Unlike some vaccines, there’s been so much demand for the new shingles vaccine Shingrix that it’s not always easy to find. It was approved in 2017, and the CDC recommends the vaccine for adults 50 and older to prevent this painful, blistering illness. It is being used in place of the previous vaccine, Zostavax.
More than a year later, doctors say they are learning more about how it works, its safety risks, and how it compares to Zostavax.
How effective is Shingrix?
“It's just remarkable," says Wilbur Chen, MD, an associate professor of medicine at the Center for Vaccine Development and Global Health, University of Maryland School of Medicine. "It has performed better than I expected." [Chen has a grant from GlaxoSmithKline, the company that makes Shingrix, but it's not related to the vaccine.]
In studies, Shingrix was more than 97% effective at preventing shingles in people 50 and older. It works just as well in older adults, who are at greater risk for a painful shingles complication called postherpetic neuralgia (PHN). "When 70- and 80-year-olds get shingles, it can be extremely debilitating," Chen says.
By contrast, Zostavax cuts the risk of shingles by only 51% and PHN by 67%. It's only about 38% effective in people over age 70.
The effects of Shingrix last longer, too. Protection stays above 85% for 4 years after you get the vaccine. "At 4 years, there was very little to any [reduction] in the measure we use for protection," says William Schaffner, MD, an infectious disease specialist and professor of preventive medicine and infectious diseases at Vanderbilt University. "That was very different from the first vaccine, Zostavax because by that time, [protection] was already diminishing."
How safe is Shingrix?
"So far so good," Schaffner says. The main side effect is soreness in the arm where you get the shot.
Other side effects are mild and usually last for 2 to 3 days, including:
"There have been no serious events associated with the vaccine that are specifically attributable to the vaccine," Schaffner says. But doctors will know more about the effects of Shingrix as time goes on. "The CDC is continuing to do, as they do with all new vaccines, a safety review."
Who shouldn't get Shingrix?
The vaccine is safe for healthy adults ages 50 and over. "That's a huge segment of the population," Schaffner says.
The only people who should definitely not get this vaccine are pregnant women and anyone who has ever had a severe allergic reaction to Shingrix or any of its ingredients.
The CDC's Advisory Committee on Immunization Practices (ACIP) hasn't confirmed whether the vaccine is safe for people who have a weakened immune system because of a disease or medicine.
"The big concern among certain groups of doctors is that they don't want to evoke a reaction that might, for example, in a transplant patient result in a rejection of the transplant," Schaffner says. "They want to make absolutely sure the vaccine is safe." Another worry is that taking drugs that weaken the immune system might make the shingles vaccine less effective.
ACIP is discussing how to give the vaccine to people with a weakened immune system. It's important for this group to be protected because they're at higher risk for shingles and its complications.
Can I get the Shingrix vaccine now?
You might have to wait. Due to higher-than-expected demand, Shingrix has been in short supply. GlaxoSmithKline has ramped up its production of the vaccine, and the company says it plans to significantly increase the number of available doses in 2019.
"My sense is it's coming in, and so those folks who have waited or have been frustrated because it wasn't available should try again," Schaffner says. To help you find Shingrix in your area, GSK offers a shingles vaccine locator on its website.
If Shingrix isn't available at your pharmacy, ask your doctor about getting the older Zostavax vaccine in the meantime. Just wait at least 8 weeks after getting Zostavax to have the Shingrix vaccine.
What do doctors still need to learn about Shingrix?
Future research will show how effective this vaccine is in special groups of people, like those with a weakened immune system. Also still unclear is how long Shingrix's protection will last. "We don't know if a person gets vaccinated at the age of 50, if we should give them a booster every 10 years, or every 15 to 20 years, or if no boosters are necessary," Chen says.
How do I pay for Shingrix?
Shingrix costs $280 for both shots. Under the Affordable Care Act, all Health Insurance Marketplace plans and most private health insurance plans will cover Shingrix with no deductibles or copayments -- as long as you get the vaccine from an in-network provider.
Medicare covers the shingles vaccine under Part D, its prescription drug plan. But not everyone on Medicare has Part D, and some of these plans have copays and deductibles. GSK says the average out-of-pocket cost for people on Medicare Part D is about $50 per dose.
Should you get Shingrix if you've already had shingles?
Yes. Shingles can come back after you've had it. "There's a somewhat increased risk that you could get a second episode, so go ahead and get the vaccine," Schaffner says. Just wait until your rash and other symptoms have cleared.
CDC: "About the Vaccine," "Shingrix Recommendations," "What Everyone Should Know About Shingles Vaccination (Shingrix)," "What Everyone Should Know About Zostavax."
Michael Hogue, PharmD, professor of pharmacy, Samford University College of Health Sciences.
William Schaffner, MD, infectious diseases specialist, Vanderbilt University.
Kenneth Schmader, MD, professor of medicine; chief, division of geriatrics, Duke University Medical Center.
Morbidity and Mortality Weekly Report: "Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines."
WebMD Health News © 2019
Cite this: Stephanie Watson. New Shingles Vaccine: What You Need to Know - Medscape - Nov 15, 2019.