When I talk to patients about the vaccines they should get routinely, we review Prevnar 13 and PneumoVax 23, the two pneumonia vaccines that should be given to seniors and other special people, a year apart; a tetanus booster given every ten years, including one adult dose of the tetanus and whooping cough combo (although Medicare will not cover it), and the shingles vaccine, or ZostaVax.
There is one shingles vaccine now, which is approved for age 50 and over, and recommended for those 60 and over. Some insurance companies will only cover it for those aged 60 and older, and it can be over $200 if you have to pay out of pocket. The vaccine is only given once, and decreases the risk of getting shingles and the severe pain that some people suffer from afterwards.
For the basics about shingles, please see an earlier article posted on this website.
Those who have seen people suffer from the severe pain that can follow the rash, known as post-herpetic neuralgia (PHN), are anxious to get their dose as soon as they are eligible. The current vaccine, a ‘live attenuated virus’ vaccine cannot be given to those on prednisone or are otherwise immunosuppressed because there is some potential for developing an illness from it. This differs from the flu, pneumonia and tetanus vaccines which can NOT produce infection. Anti-viral medications (acyclovir, valacyclovir or famcyclovir) can be given if the rash is recognized early. Medication can shorten the course of the rash, but has not been shown to decrease the pain following the infection.
Some patients have asked me about waiting for the ‘new’ shingles vaccine that might be coming out. Although it is not available yet, some of the research data was presented in the New England Journal of Medicine a few weeks ago and looks quite hopeful. This vaccine is made up of a glycoprotein (a sugar-protein component of the virus) that is replicated in a lab and a special carrier (adjuvant) that increases the immune response against that glycoprotein. It was given as two doses, two months apart. The major side effects were reactions at the vaccine site and fatigue.
In an earlier study, this new vaccine was 97% effective in preventing shingles in those over 50 years old. The current study sought to verify that it is also effective if we look specifically at the over-70 group. And, in fact, the new vaccine was shown to be 90% effective against the rash even in the sub-group over 80 years old, performing much better than the older ZostaVax, which was only 41% effective in 70-79 year olds and 18% in those over 80. It is important to recognize, however, that the populations in the trials could have differed, so a direct comparison of those numbers may not be that accurate.
In the over-70 study, ten percent of those who got shingles went on to have painful PHN, whether or not they had had the vaccine. However, in the vaccine group, since so few people got shingles, it was 10% of a much lower number, therefore saving many people from both the rash and the pain. The protection was sustained for the 3-4 years they were followed. This is also an improvement, since protection with ZostaVax wanes significantly over time, but only a single dose without a booster is approved.
This vaccine is not yet available, but the data are encouraging, especially for those over 70, and even over 80 years old, since the complications of PHN and eye involvement increase with advancing age. The improved protection also seems to be more stable over time. Further testing needs to be done on those who have already had shingles once, have taken ZostaVax, or have immunosuppression, since people with any of these were excluded from the recent trials. We’ll keep you posted!
Cunningham, et al. Efficacy of the Herpes Zoster Subunit Vaccine in Adult 70 Years of Age or Older. NEJM 375; 11 (1019-1032). September 15, 2016.
Neuzil and Griffin. Preventing Shingles and Its Complications in Older Persons. NEJM 375; 11 (1079-1080) September 15, 2016.