Currently, in community/retail pharmacy, there is a large focus on immunizations. Especially in the fall months, much time is spent on vaccinating patients against influenza (flu) and pneumonia. Recently, there has been a lot of talk about the new shingles/zoster vaccine, Shingrix. Many patients are concerned about side effects and the issues of vaccine availability.
What Is Shingles?
First, let’s learn a little about shingles, which is what the vaccine prevents. This website provides an informative overview and slideshow (https://www.webmd.com/skin-problems-and-treatments/shingles/ss/slideshow-shingles-pictures)
Shingles is a viral infection caused by the varicella-zoster virus, the same virus that causes chickenpox. If you have had chickenpox, the virus remains inactive in nerve tissue, close to your spinal cord and brain. Years later, the virus may come back as shingles. Shingles infection can cause a very painful rash. Shingles may occur anywhere on your body, but often appears as a row of blisters wrapping around your torso.
Symptoms may include:
- Pain/burning/numbness/tingling
- Sensitivity to touch
- Red rash
- Fluid-filled blisters that open and crust over
- Itching
More serious symptoms may include: fever, headache, sensitivity to light, and fatigue.
Pain, which may be very intense, may occur with or without the rash. It is important to see your doctor as soon as possible if you have any of these symptoms, for evaluation and treatment. If you do have shingles, your doctor will prescribe an antiviral medication, such as valacyclovir (Valtrex) or acyclovir (Zovirax). An antiviral can help speed healing and reduce complications. Shingles usually lasts for two to six weeks, and may reoccur.
Who Gets Shingles?
In addition to having had chickenpox as a child, other risk factors for shingles include: age greater than 50, having certain diseases that weaken your immune system (such as HIV/AIDS or cancer), undergoing radiation or chemotherapy, and taking certain medications for prevention of rejection in transplant patients, or prolonged use of steroids such as prednisone.
If you have shingles, you are contagious and can spread the virus to anyone who is not immune to chickenpox (although you have shingles, if you pass the virus to that person it will show up as chickenpox, not shingles). Until your blisters scab off, you should avoid physical contact with anyone who has not been vaccinated for chickenpox, pregnant women, newborns, or anyone with a weakened immune system.
Complications of Shingles:
Not only can shingles cause a rash and pain, but the following serious complications may also occur:
- Postherpetic neuralgia (PHN): For some people, the pain of shingles continues for a very long time, even after all of the rash/blisters are gone. Because your nerve fibers are damaged, exaggerated messages of pain are sent from your skin to your brain.
- Vision loss: Shingles in your eye or around your eye can lead to very painful eye infections which may cause loss of vision/blindness.
- Neurological problems: Depending on the affected nerves, shingles can cause brain inflammation, facial paralysis, or problems with hearing and/or balance.
- Skin Infections: Bacterial skin infections may develop.
- If you have never had chickenpox (varicella), it is a good idea to ask your doctor if you should receive the Varicella vaccine along with the Shingrix. If you have already had shingles, you can still receive the Shingrix vaccine, because you can get shingles more than once. Be sure to wait until the blisters are healed before receiving the Shingrix vaccine. Also, if you have already been vaccinated with Zostavax, it is still recommended to receive two doses of the Shingrix vaccine (wait at least 8 weeks after Zostavax before getting Shingrix).
What Should You Know About Shingrix?
Let’s take a look at the information given by the CDC (Centers For Disease Control), which is the foremost expert on vaccines and infectious disease, regarding Shingrix. (https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html)
According to the CDC, “shingles vaccination is the only protection against shingles and postherpetic neuralgia, the most common complication from shingles.” Healthy adults ages 50 years and older should get two doses of Shingrix to prevent shingles and complications of shingles.
The two doses of Shingrix are given at zero (time of first vaccine) and then 2-6 months following the first vaccine. You can get your vaccine at your pharmacy or doctor’s office, pending availability (more on that later). Most insurance companies, in my experience, cover a large portion or the entire cost of the shot. If you are one of the patients who have to pay out of pocket, cost per dose is approximately $180, so you would pay a total of about $360 to receive both vaccinations (cost varies slightly by store/chain).
