If you are a healthy adult 50 years and older, you should be vaccinated against shingles. The vaccine is Shingrix, which is very effective in preventing shingles and serious and painful complications.
This is why older and not-so-older adults get the Shingrix vaccine – despite reports of discomfort at the injection – and why experts strongly recommend taking this step to protect yourself from shingles.
[See: Ways to Boost Your Immune System.]
Shingles symptoms
According to the Centers for Disease Control and Prevention, nearly one in three people in the United States develops shingles, with an estimated 1 million people being diagnosed with shingles annually. Pain, rash, itching and first fluid-filled, then eventually crust-forming blisters, are symptoms of shingles. Some people become hypersensitive to touch or light, and experience headaches and fever.
Shingles tends to come first, ranging from mild to intense. Pain is usually worst in the first one or two weeks, sometimes making it difficult to work, sleep, and perform daily tasks. People need prescribed painkillers when shingles is at its worst.
The shingles rash of red-purple bunches tends to appear on one side of the back, chest or abdomen. Shingles usually looks like streaks across the skin. This pattern corresponds to areas known as dermatomes. A dermatome is an isolated skin section that receives sensation from a single nerve. Shingles usually affects one or a few adjacent dermatomes.
The appearance of shingles can be upsetting to those who have it, especially if a clear rash or crust-like lesions appear on one side of the forehead or surround an eye. Shingles can lead to permanent scarring.
Availability
To prevent shingles, healthy adults 50 and older should receive two doses of Shingrix, according to the CDC, two to six months apart.
The Food and Drug Administration approved Shingrix in late 2017. Initially, it was one of the two options for vaccinating shingles. However, the older vaccine, called Zostavax, is no longer available in the US, as several studies have confirmed that Shingrix is much more effective.
Initially, there was a shortage of Shingrix because people were very eager to obtain its protection. Shingrix is now widely available.
“With COVID, people are so far behind in getting their (shingles) vaccinations because they were not aggressive in getting them but did not want to go out,” says Stephan Foster, a pharmacist and liaison member of the Advisory Committee on Immunization Practices. of ACIP. “There’s enough supply. There are a lot of people who need to get it now.”
Whether you are in your 50s or a debilitated older adult in your 70s, shingles vaccination is safe and effective, according to a study published on November 16, 2020 in the Journal of the American Geriatrics Society. In the large multi-center study among approximately 27,000 people vaccinated with Shingrix or a placebo, the effectiveness ranged from approximately 90% in debilitated participants to almost 96% in non-debilitated participants. The study was supported by GlaxoSmithKline, the maker of Shingrix.
Safety
Like all vaccinations, Shingrix is constantly assessed on safety, Foster says. “The monitoring of vaccines is incredible,” he says, with several systems in place, including these:
The system for vaccination of unwanted events detects possible safety problems early on with vaccination licensed by the USA. VAERS is co-managed by the Centers for Disease Control and Prevention and the Food and Drug Administration.
The Vaccine Safety Datalink, a project managed by the CDC’s Office of Immunization Safety, contains data from participating healthcare organizations to monitor the safety of vaccines and conduct studies on rare and serious events after vaccination.
Shingrix is a non-living, recombinant vaccine produced using only a specific piece of shingles-related virus protein.
In terms of effectiveness, Foster says the likely reason Shingrix worked better than Zostavax is that Shingrix is a tool. “An adjuvant is an ingredient of the vaccine that makes our bodies respond more to it – get a better response to it,” he explains. “It’s an immune booster.”
Last week, the FDA demanded that a warning about Guillain-Barré syndrome be included in the safety labels for Shingrix. Following evaluation data from a post-marketing study, the FDA determined that “the results of the observational study show a link between GBS and Shingrix, but that available information is insufficient to establish a causal link,” according to a March 24 agency statement. .
The small but increased risk of GBS – a rare autoimmune disease affecting nerve cells sometimes caused by vaccines – was observed in the first six weeks after the first dose of Shingrix for adults 65 years and older, with more cases of GBS compared to historical data for Zostavax, the previous shingles vaccine. No increased risk was observed after the second dose.
The risk is still very small, Foster emphasizes. “Personally, I would not let the decision change” to continue with the shingles vaccination, he says.
Pay for Shingrix
Your private health insurance can cover Shingrix. However, the coverage may not apply to entries younger than 60. Look for details on individual coverage.
Medicare Part D covers according to vaccare.gov commercial vaccinations such as shingles. People who have not met their deductible may have to pay the cost of about $ 325 or both for both shots.
COVID-19 vs. Shingles Priorities
As COVID-19 vaccination takes place across the province – with seniors among priority groups – it adds a new wrinkle when planning your shingles vaccination. “I would say it’s more important that they get the COVID vaccine now,” says Foster. “And there must be a two-week window between them.”
