What Is The Herpes Zoster Vaccine

Side Effects Of Herpes Zoster Vaccine

The most common side effects of the recombinant vaccine are pain, soreness, redness, and swelling at the injection site and headache, fatigue, muscle pain, shivering, fever, and digestive upset.

The most common side effects of the live-attenuated vaccine are soreness, redness, swelling, and itching at the injection site and headache.

Very Common And Common Adverse Events

Very common adverse events occur in 10% or more of vaccinees. Common adverse events occur in 1% to less than 10% of vaccinees.

Injection site reactions are very commonly reported for both LZV and RZV. For LZV recipients the frequency is slightly higher in adults aged < 60 years. For all ages, the majority of these events were rated mild or moderate in intensity and lasted less than 2 days.

Due to the adjuvant in RZV, which induces a high cellular immune response and helps address the natural age-related decline in immunity, RZV is more reactogenic than LZV.

Injection site AEs are very commonly reported by recipients of RZV. Approximately 80% report injection-site pain and approximately 30% report redness at the site of injection.

Systemic adverse events, primarily fatigue and myalgia are common in LZV recipients and very common in RZV recipients . For RZV, they include headache .

Local and systemic reactions that were severe enough to interfere with normal activities have been more frequently reported following the receipt of RZV than LZV. However, these reactions have been temporary . Patient education on the short-term reactogenicity of the RZV is recommended prior to vaccine administration to promote adherence to the second dose.

What Is The Shingles Vaccine

The shingles vaccine prevents herpes zoster, otherwise known as shingles. Shingles is a condition that causes a painful, blistering rash on one side of the face or body. This rash usually appears in a limited area on the skin, sometimes in the form of a stripe or patch. In many cases, the rash shows up after strange sensations, such as tingling or itching, have occurred in the same area. The rash turns into blisters and can be intensely painful. Shingles can also cause:

• Fever

• Headache

• Upset stomach

The most common complication of shingles is postherpetic neuralgia, the lingering nerve pain after the rash goes away . It can be long-lasting and debilitating. Other complications can occur, depending on which part of your body shingles affects. Complications can include:

• Hearing loss

• Brain inflammation

• Vision changes or blindness

The vaccine is not intended to treat shingles or its complications, only to prevent them. It is given as an injection into the upper arm muscle in two doses that are spaced 2 to 6 months apart.

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Can You Get Chickenpox If You’ve Been Vaccinated

Yes. About 15% 20% of people who have received one dose of varicella vaccine do still get chickenpox if they are exposed, but their disease is usually mild. Vaccinated persons who get chickenpox generally have fewer than 50 spots or bumps, which may resemble bug bites more than typical, fluid-filled chickenpox blisters. In 2006, the Advisory Committee on Immunization Practices voted to recommend routine two-dose varicella vaccination for children. In one study, children who received two doses of varicella vaccine were three times less likely to get chickenpox than individuals who have had only one dose.

What Is The Most Important Information I Should Know About Zoster Vaccine Live

You should not receive this vaccine if you are pregnant or if you have active untreated tuberculosis, a weak immune system, leukemia or cancer that affects bone marrow, or if you have a history of allergic reaction to gelatin or neomycin.

To make sure zoster vaccine is safe for you, tell your doctor if you have:

• a history of allergic reaction to any vaccine
• if you have received a “live” vaccine within the past 4 weeks or
• if you have never had chickenpox.

You can still receive a vaccine if you have a minor cold. If you have tuberculosis or any other severe illness with a fever or any type of infection, wait until you get better before receiving this vaccine.

Tell your doctor if someone in your household has a weak immune system. For a short time after you receive a zoster vaccine, it is possible that the live virus could be passed from you to any person who has a weak immune system.

It is not known whether zoster vaccine is harmful to an unborn baby. However, this vaccine is not for use in pregnant women. Avoid getting pregnant for at least 3 months after you have received a zoster vaccine.

It is not known whether zoster vaccine passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Zoster vaccine is not approved for use by anyone younger than 18 years old.

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Schedule : Dangerous Drug

Substances with a high potential for causing harm at low exposure and which:

• Require special precautions for manufacture, handling or use or
• Only available to specialised and authorised users with appropriate skills
• Special regulations regarding their availability, possession, storage or use may apply

How Do You Get The Shingles Vaccine

So here is the million-dollar question, “How do I get the shingles vaccine?” If you’re looking to get this vaccine, you can start by asking your primary health care provider. A doctor or nurse practitioner can administer the shingles vaccine.

Persons who can get the publicly funded Shingrix vaccine can get it through their doctor. People who aren’t eligible for it should seek to buy it privately. If you need to buy it privately, your doctor will need to give you a prescription for it.

Most pharmacies and travel clinics sell the shingles vaccine. If there is a doctor or nurse at the travel clinic, they will administer the shot. The staff at most pharmacies in Canada can vaccinate customers.

It’s always a good idea to contact your health insurance provider if you’re not sure if it covers the cost of the shingles vaccine. The company will be more than happy to inform you if your insurance plan covers the cost of this vaccine.

