If you have ever had chicken pox as a kid, you are at risk for shingles as an adult. That’s because the virus that causes this childhood illness is varicella zoster, the same virus that causes shingles. Even though we get over chicken pox, the virus remains in our bodies. It migrates up nerve cells to the trigeminal and dorsal root ganglia near the brain and spinal cord. The virus goes dormant for decades and can reemerge when our immune system lets down its guard. This can happen as we age or after immune suppressing drugs. The key question: how effective is the Shingrix vaccine in preventing a shingles attack? That’s what this reader wants to know.
Shingles Suffering Can Be Horrific!
Q. My older brother suffered from long-lasting pain after shingles. This is something my late mother experienced as well. Consequently, I decided to go ahead and get the Shingrix vaccine.
For most people, it seems, the side effects of the vaccine are likely to be less troubling than the suffering resulting from shingles. My wife and I both had the vaccine. We had sore arms, with warmth at the injection site, but that was it. My brother is still receiving care at a pain-control clinic several years after having shingles. I would like to avoid that fate!
How Good is the Shingrix Vaccine Really?
A. The Centers for Disease Control and Prevention estimate that the Shingrix vaccine is about 97 percent effective in people 50 to 69 years old. Effectiveness drops a bit in people over 70, to about 91 percent. That’s still impressive.
Protection remains high for at least four years after vaccination. That’s also impressive.
Postherpetic Neuralgia:
Shingles is a painful rash caused by the virus that causes chickenpox. Sometimes after the rash fades, the patient is left with excruciating nerve pain and tenderness in that area of the skin. That complication is called postherpetic neuralgia.
It can be extremely hard to treat. Two doses of the Shingrix vaccine were 86 percent effective in preventing the development of postherpetic neuralgia, the lasting pain your brother has suffered.
Can You Get Shingles More Than Once?
Q. I had a bad case of chickenpox when I was a kid. When I was in my 60s, I had shingles.
I have read that the Shingrix vaccine is very effective. Since I have already had shingles, do I need this vaccine?
A. According to the CDC, people can get shingles more than once. The agency urges everyone over 50 to get two doses of the Shingrix vaccine even if they have had a previous outbreak. The immunization can protect against complications such as long-lasting nerve pain (postherpetic neuralgia) that may follow a shingles attack.
A new study suggests that the varicella zoster virus that causes shingles can reactivate the herpes virus responsible for cold sores (Journal of Alzheimer’s Disease, Aug. 2, 2022). Vaccination against shingles may reduce the risk for this worrisome chain of events. That is important because reactivation could be a risk factor for Alzheimer’s disease, so immunization might reduce the likelihood of developing dementia. However, scientists have not studied that outcome nearly as well as they have studied its protection against shingles and postherpetic neuralgia.
Comparing Shingrix to Zostavax:
Before Shingrix, doctors offered shingles prevention with the Zostavax vaccine. It is not as effective as Shingrix, and the protection fades after four or five years. Shingrix does not seem to suffer from that drawback. Still, many readers wonder about the differences between the two vaccines, as this one does.
Q. I had a shingles vaccine about six years ago, but I did have a mild outbreak of shingles several months ago. I’m seeing ads on television for Shingrix. How effective is this newer vaccine for preventing outbreaks?
A. The trial data for Shingrix shows a relative risk reduction of 97 percent. Research indicates that for every eleven people getting vaccinated, one would be spared a shingles outbreak. This is considered a very favorable result. To prevent a single longer-lasting painful episode of postherpetic neuralgia, 34 people would need to get the shot (Applied Health Economics and Health Policy, June 28, 2019).
The Two-Shot Shingrix Vaccine Dilemma!
Shingrix is given as two shots two to six months apart. After its introduction in 2017, the vaccine was in short supply, so many people who wanted to receive it had trouble finding it.
We received a number of complaints from people who got the first Shingrix vaccine but then discovered they could not get the follow-up injection.
Dr. William Schaffner is one of the country’s leading vaccine experts. He is professor of preventive medicine and infectious disease at Vanderbilt School of Medicine.
In an article for Consumer Reports, Dr. Schaffner stated:
“The CDC’s recommendation, based on evidence from clinical trials, is to get your second dose of Shingrix anywhere from two to six months after the first.
“But if it takes longer than that to locate a second dose, don’t worry, Schaffner says. The CDC advises simply getting that second dose as soon as you can find it—and no, you don’t have to start the series over.
“’The timing is not critical,’ Schaffner notes. ‘You just don’t want to get it sooner than recommended because then the body’s immunity is still working on the first dose, so you don’t get the full benefit of the second.’”
As of this writing, there is no longer such a shortage of the Shingrix vaccine. During the pandemic, fewer people have made routine doctor visits or gotten routine vaccinations. In addition, GSK continued production. As a result, the supply has been replenished. When the COVID-19 pandemic ends, however, the company may once again find it difficut to keep up.
Individuals who received the older shingles vaccine, Zostavax, at least five years ago can still benefit from the newer Shingrix vaccine.
One Last Word on a Serious Side Effect:
In 2021, the FDA required the maker of Shingrix, GSK, to change its prescribing information (FDA Safety Communication, March 24. 2021). Postmarketing research showed that people getting Shingrix were slightly more susceptible to a neurological complication called Guillain-Barré syndrome (GBS). The risk meant an addition 6 people per million developed this serious problem in the first month and a half after vaccination.
Read more about Shingrix in this post by our consultant, Karen Berger, Pharma, RPh:
There are 57 comments from other readers following Karen’s article. You may find them of interest.
Please share your own experience with Shingrix in the comment section below.
