- A new shingles vaccine has been approved by the FDA.
- Shingles is caused by the same virus that leads to chicken pox
- The new vaccine is 96 percent effective at keeping the shingles virus at bay
A new vaccine has changed how you can protect yourself against shingles, the painful virus that causes a burning, itching rash. Michael Bolton, MD, PhD, of the Swedish Infectious Disease Clinic in Edmonds, WA, talks about the new vaccine, which was approved by the FDA in October, 2017, and discusses whether it may be right for you.
Why do we need a vaccine for shingles?
“The virus that causes shingles is called the varicella-zoster virus. Varicella is chicken pox, the disease you typically encounter as a child. About 96 percent of people who have been in the United States for the last 30 years have had the chicken pox whether or not they remember symptoms. There is a vaccine for chicken pox — the varicella or chicken pox vaccine — to prevent people from getting infected. It’s good for children and for women before they become pregnant.
“The distinctive thing about the varicella-zoster virus is that when we are infected by most viruses, our body usually takes care of it and then we’re immune from it forever. In contrast, the varicella-zoster virus is in the family of the herpes virus, which never goes away. Viruses in this family live inside of us for the rest of our lives. Varicella zoster remains dormant in the nerve cells, where it is typically kept in check by the immune system for decades. Anyone who has already had the chicken pox is at risk for developing shingles later in life when the virus becomes active again as a result of age, stress or a weakened immune system, which is why a vaccine is needed. Zoster, or shingles, is when you get a reactivation of chicken pox virus.”
What happens when we get shingles?
“Shingles usually develops in one spot. It starts growing on nerves from the spine and comes out to the skin, and all the skin linked to that one nerve gets infected by a painful rash with blisters. It can be terribly painful, often one side of the body and on one strip of skin, and that’s how you know it is shingles. Generally, we can diagnose it just by seeing it.
“Fortunately, the immune system that had been falling asleep will wake up and get the virus back under control within a couple of weeks. The blisters on the rash scab over and start to heal. There is a small percentage of people who, after the body controls the virus, will end up with nerve damage that can continue to hurt for a long time, and that’s called post-herpetic neuralgia. And about one to four percent of people can get shingles again. So, our goal is with the shingles vaccine is to prevent both a shingles outbreak later in life and post-herpetic neuralgia.”
What is the difference between the old and new vaccine?
“The big difference between Zostavax and the new vaccine, Shingrix, is that Shingrix is not a live virus. It represents a completely different way of vaccinating people. When we’ve used live viruses as a vaccine in the past, as with Zostavax, they give you the greatest response from the immune system, so generally the strongest vaccines have been live. But the new vaccine is manufactured to contain nonliving viral particles. It doesn’t infect people; rather, it is only showing the immune system one of the virus proteins. It’s remarkably successful and much more protective than the original vaccine. And it’s up to about 96 percent effective, which is a significant improvement over the original vaccine. Because more providers are recommending it, even for people 50 to 60 years old, there is a good chance that your insurer will cover it, but you should check with your health insurance provider.”
Is there anything patients need to keep in mind about the new shingles vaccine?
“With the old vaccine you only needed one injection, but the new one requires two shots given about two to six months apart. There may be more side effects, mostly muscle and joint aches. That may be because it’s doing such a good job of waking up the immune system, but the symptoms usually go away in a few days. It’s not a reason to not use the new vaccine. One way of telling if the symptoms are bad is to see if people don’t come back to get the second shot, but almost everybody does come back.
“Also, at present we don’t conclusively know how long the new vaccine is effective. The old vaccine lasts around five to eight years before we see the immune system levels going down again. But the new one is so robust that we are not sure how long we want to go before we boost people. So, my advice at this point is that you should consider getting the vaccine now and wait for researchers to determine when the booster should be given.”
Who should get the new vaccine?
“The risk of the virus reactivating after age 50 increases with each decade. We recommend vaccinating adults 50+, but adults at the highest risk are 70s and older. Because the new vaccine is more effective, it makes sense to vaccinate people starting between ages 50 and 60. The new vaccine Shingrix is likely to replace the old vaccine.
“Because the new vaccine is more effective, many providers are recommending people who were vaccinated by the old vaccine get the new one too. Both vaccines are safe, whether they’ve had chicken pox or not. We also recommend people who have had shingles get the new vaccine.
“Because the old vaccine was a live attenuated virus, we were cautious about vaccinating anyone with a compromised immune system, because we didn’t want the virus to cause additional problems. Now, these individuals may be vaccinated with the new vaccine since it’s nonliving. People who have low levels of immune-suppressing drugs and people with HIV may be candidates, but pregnant women should wait to get Shingrix. Transplant recipients and people with autoimmune disorders such as multiple sclerosis and rheumatoid arthritis should discuss with their provider.
“Shingrix is now the preferred vaccine option for shingles immunization: it’s more effective than the old vaccine, safe for individuals who have or have not had chicken pox, and you can get it even if you’ve already had shingles or already gotten the old vaccine. It is relatively new, so there is always a chance that recommendations could change if new data emerges. But the current data on its safety is strong, and it is FDA-approved.”
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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.