Shingles and Shingles Vaccine: An Update

Editor's Note: This video first appeared on the Wills Eye Hospital website and is being republished on Medscape with permission.

Understanding Shingles/Ocular Shingles

Christopher J. Rapuano, MD: Hi. I'm Dr Christopher Rapuano, chief of the cornea service at Wills Eye Hospital, and I'm here with my associate, Beeran Meghpara, also on the cornea service at Wills Eye Hospital. We are coming to you from the Wills Eye Alumni Society Newsroom at Wills Eye Hospital in Philadelphia.

We are here today to talk about shingles—shingles around the body and especially shingles around the eye, and ways to prevent it.

Beeran, can you tell us a little bit about shingles around the body and also in the eye?

Beeran B. Meghpara, MD: Shingles first starts out as chickenpox. We are all exposed to chickenpox at a young age, and then it goes dormant in the body. Years later, maybe in the 50s, 60s, or 70s, and for reasons that we really don't know why, it becomes reactivated in the form of the shingles virus.

The way shingles typically presents is with a rash, either on the body or the face. It's often a painful rash. Sometimes it can be minor, and sometimes it can be quite severe. It can affect other things as well; once the rash goes away, you can get postherpetic neuralgia, which is a painful condition that can take months and months to go away, and sometimes it never goes away.

Dr Rapuano: It is a severe pain that is sometimes just devastating to patients.

Dr Meghpara: [It is] difficult to treat.

Dr Rapuano: What about [shingles] in the eye? Is that a problem or does it [resolve on its own]?

Dr Meghpara: Shingles in the eye can be a very tricky problem. It can affect all parts of the eye. It can affect the front of the eye (the cornea). It can affect the structures inside the eye (the retina). If it is not treated quickly and effectively, it can lead to vision loss.

Dr Rapuano: Glaucoma is another issue that you can get [from shingles]. So, it can create all kinds of problems in the eye.

Preventing Shingles/Ocular Shingles

Dr Rapuano: Shingles seems to be more prevalent now than 10, 15, or 20 years ago, and not only in the United States but also around the world. We don't know exactly why this is. Is there any way to prevent shingles?

Dr Meghpara: There is a very good way to prevent shingles. There is a shingles vaccine that [has been] available for about the last 10 years called Zostavax. It's done a very good job. The Zostavax [vaccine] is recommended in patients aged 60 years and older, and it reduces the risk of getting shingles by about 50%.

Dr Rapuano: Is that 50% in all comers, from [ages] 50, 60, 70, 80, 90 [years], or is there a difference?

Dr Meghpara: That's a good question. It's actually among the entire population.

One of the issues with the Zostavax [vaccine] is that as our patients get older, the effectiveness of the vaccine goes down. The other nice thing about the Zostavax [vaccine] is that even if you do get the shingles virus, the severity of the infection is sometimes less and reduces the risk of getting postherpetic neuralgia by about 66%.

Dr Rapuano: That's good. Now, the Zostavax [vaccine] is a live attenuated virus. It is not recommended in patients who are immunocompromised, and so there is a subset of our patients who are not [good candidates] for the Zostavax [vaccine].

Dr Meghpara: Exactly. That is an issue, because it's often these immunocompromised patients who are at a higher risk for getting the shingles virus.

New Vaccine for Shingles/Ocular Shingles

Dr Rapuano: [Is there] anything new with vaccines?

Dr Meghpara: Yes. There has been a newly FDA-approved immunization for shingles, called Shingrix. The reason we're excited about this—and the CDC is excited about it as well—is that it seems to be more effective in preventing the virus. The studies tell us that about 97% of patients who get this [vaccine] will not get shingles. The great thing is that this effect tends to last longer in life, even in patients [aged] 70 and older; it has about a 90% effectiveness.

Dr Rapuano: That's great. That's a big difference. Also, it's not a live virus; it's kind of a subunit—it's particles. So, theoretically, we expect it to be good for patients who are immunocompromised.

Dr Meghpara: Exactly.

Dr Rapuano: Is this available right now?

Dr Meghpara: It's not available right now, but I believe that you spoke with the manufacturer. What did they say?

Dr Rapuano: They told me they hope that it is available by the end of November 2017. In the pretty near future, we hope that it is available to patients.

How is it [administered]? Is it one shot or multiple shots?

Dr Meghpara: This is one of the downsides of this new vaccine, as it does need to be administered in two separate doses. I believe they're supposed to be 8 weeks apart. The other thing about this vaccine is that it does tend to be a little more painful when getting the injection. Typically people are reporting soreness at the injection site for about 2 days. There are a few systemic side effects, like fevers, muscle aches, and joint aches, but they typically go away by themselves in 2 days. Certainly, a little bit of discomfort and a little bit of pain outweigh the potential pain and morbidity from an actual shingles infection.

Dr Rapuano: Shingles infections are absolutely terrible in the whole body. They're even worse with more severe complications and side effects in the eye. My prior partner, a cornea specialist, got shingles in her eye, and it caused such problems that she had to stop practicing medicine. So, it really is potentially devastating.

This [new vaccine] is wonderful news for medicine in general and for ophthalmology specifically. We're hoping to have this new vaccine available to us in the near future, and we certainly recommend it to our patients 50 years and older to decrease the chance of this terrible condition.

I am Chris Rapuano, and I am here with Beeran Meghpara, from the Cornea Service of Wills Eye Hospital in Philadelphia. Thank you very much.