Shingles: Get in Line


WHILE ADULTS should keep up to date on relevant vaccines such as tetanus, they have a new one to put on top of the list: the new Shingrix vaccine for shingles, available only since fall 2017. People who received the older shingles vaccine are advised to get the new one—although recent promotions have created a supply shortage and long waiting lists at local pharmacies.

The new shingles vaccine “really looks to be a breakthrough in vaccinating older adults,” physician and NIH researcher Jeffrey Cohen told the New York Times.

The risk of developing shingles rises dramatically beginning at age 50 until, by age 80, there’s close to a one-in-two chance of getting the disease. More than a million shingles cases are reported in the U.S. each year. Shingles causes a rash, sometimes with thousands of blisters, that can be excruciatingly painful—with the risk of nerve pain, called postherpetic neuralgia, that can linger for months or years.

While the old vaccine, Zostavax, recommended for those 60 and older, protected only about 50% of those vaccinated, the new Shingrix—given in two injections two to six months apart and recommended for those 50 and older —provides up to 97% protection. In a study of those age 70 and older, Shingrix protected 90% of the time, while Zostavax offered only 38% protection for this age group, and its effectiveness waned to about zero in 11 years. The long-term effectiveness of Shingrix beyond four years is still under investigation.

Contrary to myth, those who remember having chicken pox as a child are not the only ones at risk—because it’s possible to have chickenpox without knowing it. Most Americans born before 1995, when the chickenpox vaccine became available, have dormant varicella zoster virus, which can erupt years after exposure to chickenpox to cause shingles. (Adults who have no memory of having chickenpox are advised either to get tested for immunity or to go ahead and get the two-dose chickenpox vaccine.)

Shingrix has the downside of mild side effects lasting a day or two for as many as 50% of those receiving the injections, which include fatigue, fever, chills and and aching joints. People are advised to get the vaccine when they have a day or two available in case of difficulties.

“I rarely get headaches and I had a headache that night until the next morning. That happened both times,” said Nutley, New Jersey, allergist Alan Goodman. “ I’m never cold [but] I was chilled during sleep after the second vaccine. I was back to normal in two days. The first dose I took on a Friday, which is what I would recommend, not on a Monday.”

The cost of Shingrix is covered for those with work health plans and those with Medicare Part D—though the latter group can get coverage at a pharmacy more easily than in the doctor’s office. In both cases, patients may be asked to contribute to the cost.

Among regular vaccines recommended for adults are flu shots every year; also, every 10 years, the tetanus vaccination, which can be had in combination with diphtheria protection or as a tetanus-diphtheria-pertussis combo. To protect against the dozen or so kinds of bacteria that most commonly cause serious infections, including pneumonia and ear infections, the two-shot Pneumococcal vaccine should be given on varying schedules depending on which one is given first.

For measles, adults born before 1957 are considered immune, but anyone born afterward should get the two-dose MMR (measles, mumps, rubella) vaccine even if they had this vaccination as a child. Measles, with its risk of severe complications including pneumonia and deafness, has been spreading in the US as well as most of continental Europe, especially France, mostly among people who were not vaccinated.

People with a chance of exposure to Hepatitis A or Hepatitis B—working in health care, having sex with more than one partner, or when traveling to certain countries—should get those vaccines as well.

Vaccination records are best kept by the primary-care physician, but a personal record can be helpful—especially for tetanus, because it’s hard to know where you might be if protection is needed suddenly for a cut or scrape.

Meanwhile, CVS pharmacies report delays of weeks, even months to get Shingrix. The waiting lists are long and, due to shortages from the manufacturer, shipments are limited to 10 doses. The order limits and shipping delays will continue through 2018, according to the CDC, which began reporting shortages in early May. For now, people are joining ever-lengthening lists for the next shipment.

Bottom line, get on a list.

—Mary Carpenter

2 thoughts on “Shingles: Get in Line

  1. Nancy says:

    There’s another reason to get this vaccine: my ophthalmologist told me about a case he recently saw in which the shingles sores invaded a patient’s eyes. That led to permanent blindness in one eye, on top of being excruciatingly painful. I had the original shot, but will get the new one.

  2. I had the first of two injections and had a very sore arm for three days.
    It was a tough few days, to say the least.

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