How Well Does It Work?
The CDC reports that two doses of Shingrix are more than 90% effective at preventing shingles and PHN. For at least the first four years after vaccination, protection stays above 85% effective.
Is Shingrix Available?
One concern over the Shingrix vaccine is availability; there are major shortage issues with this vaccine. I have heard stories of patients on a 400-person waiting list! (In my independent pharmacy, we use a different supplier than the chains, and we have not been as affected by the shortage). I contacted GSK (GlaxoSmithKline), manufacturer of Shingrix, regarding this issue. GSK tells me that there has been “extraordinary demand” creating “temporary out of stock situations,” and that they will be significantly increasing delivery and accelerating shipments to where Shingrix will be shipped on a regular basis. There is a Shingrix vaccine locator on the website. After using the locator, I would recommend calling the pharmacy first to confirm availability. (https://www.shingrix.com/shingles-vaccine-locator.html) You can also sign up for second vaccine reminders. Once you find the vaccine in stock, I would recommend requesting that the pharmacy holds the second dose for you; many pharmacies routinely do this. GSK reports that if it is over six months when you get your second vaccine (due to availability or any reason), you can get your second dose as soon as possible, and you do not need to restart the entire series.
What Are the Side Effects of Shingrix?
Another concern I have been hearing from patients is the potential for side effects from Shingrix vaccine. The GSK manufacturer website has a section on side effects (https://www.shingrix.com/side-effects.html) and explains that the most common side effects are: pain/redness/swelling at injection site, muscle pain, tiredness, headaches, shivering, fever, and upset stomach. Severe allergic reactions, which are less common, may include: hives, face/throat swelling, difficulty breathing, a fast heartbeat, dizziness, and weakness. Pharmacists are CPR-certified and have an Epipen ready in case of any severe reaction. While I always have my Epipen available when giving any type of vaccination, fortunately I have never had to use it.
According to the CDC:
“Studies show that Shingrix is safe. The vaccine helps your body create a strong defense against shingles. As a result, you are likely to have temporary side effects from getting the shots. The side effects may affect your ability to do normal daily activities for 2 to 3 days.
“Most people got a sore arm with mild or moderate pain after getting Shingrix, and some also had redness and swelling where they got the shot. Some people felt tired, had muscle pain, a headache, shivering, fever, stomach pain, or nausea. About 1 out of 6 people who got Shingrix experienced side effects that prevented them from doing regular activities. Symptoms went away on their own in about 2 to 3 days. Side effects were more common in younger people.”
If you experience side effects, you should report them to the Vaccine Adverse Effect Reporting System (https://vaers.hhs.gov/index.html) or by calling 1-800-822-7967.
Shingrix (not a live vaccine) is now the preferred vaccine, over Zostavax. Zostavax, which is a live vaccine (https://medlineplus.gov/ency/article/002024.htm explains the different forms of vaccines) for healthy adults 60 years and older, may be used if a person requests it, if a person is allergic to Shingrix, or if the person needs immediate vaccination and Shingrix is not available.
I consulted with a colleague, Jennifer Gershman, PharmD (https://www.pharmacytimes.com/contributor/jennifer-gershman-pharmd-cph), who has written several articles on Shingrix. I think of her as an expert on the topic.
Her recommendation:
“I highly recommend Shingrix, but believe that the percentage of people getting localized reactions like swelling, and systemic symptoms such as fever, is higher than what was reported in studies since it is now being introduced into a greater patient population. It is definitely an important vaccine to get and is much more effective than Zostavax.”
Taking into account all of the information, I strongly recommend receiving the Shingrix vaccine. The possible side effects, even if bothersome for a few days, are much easier to deal with, compared to the potential pain and long-term complications of shingles. Always consult your doctor or pharmacist for personalized advice.
