At a recent doctor's appointment, I learned about a new shingles vaccine. On October 20, 2017, the Food and Drug Administration (FDA) approved Shingrix for the prevention of shingles (herpes zoster) in adults aged 50 years and older. Shingrix is a non-live, recombinant subunit vaccine given intramuscularly in two doses, spaced two to six months apart. For full effect, it’s important to complete the course and receive both injections
Less than a week later, the Advisory Committee on Immunization Practices (ACIP) voted that Shingrix is: 1) recommended for healthy adults aged 50 years and older to prevent shingles and related complications, 2) recommended for adults who previously received the
current single-shot shingles vaccine (Zostavax) to prevent shingles and related complications, and 3) the preferred vaccine for preventing shingles and related complications. These recommendations still need to be formalized before they become official policy.
What is shingles?
Shingles is a painful outbreak of the varicella zoster virus (VZV) which is the same virus that causes chickenpox. Only a person who has previously had chickenpox can develop shingles, even children. Almost one out of every three people in the United States will develop shingles. The risk increases as you get older with about half of the cases occurring in people aged 60 or older. Just like chickenpox, shingles is highly contagious.
The Centers for Disease Control and Prevention (CDC) states that some people have a greater risk of getting shingles than others. This includes people who have medical conditions that keep their immune systems from working properly — such as leukemia and lymphoma and human immunodeficiency virus (HIV). People who receive immunosuppressive drugs, such as steroids and drugs that are given after organ transplantation, are also at high risk.
Most people who develop shingles only have it once, but sometimes you can experience multiple episodes of shingles. This means that even if you’ve already had shingles, it still may be a good idea to get the vaccine.
Shingrix versus Zostavax for people with MS
People with MS may be at higher risk of getting shingles because of reduced immune system function due to disease-modifying treatments. High-dose steroids, often used during relapses, may also increase the risk of a shingles outbreak.
One of the biggest differences between these two shingles vaccines is the fact that Zostavax contains a live-attenuated (weakened) virus to stimulate the immune system, while Shingrix is a non-live, subunit vaccine that works by introducing only a small part of the actual microbe. Those of us living with multiple sclerosis or many other chronic diseases take medications that reduce the effectiveness of our immune systems. Because of this we can’t receive vaccines that contain live virus, which would put us as even greater risk of developing the very disease we’re trying to protect ourselves from.
Since Shingrix does not contain live virus, it should be much safer for people with lowered immune systems. My doctor was very happy to inform me of this during our routine medical visit. I was thrilled to learn the news. ACIP should issue recommendations on the use of Shingrix in people with compromised immunity in February 2018.
Even if you've already had shingles, it is still a good idea to be vaccinated. An episode of shingles might provide a few years of protection from recurrence, but that protection fades away. People who have already had the Zostavax vaccine can also receive the Shingrix vaccine. In fact, the ACIP recommends it.
My experience with shingles
In August 2005, I was still in the process of being diagnosed with multiple sclerosis and was prescribed a five-day course of intravenous solumedrol (IVSM), followed by an oral steroid taper, to reduce inflammation. It was an extraordinarily stressful time because the steroids temporarily reduced my immune system. By the time September rolled around, I began to develop small, itchy blisters on one side of my face and neck. I recognized the outbreak as shingles because a family member had recently contracted the virus.
Several antiviral medications — acyclovir, valacyclovir, and famciclovir — may be used to reduce the severity of shingles and shorten its duration. But these medications need to be taken as soon as possible after the shingles rash appears in order to be effective. Since I recognized my own case of shingles, I went to the ER for assessment and treatment. It’s a good thing I did because my rash was very close to my eye. The ER doctor had an ophthalmologist examine my eye carefully to make sure that the virus had not entered it. Thankfully, it was fine.
Shingles is associated with the risk of post-herpetic neuralgia (PHN), which causes severe pain even after the rash has resolved. PHN is more common in people who are older and rarely occurs in people younger than 40. PHN-related pain may last only weeks or months, but it may also last for years.
It was difficult to know if I had PHN because I was also developing nerve pain in various parts of my body related to multiple sclerosis and I was younger than 40 at the time. Fortunately, treatment for either type of pain includes anti-seizure medications such as gabapentin (Neurontin) or pregablin (Lyrica). Gabapentin helped to reduce my pain.
(During the rash stage, analgesics may help relieve the pain caused by shingles. Wet compresses, calamine lotion, and colloidal oatmeal baths may help relieve some of the itching.)
Another advantage to Shingrix is that it reduces the risk of PHN by 91 percent. Studies show that Zostavax only reduces the risk of PHN by 67 percent. As for shingles itself, Shingrix reduces the risk by 97 percent for people between the ages of 50 and 69 and 91 percent for people 70 or older. Zostavax reduces the risk of shingles by 51 percent.
In fact, getting vaccinated against shingles may actually prevent people without MS from getting the autoimmune disease. A study in the July 2011 issue of The Journal of Infectious Diseases found that the likelihood of being diagnosed with MS was higher in those who’d had shingles within the previous year.
I'll be interested to see if additional recommendations are made in the future to allow people with compromised immune systems to use the vaccine at a younger age. We probably will not hear much more about Shingrix for the next several months, as drug companies are restricted from promoting newly approved therapies to patients for six months. They need time to inform physicians first. But I will not be surprised to see TV commercials for Shingrix sometime in the late spring.