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Is Shingrix Or Zostavax Better

Shingrix is more effective than Zostavax. Shingrix is 97% effective at preventing shingles in adults aged 50 to 69 years old whereas Zostavax is only 70% effective at preventing shingles in the same age group. Shingrix consistently prevents shingles in older adults while the effectiveness of Zostavax decreases with increasing age. However, Shingrix has more systemic side effects than Zostavax.

Shingrix Vs Zostavax: How Do Various Shingles Vaccines Stack Up

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Its important to understand what shingles is. Shingles is essentially a reactivation of chickenpox. Chickenpox is a bit of a misnomer. The pox ending refers to its blistering rash. For much of human history it was thought to be similar to smallpox . However, the two infections are entirely unrelated.

Why it was called chicken-pox is not entirely clear since the disease has nothing to do with chickens. A few theories have been put forward. One is that chicken-pox is a linguistic corruption of child-pox since the disease generally affects children. But the real reason is likely lost to history. In any case, we are better off referring to chickenpox by its scientific name of varicella.

Varicella is caused by the aptly named Varicella-zoster virus . Varicella is not a benign illness and it can be fatal, but most people survive the initial infection. However, even though the characteristic rash eventually disappears, the virus is never entirely cleared from the human body. It remains dormant in the dorsal root ganglia, a cluster of nerve cells that run parallel to the spine. Your immune system normally keeps the virus in check. But as we age, immunity can wane. By age 55, 30-40% of people have lost the specific immunity they had to the varicella-zoster virus and the virus can re-awaken.

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How Do You Get Shingles

Shingles is a disease that can affect anyone who has had chickenpox. There’s no way of knowing who will get shingles. There are risk factors that can give people an idea if they are at risk for developing shingles.

Advanced age is a major risk for this disease. The risk of getting it increases with age. Around half of the cases of shingles are diagnosed in adults 60 and older.

Persons who are older than 70 have the highest risk of getting shingles. Persons who have trouble fighting infections are also at risk. An HIV infection can also put a person at risk for shingles.

A person that has cancer of the bone marrow or lymphatic system shouldn’t get this vaccine. People undergoing radiation or chemotherapy need to refrain too.

You should know that shingles is not contagious. It can’t be transmitted from one person to another. Still, precautions need to be taken.

People who have never had chickenpox can get chickenpox from a person who has shingles. If you haven’t had chickenpox or aren’t sure if you had it, make sure to stay away from anyone who has shingles.

If you have shingles, you need to stay away from others. Avoid being around people with a weak immune system. People who have a poor immune system are highly susceptible to this disease.

There are several things that people with shingles can do to help reduce another person’s risk of getting chickenpox. Cover the shingles rash as direct contact with the fluid from the rash blisters can cause chickenpox.

Is The Shingles Vaccine Safe

As with any vaccine, its possible to have some side effects after receiving it. In clinical studies, the side effects linked to this vaccine usually lasted only 2 to 3 days, and the most common ones were:

• Pain and redness at the injection site

• Muscle pain

• Fatigue

• Headache

Most people report at least some arm pain after the injection. Some people reported that their side effects kept them from doing their usual daily activities. For this reason, its a good idea to plan to not do anything right after receiving your injection, just in case.

Severe allergic reaction to this vaccine is very rare. Symptoms of such a reaction include:

• Hives

• Swelling of the face or throat

If you notice these symptoms in the hours after your vaccination, get medical help immediately.

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Obstacles To Getting Vaccinated

Despite the fact that the small, but vocal, group of individuals who oppose vaccinations remains strong, Jain says she hasnt encountered much opposition to getting vaccinated among her patients.

A lot of patients will actually come to me asking how they can get the shingles vaccination, so I actually have experienced the opposite, she said. Theres a very small percentage of patients, Id say under 10 percent, that are very averse to getting vaccinations, though.

Jain said that with these patients, their concerns often center around possible adverse effects from the vaccination, fears that theyll contract shingles by getting the vaccination, or the belief that since theyve never had the illness, they dont need the vaccine.

Another big concern that patients have is cost, Jain told Healthline in March 2018. Zostavax cost $213, and Shingrix costs about $280 out of pocket.

Prices have fluctuated slightly in 2019, with Shingrix at $185 per injection (.

She explained that even insurance or Medicare coverage doesnt solve the problem.

The issue is that Medicare Part B is not covering it, Medicare Part D is covering part of it, and Medicaid may or may not cover it it really depends on the insurer and the insurance plan, she said. So, I think cost is also a big barrier for patients as well.

Uncommon Rare And Very Rare Adverse Events

Uncommon adverse events occur in 0.1% to less than 1% of vaccinees. Rare and very rare adverse events occur, respectively, in 0.01% to less than 0.1% and less than 0.01% of vaccinees.

Both HZ vaccines are safe with serious adverse events reported very rarely in immunocompetent individuals.

