Shingrix is the new shingles vaccine which was recently approved by the FDA. It is an improved vaccine for preventing shingles and its complications. Unlike its predecessor vaccine, Zostavax, it requires two doses to be given between two and six months apart.
It is a better vaccine because it uses recombinant technology plus an adjuvant. Recombinant technology means inserting the DNA encoding for the shingles virus into a tissue culture. The culture produces the protein antigens of the virus, but no living virus! These proteins are used to vaccinate.
The adjuvant makes the immune system respond better to the vaccine. This adjuvant (OS-21 Stimulon) is the same one used in the children’s malaria vaccine.
The new vaccine provides much better protection than the original, and is recommended for people 50 and older – regardless of whether they have previously received Zostavax. At this point, cost for both shots is $280. The main side effect is soreness at the vaccine site.
When the shingles vaccine was being researched and developed, the patient population was studied for five years. These initial studies showed the vaccine to be 90 percent effective after five years.
Based on that research it was therefore felt that Zostavax (shingles vaccine) could be given once in a lifetime. Unfortunately, it is starting to look like that won’t be the case.
Now that longer-term studies are being completed, it is apparent that immunity wanes with time. In fact, efficacy falls to 46 percent after seven years; 14 percent after 10 years, and roughly zero after 11 years.
Since these long-term research projects have just been completed, the medical community awaits advice from the Centers for Disease Control and Prevention (CDC) regarding re-vaccination protocols.
Dear Dr. K: I had shingles three years ago and now I have it again. I thought you were only supposed to get shingles once.
Your impression and what I was taught in medical school are identical, but, unfortunately, are now incorrect. There are probably two reasons for this change. One reason is that until a disease state is subjected to critical analysis, misjudgments of incidence and frequency can be made. The other is that due to modern antiviral drugs the disease itself has changed. In other words, before we had antiviral drugs to treat the shingles, the illness could be quite severe causing nerve damage, scarring of the skin and, in some cases, blindness.
But because of its severity it elicited a strong immune response and therefore a strong resistance to further outbreaks.
The use of the new antiviral drugs is very helpful in treating the shingles and preventing complications, but their result can be a less permanent immune resistance.
The Mayo Clinic has researched these trends and in its patient population they find 6.2 percent of people have a second attack of shingles within eight years. The rate was highest in people who had severe pain with their first episode. It was also higher in women and persons past the age of 50.
One new weapon in the war on shingles is the new vaccine Zostavax. It currently is recommended for adults 60 years and older as a one-time shot to help prevent shingles.