filling a syringe with medicine, Shingrix

Currently, in community/retail pharmacy, there is a large focus on immunizations. Especially in the fall months, much time is spent on vaccinating patients against influenza (flu) and pneumonia. Recently, there has been a lot of talk about the new shingles/zoster vaccine, Shingrix. Many patients are concerned about side effects and the issues of vaccine availability.

What Is Shingles?

First, let’s learn a little about shingles, which is what the vaccine prevents. This website provides an informative overview and slideshow (https://www.webmd.com/skin-problems-and-treatments/shingles/ss/slideshow-shingles-pictures)

Shingles is a viral infection caused by the varicella-zoster virus, the same virus that causes chickenpox. If you have had chickenpox, the virus remains inactive in nerve tissue, close to your spinal cord and brain. Years later, the virus may come back as shingles. Shingles infection can cause a very painful rash. Shingles may occur anywhere on your body, but often appears as a row of blisters wrapping around your torso.

Symptoms may include:

  • Pain/burning/numbness/tingling
  • Sensitivity to touch
  • Red rash
  • Fluid-filled blisters that open and crust over
  • Itching

More serious symptoms may include: fever, headache, sensitivity to light, and fatigue.

Pain, which may be very intense, may occur with or without the rash. It is important to see your doctor as soon as possible if you have any of these symptoms, for evaluation and treatment. If you do have shingles, your doctor will prescribe an antiviral medication, such as valacyclovir (Valtrex) or acyclovir (Zovirax). An antiviral can help speed healing and reduce complications. Shingles usually lasts for two to six weeks, and may reoccur.

Who Gets Shingles?

In addition to having had chickenpox as a child, other risk factors for shingles include: age greater than 50, having certain diseases that weaken your immune system (such as HIV/AIDS or cancer), undergoing radiation or chemotherapy, and taking certain medications for prevention of rejection in transplant patients, or prolonged use of steroids such as prednisone.

If you have shingles, you are contagious and can spread the virus to anyone who is not immune to chickenpox (although you have shingles, if you pass the virus to that person it will show up as chickenpox, not shingles). Until your blisters scab off, you should avoid physical contact with anyone who has not been vaccinated for chickenpox, pregnant women, newborns, or anyone with a weakened immune system.

Complications of Shingles:

Not only can shingles cause a rash and pain, but the following serious complications may also occur:

  • Postherpetic neuralgia (PHN): For some people, the pain of shingles continues for a very long time, even after all of the rash/blisters are gone. Because your nerve fibers are damaged, exaggerated messages of pain are sent from your skin to your brain.
  • Vision loss: Shingles in your eye or around your eye can lead to very painful eye infections which may cause loss of vision/blindness.
  • Neurological problems: Depending on the affected nerves, shingles can cause brain inflammation, facial paralysis, or problems with hearing and/or balance.
  • Skin Infections: Bacterial skin infections may develop.
  • If you have never had chickenpox (varicella), it is a good idea to ask your doctor if you should receive the Varicella vaccine along with the Shingrix. If you have already had shingles, you can still receive the Shingrix vaccine, because you can get shingles more than once. Be sure to wait until the blisters are healed before receiving the Shingrix vaccine. Also, if you have already been vaccinated with Zostavax, it is still recommended to receive two doses of the Shingrix vaccine (wait at least 8 weeks after Zostavax before getting Shingrix).

What Should You Know About Shingrix?

Let’s take a look at the information given by the CDC (Centers For Disease Control), which is the foremost expert on vaccines and infectious disease, regarding Shingrix. (https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html)

According to the CDC, “shingles vaccination is the only protection against shingles and postherpetic neuralgia, the most common complication from shingles.” Healthy adults ages 50 years and older should get two doses of Shingrix to prevent shingles and complications of shingles.

The two doses of Shingrix are given at zero (time of first vaccine) and then 2-6 months following the first vaccine. You can get your vaccine at your pharmacy or doctor’s office, pending availability (more on that later). Most insurance companies, in my experience, cover a large portion or the entire cost of the shot. If you are one of the patients who have to pay out of pocket, cost per dose is approximately $180, so you would pay a total of about $360 to receive both vaccinations (cost varies slightly by store/chain).

