A new shingles vaccine called Shingrix® was licensed by the U.S. Food and Drug Administration (FDA) in 2017. CDC recommends that healthy adults 50 years and older get two doses of Shingrix, 2 to 6 months apart. Shingrix provides strong protection against shingles and PHN. Shingrix is the preferred vaccine, over Zostavax.
Several steps need to occur before people can get the vaccine. The Centers for Disease Control and Prevention will officially publish the ACIP’s recommendation in Morbidity and Mortality Weekly Reports, and commercial insurers, Medicare, and Medicaid will need to approve reimbursement (the shelf price of the vaccine is $280 for the two-dose series). Most commercial health insurance plans and Medicare Part D cover Zostavax, and the same will probably be true of Shingrix. The vaccine will likely be available in early 2018
Influenza A (H3N2) has caused most of the illnesses in this severe flu season, but influenza B is becoming increasingly responsible for more infections as the flu season continues to hit the United States.
Postherpetic neuralgia is a painful condition that is one of the most common complications of an acute herpes zoster infection. Herpes zoster presents as a localised rash resembling localised chicken pox, often called ‘shingles’. Postherpetic neuralgia may persist lifelong once it occurs and has major implications for quality of life and use of healthcare resources. Corticosteroids have a potent anti-inflammatory action, which it has been suggested might minimise nerve damage and thereby relieve or prevent the pain experienced by people suffering from this condition. Five trials were identified from a systematic search of the literature which were of high enough quality to be included in the review. These trials involved 787 participants in total. We were able to combine the results from two trials (114 participants) and there was no significant difference between the corticosteroid and control groups in the presence of postherpetic neuralgia six months after the onset of the acute herpetic rash. Two of the three other included trials reported results at less than one month, so these participants did not fulfil the current criteria for a diagnosis of postherpetic neuralgia. The last trial reported results in a format unsuitable for meta-analysis. There were no significant differences in serious or non-serious adverse events between the corticosteroids and placebo groups. There was also no significant difference between the treatment groups and placebo groups in other secondary outcome analyses and subgroup analyses. It can be concluded that, based on moderate quality evidence, corticosteroids are not effective in preventing postherpetic neuralgia.
Shingles is contagious and can be spread from an affected person to babies, children, or adults who have not had chickenpox. But 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, however, people have the potential to develop shingles later in life.
Shingles can be spread when a person comes into contact with fluid contained in the blisters. The virus can be spread by direct contact with the lesions or by touching any dressings, sheets or clothes soiled with discharge from the spots.
When was the last time you woke in the morning feeling bright-eyed and bushy-tailed? With increasingly busy lives – work, study and family, let alone finding time to socialise, exercise, sleep and eat – it’s no wonder we drag ourselves through the day.
In addition, Zostavax’s effectiveness appears to last just five years, according to the CDC. And research presented in the fall at IDWeek, an annual meeting for infectious disease professionals, suggests that Zostavax may actually wane after only three years.
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SOURCES: Amesh Adalja, M.D, senior associate, Johns Hopkins Center for Health Security, Baltimore; Len Horovitz, M.D., pulmonologist, Lenox Hill Hospital, New York City; Talia Swartz, M.D., Ph.D., assistant professor, infectious diseases, Icahn School of Medicine at Mount Sinai, New York City
RZV is currently licensed for all persons 50 years of age and older. Immunosuppression is not included as a contraindication in the manufacturers’ package insert. However, immunocompromised persons and those on moderate to high doses of immunosuppressive therapy were excluded from the clinical efficacy studies so data are lacking on efficacy and safety in this group. ACIP has not made a recommendation regarding the use of RZV in these patients. This topic is anticipated to be discussed at upcoming ACIP meetings as additional data become available.
Though Shingrix was tested on some 16,600 adults in clinical trials, its real-world use has been limited. The company will be conducting additional safety and efficacy studies over the next few years, and the CDC will be monitoring any adverse events that are reported.
Shingrix was approved by the FDA in 2017 and is the preferred alternative to Zostavax. Studies suggest Shingrix offers protection against shingles beyond five years. It’s a nonliving vaccine made of a virus component, and is given in two doses, with two to six months between doses.
The shingles virus emerges from hibernation when you are at your lowest ebb physically and emotionally. Establish some good eating, sleeping and exercise habits to prevent yourself sliding down again.
Department of Health and Ageing (DOHA). The Australian Immunisation Handbook. 9th ed. [online] Canberra, ACT: Commonwealth of Australia. 2008 [Last updated Sept 2010, accessed 12 Jul 2011] Available from: http://www.health.gov.au
^ Coplan P, Black S, Rojas C, et al. (2001). “Incidence and hospitalization rates of varicella and herpes zoster before varicella vaccine introduction: a baseline assessment of the shifting epidemiology of varicella disease”. Pediatr. Infect. Dis. J. 20 (7): 641–45. doi:10.1097/00006454-200107000-00002. PMID 11465834.
The current Immunisation Authority for Registered Nurses and Midwives does not include herpes zoster (shingles) vaccine. Authorised Nurse Immunisers must not independently initiate and administer herpes zoster vaccine (Zostavax) without medical authorisation.
