Shingles vaccine is highly effective, but you may have to wait to get it
I love my local YMCA for many reasons beyond my daily swim. Top of the list: the friendships and conversations in the locker room that are frequent sources of valuable information, connections and motivation. For example, I recently overheard a discussion about Y members and friends of members who had experienced devastating attacks of shingles, including one woman who nearly lost an eye and another who was left with unrelenting nerve pain.
That was the push I needed to end my procrastination about getting the new shingles vaccine, Shingrix, which was approved by the Food and Drug Administration last October after studies involving 16,600 people showed it to be far more effective at preventing this disease than the first shingles vaccine, Zostavax, which I had had a decade earlier. The Centers for Disease Control and Prevention recommends that people 50 and older, including those previously immunized with Zostavax, should now get the Shingrix vaccine.
The process was surprisingly simple and less costly than I had anticipated (list price is $280 for the two-part shot without insurance). All I needed was a prescription from my doctor. I took it to my local pharmacy, where a staff pharmacist administered the vaccine. I’ll get the second part the same way in May. My Medicare Part D insurance covered it with a $40 copay for each part. (The cost may be higher if the vaccine is administered in a doctor’s office, so check first.)
Many millions of Americans, especially those older than 40, are susceptible to an eventual attack of shingles, caused by the very same virus that causes chickenpox. Once this virus, varicella zoster, infects a person, it lies dormant for decades in nerve roots, ready to pounce when the immune system is weakened, say, by stress, medication, trauma or disease. One-third of Americans eventually get shingles, but the risk rises with age, and by age 85 half of adults will have had at least one outbreak of shingles.
Before the introduction of the chickenpox vaccine in 1995 in the United States, some 4 million cases of chickenpox, mostly in children, occurred annually. While you may not remember whether you had chickenpox as a child, chances are you did if you were never vaccinated against it.
(The chickenpox vaccine is usually given in two doses, with the first dose recommended at age 12 to 15 months and the second at age 4 to 6. Those 13 and older who were never vaccinated or had chickenpox should get two shots at least four weeks apart.)
Studies have indicated that more than 99 percent of Americans aged 40 and older have had chickenpox even if they don’t remember it, according to Dr. Rosanne M. Leipzig, geriatrician at the Icahn School of Medicine at Mount Sinai in New York. The Centers for Disease Control and Prevention recommends that people 50 and older get the new shingles vaccine whether or not they remember having had chickenpox as a child.
Those who never had chickenpox but did get the vaccine for it may also be susceptible to shingles because the vaccine contains a weakened live virus. However, the risk of shingles for those who had the chickenpox vaccine is much lower than for people who had the natural infection.
If you are uncertain about your disease or vaccine history, you can get a blood test to check for immunity to chickenpox, though the result does not distinguish between protection via the disease or the vaccine. Thus, if the result is positive, Leipzig says you’d be wise to get the shingles vaccine because you could be harboring the live virus.
Lest you have doubts about the value of this vaccine, consider the effects of shingles. It is a painful infection of a single sensory nerve on one side of the body that can occur almost anywhere but most commonly involves the torso or face. Initial symptoms of tingling or burning pain within days develop into a red bumpy rash and very painful blisters.
The blisters heal in a week or two to form crusty scabs that eventually fall off. But for about 15 percent of people, shingles does not end there. Instead, it leaves them with deep, searing nerve pain – a condition called postherpetic neuralgia, or PHN – that can last for months or years and has no treatment or cure. More than half the cases of PHN affect people over 60.
Other possible complications of shingles include pneumonia, hearing problems, blindness and encephalitis.
That’s not all. Although most people get shingles only once, it can happen again, especially if you have a weakened immune system, which most everyone does with advancing age.
If you’re lucky you may detect the onset of shingles before the rash appears. Years ago when I went to bed with what had been a daylong gnawing irritation on one side of my back, I awakened in the middle of the night with the thought, “I have shingles.” First thing in the morning I got a prescription for the antiviral drug acyclovir, which halted progress of the disease.
Not willing to trust my luck a second time, I got the new vaccine. Here’s how it compares to its predecessor Zostavax, which overall reduces the risk of shingles by 51 percent and of PHN by 67 percent. According to the CDC, Shingrix can protect 97 percent of people in their 50s and 60s and 91 percent of those in their 70s and 80s. It also reduces the risk of PHN by 86 percent, and it appears to be longer lasting than Zostavax, which starts to lose its protection after three years.
What makes Shingrix so much better is the inclusion of a substance called an adjuvant that boosts the body’s immune response to the vaccine. Another difference is that Zostavax contains a live, weakened virus, making it unsuitable for people with poor immunity, whereas Shingrix contains a nonliving virus particle and may eventually be approved for those with compromised immunity, who are especially susceptible to a severe case of shingles.
I should tell you that the new vaccine is not exactly a walk in the park. The shot itself is painful and can cause a sore arm for a day or two. Some people develop immune-related side effects like headache, fever or an upset stomach that last less than three days, according to the manufacturer, GlaxoSmithKline. My only reaction beyond local soreness was an acid stomach for a day or two.