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Newer Shingles Vaccine Edges Out its Predecessor

Over one million cases of shingles are reported in America each year. The viral infection, marked by a rash, can cause itching, burning and chronic pain anywhere on the body. But what is the origin of the infection, and what can we do to stop it?

What is Shingles?

“Shingles is a local recurrence of the chicken pox,” said John J. Russell, MD, a family medicine physician and director of the Family Medicine Residency Program at Abington - Jefferson Health. “It will come on suddenly, and the pain can be intense.”

The rash seems to choose its location at random, but usually remains on one side of the body. In severe cases of the rash around the eye, possible side effects may include vision loss in that eye.

Severe cases of shingles can also cause chronic pain in the area of the infection, which can be felt long after the rash has healed.

“It doesn’t follow rhyme or reason when choosing a place to be, but shingles prefers the trunk of the body more than any individual limb,” said Dr. Russell. For this reason, the infection’s name is derived from an old English word for girdle or belt.

People of advanced age or with a compromised immune system are most at risk for shingles due to their vulnerability to infection.

“With each decade we get older, the likelihood of getting shingles goes up,” said Dr. Russell. “Those who are receiving chemotherapy treatment for cancer are also at a higher risk.”

Luckily, shingles is preventable with vaccination.

The Original Vaccine

The first shingles vaccine was developed as a single-shot formula in 1995 and became available in the US market in 2006. Known as Zostavax, the original vaccine used live cultures, similar to the chicken pox or MMR vaccines. The Centers for Disease Control and Prevention (CDC) named Zostavax their preferential recommendation in 2008, making it the standard treatment for physicians nationwide.

However, its “live virus” status narrowed the pool of eligible patients.

“Those with a compromised immune system, in most instances, shouldn’t receive a live vaccination,” said Dr. Russell, “This coupled with insurance issues of coverage have led to only about a third of folks over 60 receiving the shot. Plus, with no booster, the efficacy of the vaccine drops significantly in the decade after administration.”

A New Vaccination Option

With these concerns in mind, a new vaccine was developed and approved for the prevention of shingles in 2018. The new vaccine, known as Shingrix, does not use a live virus and incorporates a booster—to be administered within six months—in order to promote lasting immunity. With these features, the new vaccine has already edged out its predecessor.

In fact, Shingrix was named the CDC’s preferential recommendation in 2018, leading to a shortage of the new and sought-after treatment. The drug’s manufacturer has promised to reach a full inventory by the end of 2019.

“Currently, we still don’t have enough data to recommend it to patients who are immuno-compromised or under the age of 50,” said Dr. Russell. “However, the few years’ results we have registered a 90 to 97 percent efficacy, which is much better than the original vaccine.”

Dr. Russell hopes that this mounting evidence will open the door for a larger group of patients, and that the vaccine will be widely used. For now, he recommends that everyone who is eligible to receive the shot. You should get this new vaccine even if you previously received the older live vaccine or had shingles more than 4 months ago.

“If your physician’s office doesn’t have the new vaccine, it’s a good idea to hold out until it arrives,” said Dr. Russell. “But you should absolutely be vaccinated, even if you have had shingles before. It’s better to be vaccinated to avoid a second infection, and to avoid that chronic pain.”

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