By Lisa Larkin, MD, FACP, NCMP, IF
We’ve all seen the commercials on TV – the one that makes you cringe when you hear that if you have had chickenpox, then you have, “the virus lurking inside you that could surface at any time as a painful, blistering rash….” Scary advertising tactics aside, the latest advancement in shingles prevention provides more evidence than ever that getting the shingles vaccine is a no-brainer.
Until this fall, there was only one option for a shingles vaccine: Zostavax, a live vaccine that was approved in 2008 for the prevention of herpes zoster and its complications in adults 60 and older. However, in October this year, a new vaccine, Shingrix, was approved, and it has already gained the recommendation of the Advisory Committee on Immunization Practices (ACIP) because of its vastly improved efficacy rates.
Shingles, or herpes zoster, is a painful, blistering rash that develops as the result of the reactivation of the varicella zoster virus, the virus that causes chickenpox. No one knows what triggers the reactivation, but getting older plays a part, as aging can weaken our immune system. Even once the rash has resolved, many people experience nerve pain that can last for weeks or even month. Shingles can develop decades after the initial chickenpox infection and is most common in adults over 50. The Center for Disease Control and Prevention estimates that nearly one million people annually will develop shingles, and 1 in 3 people in the US will develop it in their lifetime.
Zostavax is indicated for adults 60 and older, and shows an average efficacy of 51% – meaning roughly half of the people who get the vaccination do not develop shingles. However, the efficacy for Zostavax varies across age groups, and its efficacy greatly declines in older populations. The new Shingrix vaccine shows much-improved efficacy – an average of 91% – and longer lasting efficacy, meaning even older age groups maintained that 91% efficacy rate. Because data from its trials demonstrated consistent efficacy across the entire population, it is indicated for adults 50 and older.
Zostavax, because it is a live vaccine, is contraindicated in people with compromised immune systems or those taking steroids. However, Shingrix is a nonlive recombinant subunit vaccine, so it can be used in these populations — a great benefit as these populations are at even greater risk of developing the virus.
The downside? Shingrix requires a series of two shots, 60-days apart (versus one with Zostavax), and some people reported pain at the injection site and discomfort for a short period after receiving the first dose. But researchers considered those side effects mild, and some ibuprofen or other over-the-counter pain medications can minimize the discomfort.
The bottom line? If you’re over 50, even if you’ve already received the Zostavax vaccine, consider getting the Shingrix vaccine. Talk to your provider or contact the office (513.760.5511) for more information.