How Well Does It Work?

The CDC reports that two doses of Shingrix are more than 90% effective at preventing shingles and PHN. For at least the first four years after vaccination, protection stays above 85% effective.

Is Shingrix Available?

One concern over the Shingrix vaccine is availability; there are major shortage issues with this vaccine. I have heard stories of patients on a 400-person waiting list! (In my independent pharmacy, we use a different supplier than the chains, and we have not been as affected by the shortage). I contacted GSK (GlaxoSmithKline), manufacturer of Shingrix, regarding this issue. GSK tells me that there has been “extraordinary demand” creating “temporary out of stock situations,” and that they will be significantly increasing delivery and accelerating shipments to where Shingrix will be shipped on a regular basis. There is a Shingrix vaccine locator on the website. After using the locator, I would recommend calling the pharmacy first to confirm availability. (https://www.shingrix.com/shingles-vaccine-locator.html) You can also sign up for second vaccine reminders. Once you find the vaccine in stock, I would recommend requesting that the pharmacy holds the second dose for you; many pharmacies routinely do this. GSK reports that if it is over six months when you get your second vaccine (due to availability or any reason), you can get your second dose as soon as possible, and you do not need to restart the entire series.

What Are the Side Effects of Shingrix?

Another concern I have been hearing from patients is the potential for side effects from Shingrix vaccine. The GSK manufacturer website has a section on side effects (https://www.shingrix.com/side-effects.html) and explains that the most common side effects are: pain/redness/swelling at injection site, muscle pain, tiredness, headaches, shivering, fever, and upset stomach. Severe allergic reactions, which are less common, may include: hives, face/throat swelling, difficulty breathing, a fast heartbeat, dizziness, and weakness.  Pharmacists are CPR-certified and have an Epipen ready in case of any severe reaction. While I always have my Epipen available when giving any type of vaccination, fortunately I have never had to use it.

According to the CDC:

“Studies show that Shingrix is safe. The vaccine helps your body create a strong defense against shingles. As a result, you are likely to have temporary side effects from getting the shots. The side effects may affect your ability to do normal daily activities for 2 to 3 days.

“Most people got a sore arm with mild or moderate pain after getting Shingrix, and some also had redness and swelling where they got the shot. Some people felt tired, had muscle pain, a headache, shivering, fever, stomach pain, or nausea. About 1 out of 6 people who got Shingrix experienced side effects that prevented them from doing regular activities.  Symptoms went away on their own in about 2 to 3 days. Side effects were more common in younger people.”

If you experience side effects, you should report them to the Vaccine Adverse Effect  Reporting System (https://vaers.hhs.gov/index.html) or by calling 1-800-822-7967.

Shingrix (not a live vaccine) is now the preferred vaccine, over Zostavax. Zostavax, which is a live vaccine (https://medlineplus.gov/ency/article/002024.htm explains the different forms of vaccines) for healthy adults 60 years and older, may be used if a person requests it, if a person is allergic to Shingrix, or if the person needs immediate vaccination and Shingrix is not available.

I consulted with a colleague, Jennifer Gershman, PharmD (https://www.pharmacytimes.com/contributor/jennifer-gershman-pharmd-cph), who has written several articles on Shingrix. I think of her as an expert on the topic.

Her recommendation:

“I highly recommend Shingrix, but believe that the percentage of people getting localized reactions like swelling, and systemic symptoms such as fever, is higher than what was reported in studies since it is now being introduced into a greater patient population. It is definitely an important vaccine to get and is much more effective than Zostavax.”

Taking into account all of the information, I strongly recommend receiving the Shingrix vaccine. The possible side effects, even if bothersome for a few days, are much easier to deal with, compared to the potential pain and long-term complications of shingles. Always consult your doctor or pharmacist for personalized advice.

