Who should get the shingles vaccine?

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June 7, 2024

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Who should get the shingles vaccine?

Who Should Get the Shingles Vaccine? A Comprehensive Guide

The shingles vaccine is a vital tool in preventing shingles (herpes zoster), a painful condition caused by the reactivation of the varicella-zoster virus (VZV). Shingles primarily affects older adults and individuals with weakened immune systems. This comprehensive guide explores who should get the shingles vaccine, including recommendations, benefits, considerations, and special populations.

1. Overview of Shingles

Definition and Cause:

  • Shingles: Shingles is a viral infection that results in a painful rash, typically on one side of the body or face. It is caused by the reactivation of the varicella-zoster virus, the same virus responsible for chickenpox.
  • Varicella-Zoster Virus: After a person recovers from chickenpox, VZV remains dormant in the nerve tissues and can reactivate later in life, leading to shingles.

Symptoms:

  • Rash and Blisters: Shingles is characterized by a painful, blistering rash that follows the path of a single nerve.
  • Pain: The pain associated with shingles can be severe and is often described as burning, throbbing, or stabbing.
  • Other Symptoms: Fever, headache, chills, and upset stomach may accompany the rash.

2. Shingles Vaccine Overview

Types of Shingles Vaccines:

  • Shingrix (Recombinant Zoster Vaccine, RZV): Shingrix is a non-live, recombinant subunit vaccine that contains a viral protein (glycoprotein E) and an adjuvant (AS01B) to enhance the immune response. Approved by the U.S. Food and Drug Administration (FDA) in 2017, Shingrix is the preferred vaccine for preventing shingles and its complications.
  • Zostavax (Live Zoster Vaccine, ZVL): Zostavax is a live attenuated vaccine that contains a weakened form of the varicella-zoster virus. Approved by the FDA in 2006, Zostavax was previously used for shingles prevention but has been largely replaced by Shingrix due to its superior efficacy and is no longer available in many countries, including the United States.

3. General Recommendations for the Shingles Vaccine

Adults Aged 50 and Older:

  • Primary Recommendation: The Centers for Disease Control and Prevention (CDC) recommends Shingrix for all adults aged 50 and older, regardless of whether they have had shingles or received Zostavax.
  • Benefits: Vaccination significantly reduces the risk of developing shingles and its complications, such as postherpetic neuralgia (PHN).

Adults Aged 19 and Older with Weakened Immune Systems:

  • Immunocompromised Individuals: Shingrix is recommended for adults aged 19 and older who have weakened immune systems due to underlying conditions or treatments, such as cancer, HIV/AIDS, or immunosuppressive therapy.
  • Enhanced Protection: Immunocompromised individuals are at a higher risk of severe shingles and complications, making vaccination particularly important for this group.

4. Special Considerations and Populations

Individuals with a History of Shingles:

  • Recurrent Shingles: While rare, shingles can recur. Shingrix is recommended for individuals who have had shingles to prevent future occurrences.
  • Timing of Vaccination: It is advised to wait until the shingles rash has completely healed before getting vaccinated.

Individuals Who Previously Received Zostavax:

  • Transition to Shingrix: Individuals who previously received Zostavax should also receive Shingrix due to its higher efficacy. There is no need to repeat the Zostavax dose before getting Shingrix.
  • Recommended Interval: It is recommended to wait at least 8 weeks after receiving Zostavax before getting Shingrix.

Individuals with Chronic Diseases:

  • Diabetes: People with diabetes have an increased risk of infections, including shingles. Vaccination can help reduce this risk.
  • Cardiovascular Disease: Conditions such as heart disease can weaken overall health and immunity. Vaccination is advisable to prevent shingles-related complications in these individuals.
  • Chronic Obstructive Pulmonary Disease (COPD): Individuals with COPD have a higher risk of developing shingles due to chronic inflammation and the use of corticosteroids. Vaccination is recommended to mitigate this risk.

Pregnancy and Breastfeeding:

  • Pregnancy: Shingrix is not recommended for pregnant women due to the lack of safety data. Women who are pregnant should wait to receive Shingrix until after delivery.
  • Breastfeeding: There is no available data on the safety of Shingrix during breastfeeding. Women should consult their healthcare provider to weigh the potential benefits and risks.

Individuals with Severe Allergies:

  • Allergic Reactions: Shingrix should not be administered to individuals with a history of severe allergic reaction to any component of the vaccine. Consultation with a healthcare provider is necessary to evaluate alternative preventive measures.

5. Benefits of the Shingles Vaccine

Prevention of Shingles:

  • Reduced Incidence: Vaccination with Shingrix significantly reduces the risk of developing shingles, which can cause severe pain and discomfort.

Prevention of Complications:

  • Postherpetic Neuralgia (PHN): Shingrix effectively prevents PHN, a common and painful complication of shingles that can last for months or even years after the rash has healed.
  • Herpes Zoster Ophthalmicus: Vaccination can reduce the risk of shingles affecting the eye, which can lead to vision loss.

Improved Quality of Life:

  • Pain Reduction: By preventing shingles and its complications, vaccination can improve overall quality of life, particularly for older adults and immunocompromised individuals.

6. Vaccine Administration and Schedule

Shingrix Dosage:

  • Two-Dose Series: Shingrix is administered in two doses. The second dose should be given 2 to 6 months after the first dose for optimal protection.

Injection Site:

  • Intramuscular Injection: Both doses of Shingrix are administered via intramuscular injection, typically in the deltoid muscle of the upper arm.

Vaccine Storage and Handling:

  • Storage Conditions: Shingrix must be stored in the refrigerator at 2°C to 8°C (36°F to 46°F) and should not be frozen.
  • Reconstitution: Shingrix comes as a lyophilized powder that must be reconstituted with the supplied adjuvant suspension before administration.

7. Side Effects and Safety

Common Side Effects:

  • Injection Site Reactions: Pain, redness, and swelling at the injection site are common side effects of Shingrix.
  • Systemic Reactions: Some people may experience muscle pain, fatigue, headache, shivering, fever, and gastrointestinal symptoms. These side effects are generally mild to moderate and resolve within a few days.

Serious Side Effects:

  • Severe Allergic Reactions: Although rare, severe allergic reactions (anaphylaxis) can occur. Signs of an allergic reaction include hives, swelling of the face and throat, difficulty breathing, and rapid heartbeat.
  • Reporting Adverse Events: Any adverse reactions following vaccination should be reported to the Vaccine Adverse Event Reporting System (VAERS) or equivalent national systems.

Safety in Immunocompromised Individuals:

  • Non-Live Vaccine: Shingrix is safe and recommended for immunocompromised individuals, as it is a non-live vaccine. It provides effective protection without the risk associated with live vaccines.

8. Cost and Insurance Coverage

Vaccine Cost:

  • Varied Pricing: The cost of Shingrix can vary, but many insurance plans, including Medicare Part D, cover the vaccine. The average cost for a two-dose series ranges from $300 to $400.
  • Financial Assistance: Some programs may offer financial assistance or discounts for those without insurance coverage. Patients should check with their healthcare provider or local pharmacy for available options.

Conclusion

The shingles vaccine is a critical preventive measure against shingles and its complications. Shingrix, the preferred vaccine, is highly effective and recommended for adults aged 50 and older, as well as for immunocompromised individuals. Vaccination can significantly reduce the risk of developing shingles, prevent complications such as postherpetic neuralgia, and improve overall quality of life. Understanding the benefits, administration, and safety of the shingles vaccine can help individuals make informed decisions about their health. Consulting with healthcare providers for personalized advice and vaccination scheduling is essential for those at risk of developing shingles.

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