But once you have been completely vaccinated for COVID-19 and the two-week period has expired, you need to put shingles vaccination back on your priority list, Foster recommends. “If anyone has ever had shingles before, they will regret not just getting it. Shingles is a bad disease. And if it can help prevent it, it’s worth it.”
Since the pandemic began, there has been an increase in shingles cases, says Dr. Ardeshir Hashmi, a geriatrician and the incumbent chair of geriatrics innovation at Cleveland Clinic. .
Early in the pandemic, patients could not come in for vaccinations or any form of preventative care, Hashmi said. Fortunately, he adds, it is changing now.
“The other reason we saw a real rise in the beginning was the tension of the pandemic,” says Hashmi. “The anxiety and social isolation mediated the stress. Older adults have a reduced immunity anyway. So the combination – stress on top of a reduced immunity – is a real fertile ground for shingles cases.”
[See: Questions Doctors Wish Their Patients Would Ask.]
Shingrix side effects
Shingrix, like many vaccines, has temporary side effects. People mostly have local reactions to vaccination with pain, redness and swelling at the injection site, says Hashmi. Fewer patients have common symptoms such as muscle aches and pains, fatigue or headaches. Rarely do patients develop fever or gastrointestinal symptoms, he says.
It is easy to treat home symptoms at the injection site, says Hashmi. “Actually, it’s local application of ice cream and just watching it closely,” he says. Patients are always warned to pay close attention to any signs of infection. “We always want to ensure any redness or heat on the site that lasts longer than seven days, or any increase in the redness area,” he says. “But it usually goes down within that first week.” He recommends paracetamol (Tylenol) if painkillers are needed.
What causes shingles?
The varicella-zoster virus causes chickenpox when it is first infected in the body, usually in childhood. Later, the virus lies dormant in the body, often for decades. When the virus is reactivated in adulthood, it causes herpes zoster, commonly known as shingles.
With the early, initial infection, the body’s immune system launches a response to remove varicella-zoster virus from cells and prevents the virus from duplicating. This immunity lasts long after chickenpox is gone. Unfortunately, the body’s immunity tends to weaken as people get older, which can pave the way for the reactivation of the virus in the form of shingles. This is what makes vaccination so important.
Is shingles contagious? Not quite. Someone with shingles in the bladder phase can spread the varicella-zoster virus to someone who has never had chickenpox or chickenpox. That person can then get chickenpox – not shingles. People with shingles should avoid direct contact with people with weakened immune systems, pregnant women and newborn babies.
Shingles Complications
Shingles can persist well after the lesions of the skin have healed. Chronic, severe pain lasting weeks, months or years after shingles is called post-herpetic neuralgia. According to the CDC, up to 15% of people with shingles develop post-herpetic neuralgia, and the risk increases with age.
Pain is often described as pain, burning, stabbing or shooting. Discomfort can also include excessive sensitivity to temperature changes, touch, itching and numbness.
The inability to work, exercise or socialize due to constant pain takes physical and emotional toll. People with postherpetic neuralgia may develop depression or other signs of mental distress.
In shingles involving the eye, loss of vision is a possible complication. In rare cases, shingles can lead to blindness. Muscle weakness or paralysis are possible complications. Encephalitis, or inflammation of the brain, is a rare long-term complication.
[See: Different Types of Pain, Explained.]
Awareness
Hashmi says he still sees a fair number of people with shingles. Fortunately, the frequency decreases as more people are vaccinated against shingles. Also, patients with shingles tend to come in with milder cases than in the past.
“There is mostly awareness and it is picked up early,” Hashmi says. “We rarely see the complications. People do not leave it that long – so it’s encouraging. But the complications we see can sometimes be quite serious.”
Post-herpetic neuralgia is the primary long-term complication in its patients. “Unfortunately, there is no good treatment for it, once it is underway.”
Eye involvement, or herpes zoster on hthalmicus, occurs in between 10% and 25% of shingles cases in older adults, says Hashmi. Over-involvement in hearing loss is another serious complication of shingles
One group of patients should not receive the shingles vaccination regularly, says Hashmi. “People who have autoimmune diseases, or have cancer and depressed immune systems, or it could be HIV – any kind of autoimmune entity – the shingles vaccine specifically is not for them.” For patients in the category who want the vaccine, he says, it is key to have discussions with their doctors, especially their specialists such as oncologists or hematologists. “There are protocols, but we have to be extremely careful.”
Otherwise, Hashmi’s in most people 50 and older insist on getting the shingles vaccine: “Like any vaccine, it is not 100%,” he says. “So you can still get shingles infections even if you have been vaccinated, but it significantly reduces your chances. It has a 90% effectiveness, which is quite high.” This is true in older patients, he adds. “We see the efficacy in people who are in their 50s, but we also see it in patients who are in their 70s.”
In addition, “for people who have had the vaccine, the rate of complications is much lower – specifically with herpetic neuralgia and the pain associated with it,” says Hashmi. All this increases the importance of getting the vaccine, he says: “Prevention is better than cure.”