Vaccines against shingles (herpes zoster) in adults (Zostavax and Shingrix)

Vaccines against shingles (herpes zoster) in adults (Zostavax and Shingrix)

Although this website focuses on pediatric medicine, I thought it would be right to add some information that is very important, in my opinion, that is more relevant to the parents and grandparents.
Given that shingles is a disease that causes considerable morbidity, and given that two vaccinations exist against this disease (named Shingrix and Zostavax), I thought it would be beneficial to provide the information about who, what and when should receive each of these vaccines.

So, what is shingles?

Are you familiar with Chickenpox? Of-course you are. You can read more about Chickenpox here.
The virus that causes Chickenpox (and shingles) is called Varicella zoster and is one of 8 viruses that comprise the Herpes family.
The first time a person contracts this virus it causes a typical disease that we all know: Chickenpox.
After that primary infection, this virus, similar to other viruses in this family, remains latent (hidden) in the nervous system, and then many years later can reactivate and cause a disease called ‘shingles’, or ‘zoster’.
This means, that shingles is a second outbreak of the same virus. On the first time when we were infected with the virus we had chicken pox and on the second time when that same virus reactivated, it causes shingles.

What does shingles cause?

It causes a vesicular rash in a one sided, belt or band-like distribution, in most cases associated with pain and itchiness in that area. See attached pictures, usually the rash is more significant than depicted in these photos.
Also, after recovery and clearing of the rash, adults may experience lingering pain in the area where the rash used to be.
This pain syndrome is called ‘post herpes neuralgia’, and is defined as prolonged pain, proceeding 3 months or more after the rash is gone.
It occurs in 10-13% of cases of shingles in patients over 50 years old. Unpleasant.
A severe and diffuse disease, extending over the limits of the belt-like distribution may occur in patients with an weak immune system.
Rarely, there may be an outbreak of the virus without the typical rash. This medical condition is difficult to diagnose and is called ‘Zoster sine herpete’.

Who and when are more likely to get shingles?

Shingles is a disease affecting older individuals. Usually over the age of 50 years. Its prevalence is of over a Million cases in the US every year.
However, theoretically, cases may be seen at any age, including adolescence, but these are the exceptions that prove the rule. I will remind that in the current era, in many countries, children get vaccination against Chickenpox during their first years of life, and then the odds of having shingles diminishes even further (in comparison with a ‘wild-type’ infection by the virus).
Why would Joe Bloggs experience an outbreak of shingles one random sunny day? Usually there’s no clear reason.
Apart from age, immune compromise is a risk factor for shingles. The virus reactivates more often in patients that suffer from an oncologic disease, as an example, as an expression of their weakened immune system. Still, most cases occur in patients over 50 years with no apparent reason and no “occult disease”.

Is shingles contagious?

Shingles is much less contagious than Chickenpox. The only people who can catch the disease from a person who has shingles are those who come in direct contact with the blisters of an ill person, and had not had Chickenpox nor received a vaccine previously. For these people, this would be the first time they come across the virus and they will contract chicken pox.
In the uncommon case of a diffuse shingles disease, the transmission may occur by contact and also by air (aerosol).
This is an important point to understand. Shingles cannot cause shingles in another person because it is always caused by the reactivation of that same virus within our body.

Is there treatment for an outbreak of shingles?

Yes. Early initiation of an anti-viral medication that is active against this virus may shorten the disease course.
However, prevention of a disease is always better that getting the disease itself.

Is there a way to prevent the outbreak of shingles?

Yes, get vaccinated.

What types of vaccines are available against shingles and what is the difference between them?

Zostavax vaccine

Manufactured by MSD. This is a live-attenuated vaccine that contains the same virus species (live attenuated) as the children’s vaccine against Chickenpox. But in larger amounts.
In most of the world, the vaccine is approved for ages 50 and above although is sometimes officially recommended for ages 60 and above.
At this stage, this entails a single dose and the efficiency is for at least 5 years.
The vaccine is given under the skin at the upper part of the arm, and does not have significant side effects.
This vaccine was shown to reduce the risk of shingles by 70%.
Given that it is a live attenuated vaccine, it cannot be administered to people suffering from an immune deficiency.
The risk of a person who was vaccinated to transmit the virus to another person is only in theory, and there are no recommendations to keep distance from family or other people after having received the vaccine.

Shingrix vaccine

Manufactured by GSK. A recombinant vaccine that is available only in some countries worldwide.
In the US, this vaccine is registered for adults aged 50 and older. The vaccine is given in two doses, 2-6 months apart.
The vaccine is given intra muscularly in the upper part of the arm.
This vaccine was shown to reduce the risk for shingles by 90%!
On the other hand, there’s a bit of a higher prevalence of side effects following the vaccine. The most common side effects are local, that is, pain, swelling and redness in the area of injection. Systemic side effects such as muscle pain, headache and fatigue are much less common.
Among the benefits of this vaccine is that it may be given to immune compromised individuals and that the duration of protection is longer.

So, at what age and which vaccine is recommended for shingles?

I recommend every person over the age of 50 to get vaccinated against shingles.
The American FDA recommends the Shingrix vaccine to every person whose age is 50 and over. This is the preferred vaccine.

So, what to do practically right now?

If It is possible for you to get a Zostavax vaccine quite easily, that will provide relatively good protection for several years.
On the other hand, it is possible to get Shingrix that is clearly preferable. I recommend anyone who is older than 50 years or is immune compromised and over 18, to get the Shingrix vaccine.

Could and should someone that received the Zostavax vaccine, be later vaccinated with Shingrix?

Certainly, and even recommended.

Is it right to vaccinate someone who had already gotten shingles in the past?

Yes, the disease may recur and therefore vaccinating individuals who had been affected before is recommended.

So mom or dad, grandma or grandpa – go get vaccinated against shingles to stay healthy.

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