doctor. People who aren’t eligible for it should seek to buy it privately. If you need to buy it privately, your doctor will need to give you a prescription for it.
Most pharmacies and travel clinics sell the shingles vaccine. If there is a doctor or nurse at the travel clinic, they will administer the shot. The staff at most pharmacies in Canada can vaccinate customers.
It’s always a good idea to contact your health insurance provider if you’re not sure if it covers the cost of the shingles vaccine. The company will be more than happy to inform you if your insurance plan covers the cost of this vaccine.
If Ive Already Had Shingles Does That Stop Me From Getting It Again
Patients often ask whether having an attack of shingles provides protection against it occurring again, precluding the need for vaccination. The answer again is no. In fact, an episode of shingles merely indicates that you are more susceptible to it. For these patients, it is even more important to consider vaccination.
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Know Your Risk Of Getting Shingles And Complications
About 1 out of every 3 people in the United States will develop shingles during their lifetime.
If youve had chickenpox, you are at risk for shingles. More than 99% of Americans born before 1980 have had chickenpox, even if they dont remember it.
Your risk of getting shingles and having serious complications increases as you get older.
About 1 in 10 people who get shingles develop nerve pain that lasts for months or years after the rash goes away. This is called postherpetic neuralgia and is the most common complication of shingles.
Shingles may lead to other serious complications involving the eye, including blindness. Very rarely, it can also lead to pneumonia, hearing problems, brain inflammation or death.
Who Should Not Get The Shingrix Vaccine
Shingrix is not recommended for:
- Anyone with a history of a life-threatening allergic reaction to the vaccine
- Women who are pregnant or nursing
- Anyone with a current shingles infection
- Those who have never been infected with chickenpox
If you are not sure if you have ever had chickenpox, the CDC recommends getting the shingles vaccine. Its estimated that 99% of adults over age 40 have had chickenpox even if they dont recall having the symptoms.
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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.
Where In The Body The Vaccination Is Given And How Many You Will Need
Like most vaccinations, the vaccine will be given in your upper arm. You will only have the vaccination once.
If you have the Zostavax vaccine, you will just need one injection. If you are not eligible for the live vaccine, you will need 2 doses of the Shingrix vaccine 2 months apart to give you the best protection. Once your course is completed, you will not need any more shingles vaccines.
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Why Is Shingrix Vaccination Particularly Important At The Moment
Of particular importance is that the Shingrix vaccine appears to have a very significant effect of boosting our levels of T cells.
T cells are a vital part of our immune systems to fight infections. However, as we age, our bodies lose T cells . This reduction increases the risk of older patients being more susceptible to infections. In our recent article, we provided a link to Episode 38 of the Royal Society of Medicine COVID-19 Series webinar. The place of Shingrix improving T cell levels was briefly discussed during this session. If you have not seen this, we would encourage you to view it.