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  1. Kimberly
    Portland OR
    Reply

    Just had my first dose of the Shingrix vaccine yesterday.I’m fairly tolerant of pain, but this one hurt, and I was so tired last night. Today my shoulder is very tender, and I’m tired again but with luck should feel better tomorrow. However, I had shingles on my head/face/eye 6 years ago and would do just about anything to avoid going through that again. Still have the nasty scars, too!

  2. Joyce
    Landrum SC
    Reply

    I had the Shingrix vaccine, and I am very glad I did. I did have some soreness and a slight fever (moreso with the first injection). The risk of having Shingles scares me to death after seeing some friends had it. Would do it again in a heartbeat!

  3. Lisa
    Oregon
    Reply

    This is very helpful. I have been conflicted about getting the vaccination and am concerned about the side effects. I am not immunocompromised but both my husband and I had reactions to our flu shots that sound similar to those mentioned. It concerns me that something that is so important is not fully covered by most plans as the flu and pneumonia vaccines are. Thank you again for the input.

  4. Jo
    Texas
    Reply

    I was eager to get the Shingrix vaccine because the Shingles I have are horrible! After the first shot I had flu like symptoms but did not care. However, three days after the shot I broke with shingles again. I received the second shot two months later, had no side effects but broke out with shingles four days later. I still have shingles outbreaks and have had the complete series of shingrix. I would MOST DEFINITELY get the shots again if there were any hope of stopping this horrible shingles. Please get the shots. You do not want to be where I am at with shingles all of the time. The pain is horrible. I do not regret getting the shingrix vaccine and like I said, I would take it every year if I thought it would eventually stop the shingles outbreaks.

  5. Diane
    North Carolina
    Reply

    I had the Zostervax shot about seven years ago within a month I broke out in hives that were acutely itchy. The hives lasted for five years and I lived on antihistamines that made me miserable. I have decided not to try the Shingrix vaccine because I can’t risk the hives returning. I hope this is the right decision,

  6. Kay
    South Carolina
    Reply

    My husband and I both had the Shingrix shots. He had a mild fever and tiredness and, of course, a sore arm the day after one of his shots. I don’t remember if it was the first or the second one, but he had no side effects from the other one. I had a much worse reaction; the first shot put me in bed for two days with a sinus headache, fever, extreme tiredness. The second one, two months later, affected me the same way but for just one day.
    I would do it again in a heartbeat. I think vaccines are miracles of modern medicines and I thank the researchers who spend their lives trying to develop treatments that will make a real difference in the health of us all. I would far rather have a few days of side effects than the disease.
    Even though I am on an ACA plan with a very high deductible, my insurance covered it completely. There was an issue with availability for both the shots, but I was lucky enough for it to work out. My husband had no availability issues.

  7. Doris
    CT
    Reply

    Excellent article – thank you. After the first dose had a very sore arm and a headache the next day. After the second dose, woke up 12 hours later with fever, chills, aches – the “hit by a truck”‘feeling. That passed in about 12 hours but the headache persisted a bit longer, as did the sore arm. I agree that the estimates of bad reactions are low. I reported my experience through VAERS. I still think it’s better than a case of shingles, though.

  8. HK
    Florida
    Reply

    I am unconvinced that the shingles shots are necessary. My 67 year-old daughter (got it in Nov. 2018), and my 65 year-old son (got it in Feb. 2018 just weeks after his father died). Both had the shot years ago, and then both got shingles in 2018. Both tell me they will take the new ones. My son has no lasting episodes of it, and my daughter had a mild case, suffered from extreme pain in the mandible and seen 2 times before a rash formed before shingles was diagnosed. I feel if it was so common a disease Medicare and all insurances would cover it. I would have to pay almost $400.00 to have it since I didn’t reach my maximum for prescription medications. I only take 1 prescription, Synthroid, for Graves Disease. I am 87 years old. $400.00 is a lot of money for me to spend.

