The Medicine Cabinet: Ask the Harvard Experts
Q: I recently read that the new shingles vaccine might be better than the older vaccine. I did have one shot of the older vaccine about seven years ago. Should I get this new one?
A: Shingles is caused by the same virus — the varicella zoster virus — that causes chickenpox. Once you have had chickenpox, the virus that caused it remains alive inside your nerves. It is inactive, but it can be reactivated later in life. This causes shingles.
When the virus reactivates, the infected nerves, and the skin the nerves go to, become inflamed, causing a burning or stabbing pain. A few days later, when the virus reaches the skin, a rash of blisters appear along the affected nerve. The skin may be very sensitive, unable to tolerate even the lightest touch.
Up to 10 percent of adults who get shingles experience long-term pain, even after the rash has healed completely. This condition is called post-herpetic neuralgia. It may last for months, or even years.
Until recently, only one shingles vaccine called Zostavax was available. In the large clinical trial that led to its approval by the FDA, the shingles vaccine cut the risk of getting shingles by 51 percent and the risk of postherpetic neuralgia by 67 percent.
While a 50 percent decreased risk is okay, that’s not great. Also, Zostavax starts losing its protective effect against shingles within a few years.
The newer shingles vaccine appears to be both much more effective and provide longer protection. It’s called Shingrix. In a large four year study, it continued to provide over 90 percent protection against shingles across all age groups.
As opposed to one shot only for Zostavax, Shingrix requires two shots (two to six months apart) to be maximally protective.
Side effects of both vaccines are minimal. But Shingrix does not have the long-term safety record that Zostavax has.
The FDA approved Shingrix in October 2017 for people ages 50 and older. A CDC advisory panel supported the recommendation and the Advisory Committee on Immunization Practices agreed, including people who have already received Zostavax.
The CDC has not yet released formal recommendations for Shingrix. So, medical insurance probably would not cover the $280 cost of the two shots today. But I expect that to change in the near future.
Like you, I have already had Zostavax. I do plan on getting Shingrix once it is covered by my medical insurance.
(Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)
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