Good news on the adult vaccination front: A new and superior shingles vaccine, Shingrix, manufactured by Glaxo SmithKline, has now been approved. Shingrix is more than 90% effective, as opposed to the around 50% effectiveness of the earlier version, Merck’s Zostavax. Also unlike Zostavax, the effectiveness of Shingrix doesn’t drop off dramatically among older individuals.
A few weeks ago I posted an essay about my sister’s experience with a relatively mild case of shingles, which I correctly attributed to her having been vaccinated with Zostavax. The operative word here is “relatively.” When I notified my family about the new and improved vaccine, her immediate response was, “Since studies have shown you can get shingles more than once, I will check it out. Having been there, [I advise you to] do what you can to avoid getting shingles!”
Because, as my sister noted, having shingles doesn't protect you from getting it again, the CDC is recommending that you have the Shingrix shot even if you've already had shingles. And even if you've already been inoculated with Zostavax, the CDC is recommending repeat vaccination with Shingrix.
A few comments. First, two doses of Shingrix are required, 2-6 months apart, as opposed to just one of Zostavax. Second, the side effects are a little more common and severe than those of Zostavax, so time your shot to allow 2-3 days to recover from being a little feverish and achy, and don’t schedule it just before an important event. Third, it is a little pricier than its predecessor - $280 for the two shots. (Medicare will cover Shingrix under Part D, not under Part B like the flu vaccine, which may favor being vaccinated in a pharmacy rather than a doctor's office.) I hope these drawbacks don’t reduce uptake but fear they will, given the shockingly low participation in the Zostavax program.
One additional point: Shingrix is recommended for everyone fifty and over, not sixty and over like Zostavax.
I’ve known several people who have had shingles, and they’ve all suffered severely from painful blisters on their face and/or back that persisted for several weeks, along with fever, headache, fatigue, and light sensitivity or some combination of these symptoms.
So when my sister called a couple of weeks before a long-planned and eagerly-anticipated family celebration to tell me she’d been diagnosed with shingles, my heart sank to my toes. Our gathering wouldn’t be complete without her, plus I shuddered to think of the ordeal she faced.
What happened was - pretty much nothing. She had a few dry scabs on her back and a few days of feeling achy, and that was it. Although her doctor assured her she was not contagious, she offered to cancel her trip if our niece, scheduled to host my sister for several days, had any qualms about exposing her toddler son. Presumably our niece’s pediatrician assured her it was safe to proceed with Plan A, and a good time was had by all.
Getting off so lightly wasn’t just my sister’s good luck. She had had her shingles shot, which not only reduces the risk of shingles but can dramatically diminish the severity of the condition. Why anyone who has known or even heard about a shingles victim would not rush to be vaccinated is a mystery to me, but in fact the shingles shot is the most neglected of adult inoculations. Although it's recommended for adults sixty and over, even if they have already had shingles, only 28% of Americans in that age range - just over a quarter - were vaccinated in 2014. Where’s the logic in that?
Shingles, also called herpes zoster, is caused by the varicella zoster virus, the same microorganism responsible for chickenpox (varicella). Once a person has had or been vaccinated for chickenpox, the virus becomes dormant in nerve roots. In about a third of these individuals, by mechanisms not well understood, the virus reactivates later in life and cause shingles. (There is no evidence, by the way, that having been vaccinated in childhood, as opposed to having had chickenpox, affects either way the likelihood of developing shingles.)
A small percentage of shingles patients will be hospitalized; a few will die. Most will be thoroughly miserable. One of my neighbors considered her shingles episode to be her “lost summer.” At our age, who wants to lose even one precious season if it can be avoided?
Although shingles cannot be spread from person to person, there is a remote chance of spreading the virus to someone who has never had either chickenpox or the chickenpox vaccine, but only via direct contact with weeping lesions. Admittedly an unlikely scenario, but still, one more reason to ensure that every medically-eligible child is vaccinated for chickenpox.