  9. Kathleen
    Chicago
    Reply

    First shot, sore arm same day, next day, 2nd evening woke up from dead sleep retching for full 12 hours then another full day of weakness before 3rd day OK. The bad reactions seemed removed enough from the shot that I thought it was a coincidence, and I had gotten a flu or virus. Next shot, total repeat of the above. NOWHERE in side effects are vomiting and flu-like symptoms mentioned. I have since talked to many people (I’m a Medicare insurance agent) with my identical symptoms. Why are these symptoms / reactions not in the warnings?

  10. Joan S
    Madison, WI
    Reply

    My husband had a nasty case of Shingles 20 years ago, after which I obtained the Zostavax shot. This year our Integrative MD recommended that we both get the Shingrix shots and said the cost would be less at our pharmacy than through his clinic. Our pharmacy put us on a wait list of about 10 or 11 and called soon as their next supply arrived. We had minor discomfort the first day. The druggist called to remind us about the second shots, and he had them in stock. We had more discomfort with the second shots, but only for one day. No cost with our insurance!

  11. Jay
    California
    Reply

    No thanks. I got very sick after the flu shot, almost like having the full blown flu. I’ve had chickenpox and am willing to take my chances. I also get cold sores and regularly take Valtrex for prevention. Getting a vaccine for shingles requires one to stop the Valtrex for a few weeks prior. Too iffy for me.

  12. sylvia r.
    VA
    Reply

    Was given shingles shot number 2 at a big chain pharmacy. Was told told it was fine to take it with the flu shot.
    Do not know if the combination was at fault or not, but I would not recommend taking the two at the same time!
    Had fever, chills, muscle aches, almost useless arm where shingles shot was given. Could hardly move or turn over in the bed the night after the shots. Felt worn out and dead tired. Lasted a couple of days but arm sore for a good week.

    Would still recommend taking it. We had had the shot that first came out but my husband got Shingles on his face anyway. Dreadful pain, big open sores from blisters, and he still has odd nerve tingling in the area where the breakouts were, and it has been a couple of years. Protection is worth the side effects. The shingles lasted for months!

  13. Greta
    WA
    Reply

    I had a strong reaction to the first shot. Very sore and red at injection site for a week. Shivering, headache, body ache and upset stomach for 2-3 days. I am currently past due for my 2nd shot, but am putting it off (if they even have it) because I am sick with Graves’ Disease. I recently read that if you delay the second shot you don’t have to start over, but effectiveness will be less.

  14. Doris
    San Antonio, TX
    Reply

    I had the earlier shingles vaccine several years ago. Do I need to have Shingrix also, as sort of a booster?

    • Karen
      Nj
      Reply

      Hi Doris! If you had the Zostavax it is recommended to get two doses of the Shingrix.

  15. Teri
    Saddle River, NJ
    Reply

    Does taking Lysine on a regular basis, say almost daily, prevent shingles?

    • sheri
      surfside beach sc
      Reply

      Hey Teri

      Every day I take 1000 mg. of L Lysine to control my herpes zoster and it works really well. I suggested it to a friend of mine who had been through the medical mill trying to find relief for his vicious outbreaks of shingles. Based on absolutely zero, nada, no medical training, I have always thought that chickenpox, herpes and shingles are all related. The last time I saw him, I asked him how he was doing and he said ” it’s like a miracle”. Maybe give it a whirl, girl.

      P.S.- I buy my Lysine at CVS. Have purchased it at other stores and immediately had an outbreak.

    • Jan
      Reply

      I take Lysine daily and would like to know also if it might help to protect me. I eat healthy and currently take one Rx and supplements.

  16. Ej
    Washington
    Reply

    With the original shingles shot I didn’t have any kind of reaction. With the two-part one the first shot my arm really hurt, and for an hour and a half that evening I ached all over. Got second shot in two months, and that day all the joints in my hand swelled up and felt like they were burning. It was like it triggered an arthritic reaction in my body, as the aching did spread to other areas as well. I don’t hurt as much now, about five months since, but I still have some of that pain in my joints. I hurt so much it was hard to sleep. Taking pain pills was not an option for me because of other problems.

    Yes, I reported it right away but don’t see my reaction being listed as a possible side effect. Just be aware!

