Benjamin Bergen, Doctor of Pharmacy Candidate Class of 2018, Albany College of Pharmacy and Health Sciences

In Fall 2017, a new inactivated recombinant shingles vaccine, Shingrix, came to the market to help people better protect themselves against the herpes zoster (shingles) virus.¹

What is shingles?

Shingles is a painful rash that usually develops on only one side of the body, caused by the chickenpox virus reactivating in the body years after initial infection. Since over 99% of people over 40 have had chickenpox, vaccination is recommended regardless of the person remembering if they had it. Blisters appear that scab over in 7 to 10 days and clear up within 2 to 4 weeks. Some people with shingles have a long-lasting burning sensation that can last for months or years after the rash goes away, called postherpetic neuralgia (PNH). The risk to get both shingles and PHN increases with age.¹

Zostavax: The “old” shingles shot

Previously, the only available product for protection against shingles was Zostavax, Merck’s live vaccine which was approved in 2006. Zostavax was FDA approved for people over 50 years of age, but the Centers for Disease Control and Prevention (CDC) only recommended it for people 60 years of age and older. Zostavax should not be given to any person that has:^1,2

• An anaphylactic allergy to gelatin, neomycin, or any other component of the vaccine
• Immunosuppression for any reason, including:
  • Primary or acquired immunodeficiency states
  • AIDs or other clinical manifestations of HIV
  • Leukemia or lymphoma, or any other malignant neoplasms affecting the bone marrow or lymphatic system
  • Receiving immunosuppressive therapy
    • Cancer treatment such as radiation or chemotherapy
    • Long-term steroids (ie: prednisone)
    • Biologic therapy such as adalimumab (Humira) or etanercept (Enbrel)
  • Women should not become pregnant for at least 4 weeks after receiving the vaccine

Shingrix: The new shingles shot

The CDC now recommends Shingrix over Zostavax for the prevention of shingles and related complications for all immunocompetent adults aged 50 and older:^1,3

• Regardless of having a history of shingles
• Regardless of prior Zostavax vaccination. There should be at least 8 weeks between the vaccinations.
• With chronic medical conditions such as diabetes, chronic kidney disease, or rheumatoid arthritis
• At the same time as the flu or pneumonia vaccines

There are exceptions

The CDC still recommends Zostavax in certain cases, such as if Shingrix is unavailable or if a person is allergic to Shingrix.¹ Shingrix has been shown to be much more effective than Zostavax for preventing shingles in different age groups, illustrated in the following table:^2,3

Age Group	Zostavax Efficacy	Shingrix Efficacy
50-59	70%	96%
60-69	64%	97%
70-79	41%	91%
>80	18%	91%

 

Shingrix should not be given to any person that:^1,3

• Has a history of a severe allergies reaction to any component of the vaccine or after a previous dose of Shingrix.
• Tested negative for immunity to varicella zoster virus (the chickenpox vaccine should then be given)
• Currently has shingles
• Is currently pregnant.

Possible side effects

The most common side effect with Shingrix is pain at the injection site. This is more common in younger people. Other side effects include muscle pain, fatigue, headache, shivering, fever, and gastrointestinal symptoms.

Head-to-head comparison

Shingrix is covered by Medicare Part D, the prescription drug plan, and may have a copay. A full comparison of the two vaccines is shown below:

Zostavax2	Shingrix3
Live attenuated vaccine	Recombinant Inactivated Vaccine
Cannot be given to immunosuppressed patients	Has not been studied in immunosuppressed patients
No longer CDC recommended	CDC recommended for patients aged 50 or older
Single vaccination	Two vaccinations, 2-6 months apart
Patients over 60: 39% decrease in postherpetic neuralgia	Patients over 70: 88% decrease in postherpetic neuralgia

Call to action

If you are interested in learning more about vaccines and autoimmune disease, I encourage you to read our flu vaccine and pneumonia vaccine articles.

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis and treatment.

References:

1. Herpes Zoster Shingrix Vaccine Recommendations. The Centers for Disease Control and Prevention. Cited 1 May 2018.
2. Zostavax Prescribing Information. Food and Drug Administration 2006. Revised 2018.
3. Shingrix Prescribing Information. Food and Drug Administration 2017. Revised Oct 2017.