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha’s educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
Antiviral drugs may reduce the severity and duration of shingles; however, they do not prevent postherpetic neuralgia. Of these drugs, aciclovir has been the standard treatment, but the new drugs valaciclovir and famciclovir demonstrate similar or superior efficacy and good safety and tolerability. The drugs are used both for prevention (for example in HIV/AIDS) and as therapy during the acute phase. Complications in immunocompromised individuals with shingles may be reduced with intravenous aciclovir. In people who are at a high risk for repeated attacks of shingles, five daily oral doses of aciclovir are usually effective.
For some seniors, it can mean the difference between living independently and having to move into a long-term care facility because of its long-lasting effects, Livingstone said. Losing their independence is a huge issue for older people, she added.
The varicella zoster vaccine, marketed under the name Zostavax, has been shown to lower the risk of developing herpes zoster (also known as shingles) by more than half. Among those who develop shingles despite getting a shot, the infection lasts for a shorter period of time, and symptoms are less severe. The risk of postherpetic neuralgia, a painful complication of shingles, is reduced by 67%.
“But, with time and as one gets older, there is a decline in natural immunity and the virus can flair up again, presenting as shingles,” Glass said. Consequently, the risk of shingles increases as one gets older and the likelihood of persistent pain increases dramatically after the age of 50.
A dormant virus basically goes unnoticed for some time (potentially even forever) and doesn’t cause symptoms, yet it can stay active on some level for many years. Certain factors that compromise immunity can cause the virus to act up and become noticeable once again — in the case of shingles causing a skin rash.
In pre-licensure clinical trials of RZV the most common adverse reactions were pain at the injection site (78%), myalgia (45%), and fatigue (45%). Any grade 3 adverse event (reactions related to vaccination which were severe enough to prevent normal activities) was reported in 17% of vaccine recipients compared with 3% of placebo recipients. Grade 3 injection-site reactions (pain, redness, and swelling) were reported by 9% of vaccine recipients, compared with 0.3% of placebo recipients. Grade 3 solicited systemic events (myalgia, fatigue, headache, shivering, fever, and gastrointestinal symptoms) were reported by 11% of vaccine recipients and 2.4% of placebo recipients. The occurrence of local grade 3 reactions did not differ by vaccine dose. However systemic grade 3 reactions were reported more frequently after dose 2.
Ophthalmic shingles affects the nerve that controls facial sensation and movement in your face. In this type, the shingles rash appears around your eye and over your forehead and nose. Ophthalmic shingles may be accompanied by headache.
Although there is no cure, there is evidence to suggest that treatment with antiviral and anti-inflammatory drugs can shorten the duration of the rash and reduce the severity of post-herpetic neuralgia. Early treatment with antiviral medication such as Famvir or Zelitrex may shorten the course of the disease and diminish the severity and risk of post-herpetic neuralgia. Treatment must however be started within three days of the outbreak.
According to Schaffner, it’s anticipated that deductibles and co-pays aside, private insurers will probably cover the cost of Shingrix—which is $280 for the two shots. That’s what insurers generally do with Zostavax (which costs $213 for those who have to pay full price, according to the CDC).
Care of the skin rash can be provided at home, and this can offer some symptom relief. Topical calamine lotion can be applied to the rash in order decrease itching. Cool wet compresses against the rash can sometimes be soothing, and for some individuals, a compress with aluminum acetate solution (Burow’s solution or Domeboro) may also be helpful. For some, colloidal oatmeal baths may also provide relief from the itching. It is important to maintain good personal hygiene, avoid scratching the rash, and to try to keep the affected area clean in order to prevent a secondary bacterial infection of the skin. The rash should be covered to decrease the risk of transmissibility should you come into contact with susceptible individuals.
The rash from shingles tends to develop in a certain pattern, most commonly on the trunk. It is sometimes referred to as a “shingles band” due to the striped pattern. The rash may start as red patches but changes over time and develops into fluid-filled blisters. These blisters may ooze.
A 60-year-old patient was inadvertently given varicella vaccine instead of zoster vaccine. Should the patient still be given the zoster vaccine? If so, how long an interval should occur between the 2 doses?
The shingles vaccine has been tested on thousands of people to ensure its efficacy and safety. Most of the time, the vaccine is safely administered without any side effects. When it does cause reactions, they’re usually mild. People have reported side effects including redness, swelling, itching, or soreness in the area of skin where they were injected. A small number of people have complained of a headache after being vaccinated.
Fibre (fiber) cement shingles are often known by their manufacturer’s name such as eternit or transite. Sometimes the fiber in the cement material was asbestos which has been banned for health reasons since the 1980s. Removal of asbestos shingles requires extra precautions and disposal methods.
Pregnant females who get shingles are not at as high a risk for viral complications as those pregnant females who become infected with chickenpox. However, if shingles develops within a few weeks of the delivery date, the infant may be at risk for viral complications, and the affected woman should notify her OB-GYN doctor immediately. In addition, shingles at any time during pregnancy may require special treatments; the OB-GYN physician needs to be contacted to help arrange individualized treatment plans.
Antiviral medicines are not advised routinely for everybody with shingles. For example, young adults and children who develop shingles on their tummy (abdomen) very often have mild symptoms and have a low risk of developing complications. Therefore, in this situation an antiviral medicine is not necessary. Your doctor will advise if you should take an antiviral medicine.