Are You Protected? Essential Vaccinations Every Adult Should Consider – Part 1

Preventing the Pain of Shingles

While most discussions of vaccines have historically centered on children, the need for preventive immunizations doesn’t end in adulthood. New vaccines developed to prevent or minimize shingles, tetanus, influenza, pneumonia and COVID-19 in adults bring numerous benefits, as I share in this three-part series. I encourage all to consider scheduling these immunizations, which are essential to avoiding serious complications of disease…an ounce of prevention is indeed worth a pound of cure.

In this blog, I focus on Shingrix, a fairly new vaccine that helps reduce the likelihood of shingles, a very painful rash that can last days, weeks or months. Shingles can be quite uncomfortable on your skin, but more dangerous if located in the eye (can cause blindness) or ear (can impair hearing). Hopefully, Shingrix will keep you from getting shingles, but if you do get it, the duration and severity of your symptoms will be lessened as will the risk of contracting herpetic neuralgia, a common, long and painful complication of shingles.

What causes shingles?

It is caused by reactivation of the chicken pox virus (varicella zoster). Prior to the development of the first chicken pox vaccine in 1984, almost 100% of all children exposed to chickenpox became infected with this very contagious illness. The rapidly spreading rash ranged from mild to severe, with symptoms including nausea, achy muscles, headache and fevers, and affected children from head to toe.

Unfortunately, many people who had chicken pox did not entirely eradicate the virus organisms from their body, and they lived quietly in the dorsal root ganglia of their spinal cord or cranial nerves for many years. At a later date, usually decades after the initial illness, the dormant cells reactivate and move along the nerves into nerve endings in the skin. These produce painful, fluid-filled blisters that look just like chickenpox blisters, and are filled with live virus particles which are contagious. Keep in mind that if you have shingles you can transmit chicken pox to someone who has never had chickenpox and never been vaccinated. However, you cannot give someone else shingles; it’s only activated by you, in your body.

The first shingles vaccine

In 2006 pharmaceutical company Merck came out with a new, live attenuated vaccine called Zostavax, and claimed a 50% reduction in the rate of shingles reported in clinical trials. I was dubious of this claim then, as it didn’t seem possible to prevent a virus spreading from yourself to yourself. I also didn’t think their numbers would be borne out in real world clinical experience. As it turns out, I was wrong in that regard. Not only was the 50% reduction rate true, but people who got shingles experienced much less severe symptoms and for a shorter period of time. However, Zostavax did not prove to be an enduring solution as a significant drop in its efficacy was seen after five years. Boosters were going to be needed, but the release of Shingrix at that time provided a better solution.

Shingrix enters the scene

Shingrix Shingles VaccineIntroduced in 2017, Shingrix is a recombinant vaccine that provides greater than 90% efficacy against both shingles and post herpetic neuralgia, the long-lasting complications that can occur afterwards. It is given in two doses spaced two to six months apart. Unlike Zostavax, the efficacy of Shingrix appears to be maintained over time, in part because of an “adjuvant” component that boosts the body’s immune response. Unfortunately, for some people this can also cause an unpleasant reaction to the shot itself, but be assured it is nothing serious. You can’t get chickenpox or shingles from the vaccine; the only downside is that you might experience a sore arm or a day or two of flu-like symptoms.  Overall this is a very good, effective vaccine.

Who should get the Shingrix vaccine?

Shingles dosage

I recommend it for most of my patients over 50, unless they have a known allergy to one of the ingredients. People often ask: “If I already had shingles, do I need the Shingrix vaccine?” The answer is a definite “yes” because those who previously had shingles are at greater risk of developing a second episode of shingles. I encourage members of Larew Internal Medicine to call the office to discuss whether Shingrix is right for your individual health situation.

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