New Shingles Vaccine Found to Be More Effective

A new shingles vaccine is available, and it's more effective at preventing the painful condition. Experts hope this development may convince more people to get vaccinated.

While not life-threatening, shingles is a painful, debilitating condition. It is caused by the varicella-zoster virus, which also causes chicken pox. Anyone who had chicken pox can develop shingles later in life when the virus, long dormant in the body, suddenly reactivates, typically following periods of mental and physical stress.

The ensuing blister-producing rash, which usually occurs on one side of the body, can last for several weeks. In some cases, the patient may have nerve pain, itching, and tingling that can linger for months, known as post-herpetic neuralgia. Shingles is potentially contagious to infants, pregnant women and nursing mothers, patients undergoing chemotherapy, and anyone who has never been exposed to the chicken pox virus.

About 1 million U.S. adults develop shingles each year. One in three people will get shingles at some point, usually after age 50.

Not the First Shingles Vaccine

Shingrix isn’t the first vaccine for shingles. Zostavax, which came on the market in 2006, is a live zoster vaccine that’s injected in the skin in one dose. Zostavax has been shown to reduce the risk of shingles by 51 percent in people age 60 and older, according to the CDC. However, adults vaccinated before age 60 may not be protected later in life when the risk for shingles is higher.

“The issue is that the efficacy of the new vaccine is so much better,” says Lorraine Rosamilia, MD, a dermatologist at Geisinger Health System in State College, Pennsylvania. “So if insurance companies don’t distinguish between the two vaccines, or it isn’t a large cost differential, the Shingrix vaccine protects you better against getting shingles, post-herpetic neuralgia, and getting a severe case of shingles.”

“Shingrix is much more effective, and it’s anticipated that the effect will last much, much longer,” says William Schaffner, MD, a professor of preventive medicine in the department of health policy and a professor of medicine in the division of infectious diseases at Vanderbilt University in Nashville, Tennessee. “Zostavax was a wonderful vaccine when it first came out. But this is shingles vaccine 2.0.”

Shingrix was developed to overcome the age-related decline in immunity seen with Zostavax. It reduces the chances of an outbreak by more than 90 percent in all age groups, and it also lowers the chances of developing post-herpetic neuralgia.

Shingrix is delivered as an intramuscular injection in two doses spaced two to six months apart.

Vaccines are crucial because there is no effective treatment for shingles. Doctors can prescribe antiviral medications, such as acyclovir, valacyclovir, and famciclovir, to lessen the severity of the rash and shorten the duration of the infection; but antivirals must be started within the first few days to be effective. Patients are often prescribed painkillers to alleviate some of the discomfort.

Convincing Adults to Get Vaccinated

There is a downside to the new vaccine. Studies show Shingrix is associated with more injection-related side effects that Zostavax, such as pain at the injection site and fever.

“Zostavax was easy to take,” Dr. Schaffner notes. “Shingrix is different. It causes a large proportion of people to have swelling, redness, and some pain in their arm. Some people feel some fatigue or headache for a day or so, just out of sorts — about 10 percent of people. So people should be aware going in that there is much more of a local reaction to this vaccine.”

Persuading adults to get the shingles vaccine has been tough, according to Rosamilia. Only an estimated 20 percent of adults eligible for Zostavax actually get the vaccine, she says.

“Zostavax was recommended for people ages 60 and older, and Shingrix is recommended for ages 50 and older,” Schaffner says. “If you’ve had Zostavax, you should get Shingrix anyway. Shingrix is the preferred vaccine.”

Shingles Complications

In rare cases, shingles can lead to serious complications. “There are people who can get eye involvement and lose their sight, or ear involvement and lose their hearing, or have a chronic pain syndrome and have to be on pain medication the rest of their life,” Rosamilia says. Shingles can also lead to pneumonia or inflammation of the brain (encephalitis).

“We need to do more to get people aware of how nasty shingles and post-herpetic neuralgia can be,” Schaffner says. “The more people know about that, the more eager they are to get the vaccine.”

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