Recurrence or exacerbation of herpes zoster ophthalmicus following LZV vaccination has been reported very rarely, involving several cases world-wide following LZV immunization. Following a causality assessment of seven cases of HZO which were temporally associated with the administration of LZV, NACI concluded that there was insufficient evidence to recommend for or against the administration of LZV in individuals with a history of HZO. More evidence is required for further assessment of risk related to HZO recurrence in LZV recipients. At this time, there is insufficient evidence to assess the risk related to HZO recurrence following RZV recipients.

See Contraindications and Precautions if considering vaccinating a person with previous HZO.

For more information, refer to Vaccine safety in Part 2 and the product monograph in Health Canada’s Drug Product Database.

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Natural History Of Herpes Zoster

During varicella, varicella-zoster virus establishes life-long latency in neurons in sensory ganglia. Herpes zoster results when latent virus reactivates, multiplies in the ganglion, and spreads back down the sensory nerve. Varicella induces immunity to VZV that prevents reactivating virus from multiplying, thus preventing herpes zoster. This immunity decreases over time until it falls below a critical threshold, permitting reactivating VZV to multiply and cause herpes zoster. The age-related decline in VZV-specific immunity is slowed by periodic stimulation due to exogenous exposure to VZV from contact with varicella and by episodes of reactivation of latent VZV where host immunity inhibits virus multiplication before it can cause herpes zoster .

Modified from R Edgar Hope-Simpson .

Dose And Administration Of Herpes Zoster Vaccine

The recombinant zoster vaccine dose is given IM in 2 doses , 2 to 6 months apart.

For adults who previously received the live-attenuated zoster vaccine, 2 doses of the recombinant vaccine are given 2 to 6 months apart and 2 months after the live-attenuated vaccine was given.

The live-attenuated zoster vaccine is given as a single 0.65-mL subcutaneous dose in the deltoid region of the upper arm.

Zoster vaccine should be given 14 days before immunosuppressive therapy is begun some experts prefer waiting 1 month after zoster vaccination to begin immunosuppressive therapy if possible.

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When Should I See A Doctor Because Of The Side Effects I Experience From Shingrix

In clinical trials, Shingrix was not associated with serious adverse events. In fact, serious side effects from vaccines are extremely rare. For example, for every 1 million doses of a vaccine given, only one or two people may have a severe allergic reaction. Signs of an allergic reaction happen within minutes or hours after vaccination and include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, or weakness. If you experience these or any other life-threatening symptoms, see a doctor right away.

Shingrix causes a strong response in your immune system, so it may produce short-term side effects more intense than you are used to from other vaccines. These side effects can be uncomfortable, but they are expected and usually go away on their own in 2 or 3 days.

Host Immune Responses To Varicella

Primary VZV infection induces VZV-specific antibodies and cell-mediated immune responses. Varicella-zoster virus-specific antibodies are involved in protecting the host during re-exposure to the virus by contact with persons who have varicella or HZ, but they appear to have little impact on varicella severity, since antibody immunodeficiency is not associated with severe varicella or second episodes of varicella . Levels of VZV-specific antibodies remain high with relatively little change during life . Varicella-zoster virus CMI involves T lymphocytes, including CD4+ and CD8+ effector and memory T cells, as well as natural killer cells . The magnitude of VZV-specific T-cell responses are inversely correlated with severity of varicella and HZ . Varicella-zoster virus CMI is necessary to maintain VZV latency.

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What Other Drugs Will Affect Zoster Vaccine Live

Before receiving this vaccine, tell your doctor about all other vaccines you have recently received.

Other drugs may interact with zoster vaccine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Herpes Zoster In People Who Are Immunocompromised

People who are immunocompromised have an increased risk of herpes zoster compared with non-immunocompromised people. Rates of herpes zoster are up to 15 times higher in people who are immunocompromised due to HIV. In the 1st year after haematopoietic stem cell transplantation, up to 30% of patients may develop herpes zoster.25,36

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Global Needs For A Zoster Vaccine

The worlds population is aging . One in 6 persons worldwide and one in 4 in North America and Europe will be 65 yoa by 2050 . The population of older adults is expected to double between 2019 and 2050 in every region except sub-Saharan Africa .

One third of adults will develop HZ in their lifetime, and half who reach 85 yoa will be afflicted with HZ . Although rarely fatal, HZ has a major adverse impact on the elderly, causing chronic neuropathic pain, decreased physical and social functioning, emotional distress, reduced productivity, medical costs, and irreversible loss of independence .

We estimate that, in the absence of HZ vaccination, 278 million cases of HZ will occur globally over the next decade, including 10.5 million cases in persons 85 yoa 20.7 million persons50 yoa would experience PHN .

Herpes zoster vaccination is cost effective in older adults , but low- and middle-income countries have many other public health priorities. Nevertheless, because childhood varicella vaccination would eventually reduce the incidence of HZ in older adults, adding it to the WHO Regional Strategic Plan for Immunization for the African region would eventually reduce the human and economic cost of HZ. Furthermore, as the current population of persons already latently infected with wild-type VZV ages, the burden of HZ among older adults will increase enormously. Thus, a safe, effective, and inexpensive HZ vaccine is needed.