You may be concerned about additives to the shingles vaccine — especially thimerosal. Thimerosal is a preservative that contains mercury. It’s added then removed to some vaccines to prevent bacteria and other germs from growing in them. The worry about thimerosal arose when early research linked it to autism, although this connection has since been found to be untrue. The shingles vaccine does not contain any thimerosal.
Recombinant zoster vaccine (RZV, Shingrix, GlaxoSmithKline) was licensed by the FDA in October 2017. It is a subunit vaccine that contains recombinant varicella zoster virus (VZV) glycoprotein E in combination with a novel adjuvant (AS01B). RZV does not contain live VZV. It is approved for persons 50 years and older. RZV is administered as a 2-dose series by the intramuscular route. The second dose should be given 2 to 6 months after the first dose.
The frequency of CNS infections presented at the emergency room of a community hospital is not negligible, so a means of diagnosing cases is needed. PCR is not a foolproof method of diagnosis, but because so many other indicators have turned out to not be reliable in diagnosing VZV infections in the CNS, screening for VZV by PCR is recommended. Negative PCR does not rule out VZV involvement, but a positive PCR can be used for diagnosis, and appropriate treatment started (for example, antivirals can be prescribed rather than antibiotics).
Bell’s palsy is one type of facial nerve paralysis. The 7th cranial nerve controls the muscles of the face, and although scientists do not know the exact cause of Bell’s palsy, they think it may be due to nerve damage from an infection, for example, the flu, common cold viruses, and more serious infections like meningitis. The symptoms of Bell’s palsy vary from person to person, but can include:
^ a b Araújo LQ, Macintyre CR, Vujacich C (2007). “Epidemiology and burden of herpes zoster and post-herpetic neuralgia in Australia, Asia and South America” (PDF). Herpes. 14 (Suppl 2): 40A–44A. PMID 17939895.
Only people who have had chickenpox in the past (usually in childhood) can get shingles. The reason why the chickenpox virus reactivates as shingles is not fully understood. It is thought that the following factors influence the development of shingles:
Many people who are affected will experience pain, itching, or tingling at the site of the rash around 1 to 5 days before the shingles outbreak. A rash and pain may not be present during some outbreaks.
An antiviral medicine is most useful when started in the early stages of shingles (within 72 hours of the rash appearing). However, in some cases your doctor may still advise you have an antiviral medicine even if the rash is more than 72 hours old – particularly in elderly people with severe shingles, or if shingles affects an eye.
When a shingles rash is kept covered, the risk of spreading the virus to others is low, according to the CDC. The varicella zoster virus is spread through direct contact with the fluid inside shingles blisters during the active stage of the infection. The virus is not transmittable before the blisters form or after the area develops crusts over its surface.
Effective treatments are available to help lessen the impact of shingles. For best prognosis and fastest recovery, early start of oral antiviral pills is most important. All shingles cases will eventually resolve with or without treatment.
Antiviral medications, such as acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir), can decrease the duration of skin rash and pain, including the pain of PHN. These medications must be started early (up to about 24-72 hours after rash development) in the disease course to have any benefit. The doctor will decide which medications you may need. In special cases (for example, those with suppressed immune function), the antiviral medication may need to be given intravenously in the hospital. Only acyclovir is approved for use in children who get shingles.
Zoster vaccines are given to people who presumably had chickenpox earlier in life and so have immunity to varicella virus. The cancer chemotherapy will not change the person’s immunity to varicella virus. If the person received RZV no action is necessary. However, if ZVL was given the patient should be monitored for the next two weeks for symptoms that might indicate an adverse reaction, such as fever and rash. If symptoms suggestive of varicella develop, the patient can be started on antiviral therapy, such as acyclovir.
United States. Centers for Disease Control and Prevention. “Vaccines and Preventable Diseases: What Everyone Should Know About Shingles Vaccine.”
Most people have chickenpox in childhood, but after the illness has gone, the varicella-zoster virus remains dormant (inactive) in the nervous system. The immune system keeps the virus in check, but later in life it can be reactivated and cause shingles.
Tests showed that the vaccine significantly reduced the incidence of shingles in older adults. The single-dose vaccine was shown to be more than 60% effective in reducing shingles symptoms, and it also reduced the incidence of post-herpetic neuralgia (PHN) by at least two-thirds. Even if you have had shingles, you can still have the vaccine to help prevent future outbreaks.
While RZV is the preferred zoster vaccine, ZVL may still be given to immunocompetent adults aged 60 years and older in certain cases, such as when RZV is not available, or when a person prefers ZVL or is allergic to RZV.
Most people first notice shingles when they feel itching and burning on their skin, followed by signs of a rash, including redness and bumps that develop on only one side of the body (such as the left side of the back, in one eye or on one arm). The blisters associated with shingles can look similar to those caused by herpes simplex virus, although the two viruses are different.
Shingles is contagious. Shingles can be spread from an affected person to babies, children, or adults who have not had chickenpox. Instead of developing shingles, these people develop chickenpox. Once they have had chickenpox, people cannot catch shingles (or contract the virus) from someone else. Once infected with VZV, however, people have the potential to develop shingles later in life.
Dworkin R.H., MD, et al. “Recommendations for the Management of Herpes Zoster.” Oxford Journal of Clinical Infectious Diseases; 44 (Supp. 1): page 1-26. http://cid.oxfordjournals.org/content/44/Supplement_1/S1.long#sec-6. Accessed May 2014.
Once they are no longer acutely ill, they can be vaccinated with RZV or ZVL. There is no evidence that either vaccine will have therapeutic effect for a person with existing zoster or postherpetic neuralgia.
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There are key differences between the ways Shingrix and Zostavax are designed. The new shingles vaccine contains an adjuvant, a substance that boosts the immune system’s response. This may be what makes Shingrix both more effective and longer-lasting, says Schaffner at Vanderbilt.