The New Shingles Vaccine is much better than the old; Wait to get this one

Shingles is a painful viral rash that can affect anyone who has ever had chicken pox. It’s more common as we get older and immunity wanes and sometimes patients who have shingles are left with a lingering pain syndrome called post-herpetic neuralgia. Naturopathic medicine has some effective therapies for shingles, but the new vaccine that has just been approved is worth recommending, especially to older adults.

Shingrix Vaccine

The Shingrix vaccine from GlaxoSmithKline is a non-live recombinant vaccine that uses a newer (also used in new malaria vaccine) adjuvant called ASO1B which is a purified saponin from the bark of the Quillaja saponaria (soap bark) tree native to central Chile. It was approved by the Federal Drug Administration (FDA) in October of 2017 for use in adults over age 50.

Why is this Vaccine Better than the Previous One?

What’s most exciting about this vaccine is that it confers 90% immunity at any age and the immunity holds longer. This is markedly different from the previously available Zostavax vaccine in several ways. Zostavax conferred 50% immunity in middle-aged patients and that decreased substantially with age. The older vaccine also waned with time and by the end of 5 years almost no immunity could be detected. Study groups were done on people ages 50-80 and the effectiveness was approximately the same (90%) and did not see a decline with age.¹ The initial phase 3 clinical data (38,000 participants) followed patients over 4 years and showed slight decline in immunity (from ~90% to ~87%) in that time. This makes researchers hopeful that sustained benefits will persist.

Who Should get this Vaccine?

The Centers for Disease Control (CDC) recommends it for all adults older than 50. Shingrix does not prevent chicken pox. Note: this is a vaccine only for patients who have had chicken pox and are at risk of developing shingles (more likely with age). While it is effective for younger patients as well, it is not necessary for anyone who has had the chicken pox vaccine.

What are the Side Effects?

Common side effects include pain, redness or swelling at injection site as well as muscle pain, fatigue, fever, headache and upset stomach. Compared to other vaccines, patients are reporting more temporary side effects like discomfort at injection site or feeling ill for a day or so, more commonly in older patients than in younger.

Cost and Dosing

This is a comparatively more expensive vaccine – $140 per dose (with 2 doses required). It is commonly covered by private insurance and it is covered by Medicare, but only Part D (not Part B like flu shots). Not every Medicare patient has Part D and it may be easier to get the shot through a pharmacy rather than through a physician’s office.

Is it Safe if You are Immuno-compromised?

It’s okay to get this new vaccine if you’ve had the previous Zostavax immunization, but you may with to consult with your physician if the Zostavax was given within the last year. This vaccine is also safe if you are immuno-compromised because it is not a live attenuated vaccine. Two doses are required at least 2 months apart. Shingrix should be widely available in 2018.

Source:

Cunningham A, Lal H, Kovac M, et al. Efficacy of the Herpes Zoster Subunit Vaccine in Adults 70 Years of Age or Older. New England Journal of Medicine 2016;375:1019-1032

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Dr. Alethea Fleming, ND is a passionate advocate for naturopathic geriatric medicine. A 2007 Bastyr University graduate, she also earned a certificate in Gerontology from the University of Washington. Dr. Fleming is the owner and lead physician of the Vital Aging Clinic in Anacortes, Washington where she provides primary care to all adults as well as adjunctive geriatric care. Dr. Fleming is active in multiple community organizations as well as a member of WANP, AANP and OncANP. In her off hours, Dr. Fleming can be found hiking the beautiful trails of Fidalgo Island, spending time with her wonderful husband and son, or with her nose firmly in a good book.