Shingles Vaccine (This one’s for Parents and Grandparents; updated 8/2018)

Shingrix

Most of my posts will be about vaccines used in childhood, but there is an important one for many parents to be aware of that I’ve just become eligible for and many people are not yet clued into.  This is the newer version of the shingles vaccine.

What is it?

Shingles (i.e. zoster virus infection) is caused by the same virus that causes chickenpox in children, although we see a lot less of it now that there is an effective vaccine, available since the 1980s.

About varicella:

For most children, varicella is a mild but uncomfortable illness, causing fever, fatigue and blistering rash for most who still get it.  A small number of children are hospitalized for dehydration and a tiny number (about 1 in 10,000 of those infected) have a fatal complication.  Most of these fatal cases already have immune system problems before the infection develops.  Luckily, there is a very effective vaccine that almost all children get at 12-18 months old and again at 4-6 years old.  Receiving both doses of the vaccination is 88-98% effective in preventing any form of chickenpox and about 100% effective in preventing severe chickenpox.  It is routinely recommended and required for licensed daycare and school attendance, among other activities.

About shingles (hint: same virus but different symptoms in adults):

Once you get chickenpox, as most adults over 40 did as a child, the virus stays in your body but is kept dormant by your immune system.  As we age, our immune system slowly weakens and infectious conditions start to occur more easily.  Shingles is the condition that develops as the varicella-zoster (i.e. chickenpox) virus reactivates.  Initially one may have only severe pain, often in the abdominal region, chest or back.  Sometimes the pain may be so severe it is confused with appendicitis or a heart attack.  After several days, the pain improves but a rash develops in a particular pattern – it develops along the path of the sensory nerve that was harboring the virus for all those years.  The rash is most commonly red bumps and blisters, on only one side of the body, which can be painful, itchy or both.  The rash fades over time but the pain can be intense enough to need opiates.  After recovery, many people afterwards develop persistent pain, called post-herpetic neuralgia for months or years.  A family friend had this about 2 years ago and she still has fairly severe pain at times.

The older vaccine for adults (called Zostavax) was the same vaccine as we use to prevent chickenpox in children, only about 14 times stronger.  It was fairly effective and usually recommended for adults over 60.  For this reason, many people think of the shingles (or more properly the zoster) vaccine as a vaccine for the elderly.  Not true!!  The previous version was indeed generally recommended for those 60 and over but there is a newer, more effective version that is now recommended for adults age 50 and over (like my wife and me).  In fact, when given earlier, one has a more robust immune response, which means it works better when you receive it at a younger age.  The new vaccine is called “Shingrix” (ok, so no points for the name).  This is a new recommendation, so when calling your doctor’s office you may have to gently remind them that this is the new vaccine which is now given at a younger age (you can even send them the link below).  I strongly recommend this vaccine for all adults who are 50 and over.  It is safe and effective and should be covered by everyone’s medical insurance if they are over 50, even if they have already received Zostavax (the older version) in the past.

**Be aware, many doctors’ offices and retail pharmacies STILL do not have this in stock, even a year after its licensure.  I’m sure GSK (GlaxoSmithKlineBeecham) is doing everything in its power to increase their output, so hopefully it will not be long, but it would make sense to make a call to your doctor now, just to get onto a waiting list if possible.

See below for the excerpt from the CDC website at https://www.cdc.gov/vaccines/vpd/shingles/hcp/shingrix/recommendations.html

Here’s a post from the excellent blog Shotofprevention.com about needing this vaccine and how few adults are aware of it.

Summary of Recommendations

Routine Vaccination of People 50 Years Old and Older

CDC recommends Shingrix® (recombinant zoster vaccine) as preferred over Zostavax® (zoster vaccine live) for the prevention of herpes zoster (shingles) and related complications. CDC recommends two doses of Shingrix separated by 2 to 6 months for immunocompetent adults age 50 years and older:

CDC Expert Commentary with Medscape

Medscape video; Dr. Kathleen Dooling

Everything You Need to Know About Shingrix
[3:58 mins]
Dr. Kathleen Dooling discusses storage, administration, and patient counseling for the new shingles vaccine
Released: 4/30/18

  • Whether or not they report a prior episode of herpes zoster
  • Whether or not they report a prior dose of Zostavax
  • Who have chronic medical conditions (e.g., chronic renal failure, diabetes mellitus, rheumatoid arthritis, chronic pulmonary disease), unless a contraindication or precaution exists. Similar to Zostavax, Shingrix may be used for adults who are
    • are taking low-dose immunosuppressive therapy
    • are anticipating immunosuppression
    • have recovered from an immunocompromising illness
  • Who are getting other adult vaccines in the same doctor’s visit, including those routinely recommended for adults age 50 years and older, such as influenza and pneumococcal vaccines. The safety and efficacy of concomitant administration of two adjuvanted vaccines, such as Shingrix and Fluad, have not been evaluated.
  • It is not necessary to screen, either verbally or by laboratory serology, for evidence of prior varicella infection.

 

See this nice table from the CDC Website!

TABLE. Recommended storage, use, and administration of currently licensed herpes zoster (shingles) vaccines — United States, 2018Return to your place in the text
Characteristic Brand name (manufacturer)
Shingrix (GSK) Zostavax (Merck)
Vaccine type Recombinant adjuvanted (RZV, licensed 2017)* Live attenuated virus (ZVL, licensed 2006)
Packaging Supplied as 2 components: 1) single-dose vial of lyophilized varicella zoster virus glycoprotein E antigen and 2) a single-dose vial of AS01B adjuvant suspension Single-dose vial of lyophilized vaccine and a vial of sterile water diluent
Storage Antigen and adjuvant should be stored refrigerated between 2°C and 8°C (36°F and 46°F); discard antigen or adjuvant components if frozen; discard reconstituted vaccine if frozen Vaccine should be stored frozen between -50°C and -15°C (-58°F and +5°F),§ diluent should be stored separately at room temperature or refrigerated between 2° and 8°C (36°F and 46°F); do not freeze reconstituted vaccine
Reconstitution Reconstitute the lyophilized varicella zoster virus glycoprotein E antigen component with the accompanying AS01B adjuvant suspension component (single reconstituted dose is 0.5 mL) Reconstitute lyophilized vaccine with the supplied diluent (single reconstituted dose is 0.65 mL)
Use Administer immediately after reconstitution or refrigerate and use within 6 hours; discard reconstituted vaccine if not used within 6 hours Reconstitute immediately upon removal of vaccine from the freezer and administer immediately after reconstitution; discard reconstituted vaccine if not used within 30 minutes
Route Intramuscular (IM) injection Subcutaneous (SQ) injection
Dose/Schedule 2 doses; second dose 2–6 months after the first dose 1 dose
Indication Prevention of herpes zoster in adults aged ≥50 years Prevention of herpes zoster in adults aged ≥50 years
ACIP recommendation Immunocompetent adults aged ≥50 years, including those who previously received ZVL, RZV is preferred over ZVL for the prevention of herpes zoster and related complications Immunocompetent adults aged ≥60 years**

Abbreviations: ACIP = Advisory Committee on Immunization Practices, GSK = GlaxoSmithKline; RZV = recombinant zoster vaccine; ZVL = zoster vaccine live.

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Author: marcgrella

Primary care pediatrician; vaccine advocate; hunger fighter; refugee supporter.

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