New Shingles Vaccine on the Horizon

It comes on suddenly. Your skin starts to hurt, itch and tingle before a rash on one side of your body or face shows up. And then you know … you have shingles. The next week to 10 days, the rash will produce blisters that will finally scab over and, with luck, the condition will clear up completely in two to four weeks.

There are approximately one million cases of shingles in the United States annually, so chances are you will know someone who has had it in your lifetime. Affecting as many as one in three Americans, shingles can strike not just once, but two or even three times.

Shingles shows up in people who have previously had chickenpox, as the virus (varicella zoster) that causes it stays dormant until reappearing as shingles later in life. Unfortunately, doctors and scientists don’t know why the virus can “re-activate,” causing a second (or third or fourth!) round of misery in a person’s life. Shingles can’t be passed from person to person, but the virus can be spread through direct contact with fluids from shingles blisters, which could cause chickenpox in a person who hasn’t previously had it or received the chickenpox vaccine.

If you’re unlucky enough to turn up with shingles, avoid spreading the virus by keeping the rash covered, don’t touch or scratch the rash, and wash your hands often. Additionally, stay away from high-risk people, such as pregnant women who have never had chickenpox or the vaccine, premature or low birth weight infants, and people with compromised immune systems.

Known for its telltale rash, shingles can be more than just an annoyance, with some 20 percent of sufferers experiencing postherpetic neuralgia (PHN), which causes severe nerve pain at the rash site. PHN usually clears up within a few weeks but can persist for years in some cases. As people age, the likelihood of PHN increases, as well as the potential for increased severity of pain.

For the last decade, the CDC has recommended that adults over the age of 60 receive the shingles vaccine (Zostavax), which reduces a recipient’s risk of developing shingles by 51 percent and PHN by 67 percent. While those numbers are decent, the vaccine certainly isn’t fool-proof, and it isn’t available to everybody.

Jeff Goudreau, M.D., internist and physician on the medical staff at Texas Health Dallas, says good news looms on the horizon.

“This is actually a great time to talk about the shingles vaccine,” he says. “The one we have access to right now isn’t that great, but there’s a new one called Shingrix that was approved [by the FDA] in October that should be coming out soon. The current vaccine is called an active virus vaccine. The problem is that people who are immunosuppressed, have HIV or cancer, or are taking steroids or prednisone can’t have this vaccine, but they are the ones who really need it because shingles can impact them more severely.

“The current vaccine is only one shot, but if it’s not covered by insurance, it can be pricey—around $275. The biggest problem is that it only lasts about five years in the body and we can’t give a booster. I’ve seen several patients get shingles about six to seven years after having the vaccine because, after a time, it pretty much becomes null and void. And once you get the vaccine, you can’t get it again.”

The CDC’s webpage on the shingles vaccine was recently updated to reflect information about the new vaccine mentioned by Goudreau. It reports that the Advisory Committee on Immunization Practices recommends the vaccine for adults over 50, even if they’ve had the previous Zostavax immunization.

Goudreau says the introduction of the new shingles vaccine will be significant.

“This is a game changer,” he says. “The new [vaccine] is an inactive vaccine, so anybody can have it. It’s effective at any age, but it is a two-shot vaccine so people have to get that second shot two months after the first one. It will run around $250 if it’s not covered by insurance, but it’s much more effective.

“People can get the new vaccine even if they had the old one because this will lessen the seriousness of shingles even if they’ve had it previously. Also, because it doesn’t ‘expire’ like the old one, I’d strongly recommend that even people as young as 50 think about getting it. Ask your doctor about it the next time you go in, because it should be out on the market soon.”

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