Critical to the performance of the new vaccine will be decisions that will come next week, at a meeting of the Advisory Committee on Immunization Practices. The ACIP — an expert panel that advises the Centers for Disease Control and Prevention on vaccine issues — is expected to vote Wednesday to recommend use of this vaccine in adults 50 and older.
Shingles, or herpes zoster, is a painful rash caused by the varicella zoster virus. Other shingles symptoms include headache, fever, nausea, and body aches. Treatment focuses on pain management and shortening the duration of the illness with antiviral medications.
An advisory panel of the U.S. Centers for Disease Control and Prevention recommended Wednesday that all adults 50 and older receive the new two-shot vaccine, just days after the U.S. Food and Drug Administration announced its approval of Shingrix.
A review by Cochrane concluded that the live vaccine was useful for preventing shingles for at least three years. This equates to about 50% relative risk reduction. The vaccine reduced rates of persistent, severe pain after shingles by 66% in people who contracted shingles despite vaccination. Vaccine efficacy was maintained through four years of follow-up. It has been recommended that people with primary or acquired immunodeficiency should not receive the live vaccine.
The shingles vaccine contains ingredients that can cause an allergic reaction in some people. Avoid the shot if you’ve ever had a reaction to gelatin, the antibiotic neomycin, or other ingredients in the vaccine. You also want to avoid the shingles vaccine if your immune system is weakened due to:
Typically, shingles appears on the trunk. The rash also can develop on other areas of the body, including the face. When the rash appears on the face, it often develops around the eyes or over the nose.
Unfortunately even after the rash clears up after about two to four weeks, pain might still be experienced for up to several more weeks as the nerves recalibrate and recover from the virus. This is called “postherpetic neuralgia” (PHN) and is considered to be the most common complication of shingles. The rate of PHN is almost 30 percent higher in people older than age 50 compared with younger individuals. (4)
Shingles is caused by the varicella-zoster virus — the same virus that causes chickenpox. Anyone who’s had chickenpox may develop shingles. After you recover from chickenpox, the virus can enter your nervous system and lie dormant for years.
People 60 years of age or older should get shingles vaccine (Zostavax). They should get the vaccine whether or not they recall having had chickenpox, which is caused by the same virus as shingles. Studies show that more than 99% of Americans aged 40 and older have had chickenpox, even if they don’t remember getting the disease. There is no maximum age for getting shingles vaccine.
Shingles can affect any part of the body, including the face. Classically, the rash caused by shingles often takes the shape of a belt from the midline on one side of the body. The rash forms its characteristic pattern because the virus works down the nerves that branch out from the spinal cord. The chest and lumbar region are most commonly affected.
Avoid other at-risk people. Stay away from premature babies, infants with low birth weights, and children who haven’t yet had chickenpox or its vaccine. Also avoid people with weak immune systems. These include people with HIV, organ transplant recipients, and people taking immunosuppressant medications or having chemotherapy.
Immunization with the varicella vaccine (chickenpox vaccine) is now recommended and routine in the U.S. It is a two-dose vaccine, given once between the age of 12 and 15 months and again between 4 and 6 years.
Neither situation is a contraindication to ZVL vaccination. A person who receives ZVL who has close household or occupational contact with people who are at risk for developing severe varicella or zoster infection need not take any special precautions after receiving ZVL vaccine. The only exception is in the rare instance when a person develops a varicella-like rash after receiving ZVL. A vaccine rash is expected to occur less frequently after ZVL than after varicella vaccine. If a rash develops, the vaccinated person should avoid contact with an immunocompromised person if the immunocompromised person is susceptible to varicella.
The ACIP preferential recommendation is an unusual situation for a variety of reasons. The Merck vaccine was approved in 2006 for those over age 50, but only recommended for those over age 60 because of evidence that immunity waned over time. The concern was that earlier receipt of the vaccine would lead vaccinees not to have adequate protection at the time they were at most risk of shingles and its complications. In contrast, the immunity generated by Shingrix is long lasting. Given that shingles risk increases particularly after age 50, earlier receipt of shingles vaccine will prevent many cases in those age 50-60. Another key difference between the vaccines is the degree of effectiveness: Zostavax is 64% effective at preventing shingles in people age 60-69. The GSK vaccine is 98% effective at preventing shingles in the same age group.
Emotional stress considered a trigger for shingles because it has been shown to weaken the body’s immune system. This can happen in those who have undergone a sudden shock, such as the death of a loved one, or people who face chronic work or life stress. An immune system weakened by stress provides the shingles virus with a window of opportunity. This is particularly true of people who already have challenged immune systems, either because they are older or because they have an immune deficiency or a chronic disease.
Why the discrepancy between kids and grown-ups? Cost can be a big deterrent for adults who are considering some vaccinations. The federal Vaccines for Children Program helps parents whose kids are eligible for Medicaid or are uninsured cover the cost of vaccines up to age 19.
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.
Ask your doctor about prescribing antivirals, which can accelerate healing. Also ask about Zostavax, the shingles vaccine approved for people over age 50. “It’s safe and hastens healing, but it’s only about 50-percent effective,” Gershon adds.
Zostavax offers moderate protection against shingles and post-herpetic neuralgia in the first few years after vaccination — 51 percent and 67 percent, respectively. But the protection wanes quite quickly and appears to be gone within seven to nine years after vaccination.
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.
The shingles vaccine has not been shown to cause any serious side effects or health consequences. Minor side effects of the vaccine include redness, swelling, soreness, or itching at the site of injection, and headache. It is safe for those who have received the shingles vaccine to be around babies or those with weakened immune systems. It has not been shown that a person can develop chickenpox from getting the shingles vaccine, although some people who receive the vaccine may develop a mild chickenpox-like rash near the injection site. This rash should be kept covered and will disappear on its own.
A few days later, you may see a rash in the spot where you felt the pain. It’s usually only on one side of your body or face, but it can, in rare cases, form on your face or all over your body. The condition also: