There aren’t too many non-lethal conditions more dreadful than shingles, also known as varicella zoster. Although shingles can be lethal too if the host is immunocompromised –– i.e. if they have a weakened immune system. I have terrible memories of treating patients with shingles; most were in a lot of pain.

The culprit virus is the same devil that causes chickenpox (varicella zoster virus). In medicalese, chickenpox is referred to as varicella, and shingles is zoster.  In fact, you can’t get shingles unless you’ve had chickenpox –– whether you knew you had it or not!

Herpesvirus varicella-zoster (Shingles)

Source: Shutterstock

People over 65 are much more likely to contract shingles, but it can occur at any time of life in someone who has had varicella.

Key features of Zoster:

  1. It’s a red vesicular (blistery) rash that emerges on one side of the body only and follows a nerve path.
  2. It can be accompanied by other symptoms, such as fever and malaise just before and just after the rash breaks out.
  3. When the rash is on the face, it can cause serious complications in the eye.
  4. It can cause a burning pain –– sometimes severe –– in the nerve it affects after the rash is gone. This is called post-herpetic neuralgia and it’s difficult to treat.
  5. You can get shingles more than once.
  6. It can be treated with an antiviral, which can shorten the course, but is not guaranteed to prevent the nerve pain. The antiviral should be started within 48 hours of the appearance of the rash.

It was a good day when a moderately effective shingles vaccine, Zostavax, came on the market in 2006. Zostavax is a live attenuated virus, so it cannot be given to those with a compromised immune system. Nevertheless, it has a very low side effect profile.

When developed, the FDA approved it for use for people over age 60. It is a one-time vaccine, but it doesn’t have proven efficacy beyond 4 years. Furthermore, the efficacy of Zostavax is only 33-55% in one published review.

Shingrix, a newer vaccine, was introduced in 2017. It is a synthesized viral antigen that causes a robust immune response, but it is not a live virus.  The CDC is recommending it for anyone over age 50.

Shingrix vaccine efficacy was 96.6% in adults age 50 to 59 years, 97.4% in adults age 60 to 69 years, and 91.3% in adults age 70 years and older. In other words, Shringrix is much better at preventing shingles than Zostavax.

I can report from personal experience that the vaccine can make you feel “viral” the day after you get it: achy, and a little feverish. It also requires 2 doses, 3 months apart.

Paula Span reports that Shringrix is not covered by Medicare Part B (office visit expenses), but rather Part D which is the pure pharmacy benefit. For those not on Medicare, it may not be covered by some private insurance. So be prepared to pay as much as $140 per dose at the pharmacy.

Because shingles is such a painful and debilitating condition, the efficacy of the newer vaccine is welcome news and worth the cost and the achiness. With the arrival of Shingrix, it’s time to give the devil itself (shingles) the short shrift!

Full Disclosure: I have no relationship, financial or otherwise with the manufacturer of Shingrix, Glaxo-Smith-Kline. This is a pure informational piece. If you have more questions or concerns, consult your physician.

References:

  1. https://en.wikipedia.org/wiki/Zoster_vaccine
  2. https://www.cdc.gov/vaccines/vpd/shingles/hcp/shingrix/about-vaccine.html
  3. https://www.nytimes.com/2017/11/10/health/shingrix-shingles-vaccine.html
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919834/

Posted by Jennifer Brokaw

Dr. Jennifer Brokaw worked for fourteen years as a board-certified emergency physician before becoming a private consultant, patient advocate, writer, and speaker on the topics of end-of-life planning, medical decision-making and medical advocacy.

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