  17. Betty
    UT
    Reply

    I was raised before the chicken pox vaccine became available. I was the only child in 2nd grade not to get chickenpox. I kept having kids breathe on me because I wanted to stay at home for two weeks like all the other kids, but it didn’t happen. I was told a few years ago that getting the chicken pox vaccine could cause shingles, so I didn’t get it. Is there anything a person who hasn’t had chickenpox or chickenpox vaccine should know about getting the shingles shots?

  18. David
    NY
    Reply

    Both my wife and I had the first dose. Her main complaint was extreme tiredness. My major side effect was a tremendous exaggeration of my usually mild essential tremor. This was NOT shivering. Fortunately, it subsided to my normal state after a few hours, but I am concerned about the second dose. I reported this to the manufacturer, and they didn’t know of other people who had this experience. I do know of at least one other person similarly affected.

  19. Elliott
    Virginia
    Reply

    I had the first injection in Sept, second in December. I have a compromised immune system yet the only side effect I had was a sore arm (same feeling as getting a tetanus shot). No redness or swelling.

    I honestly expected more side effects due to my health problems and was surprised when they didn’t occur.

    It’s my understanding that you need to have the injections at a pharmacy. With Medicare and most other insurances, it’s covered 100%, sometimes a small co-pay, under your drug coverage.

    It’s always our responsibility as the patient to check with our insurance on coverage PRIOR to having any procedure done.

    I’m not a fan of Big Pharma and their money making schemes but I don’t believe there is any correlation between having the vaccine and developing the herpes virus.

    From what I’ve seen and heard first hand of the pain of shingles, I personally would recommend receiving the vaccine.

  20. Douglas
    Texas
    Reply

    What if I got a shingles vaccine several years ago when I turned 60? Should I now also get this new Shingrix shingles vaccine? Do I need to have both vaccines?

    • Karen
      Nj
      Reply

      Hi, Douglas, yes if you had zostavax it is recommended to get two doses of Shingrix.

    • Terry Graedon
      Reply

      Public health experts do recommend that you get this newer, more potent vaccine even though you had the first one already.

  21. Tara
    NC
    Reply

    I had the first Shringrix, with no side effects, except a little soreness at injection site.
    Walmart Pharmacy let me know when my second one was available, and I had the second one at 4 months. That night I had chills & shivering. Next morning, I woke up dizzy and faint feeling. After resting for a while longer, decided to get up and make coffee. Stirring coffee at counter…passed out…next thing I woke up on floor. Lucky nothing was broken, only some bruises from hitting counter on way to floor. By afternoon, I was feeling normal. I’m glad I took the vaccine, because I do not want to get Shingles. Just a reminder to be more careful if you’re feeling faint. I’m 78 yrs old.

  22. Sherri D.
    Pennsylvania
    Reply

    I am curious as to why I was charged $397 for both the first and second doses of Shingrex. My Highmark insurance paid very little as well as Medicare. Just MY portion for each shot was $397 each time! I had no idea it would be so expensive.
    I had flu-like symptoms with both injections. Severe body aches and general unwellness were so bad that I was in bed for 5 days with the first shot and 3 days with the second.
    My husband had the arm soreness with the first shot and 2 days of flu-like symptoms with the second.
    I hope it was worthwhile, but there’s no real way to know.

  23. Louise
    Houston, TX
    Reply

    I got both of my SHINGRIX shots without any ill effects although I had to wait more than 2 months to get the second dose. My system was not at peak as I had a lot of ill effects from a harmone depressant drug following my double mystectomy in late March.
    If the shots are costing you a bundle you have a lousey drug plan.

  24. Brian
    Charlotte, North Carolina
    Reply

    After watching my older brother (he’s in his mid 70s, I’m 67) suffer from the lingering pain after shingles -something my late mother experienced as well- I think this is an instance in which there is no free ride. For most people, it would seem, the side-effects of the vaccine are very likely to be less troubling than the suffering experienced with shingles. My wife and I had sore arms, with some warmth at the injection site, but that was it. I think people who have more pronounced negative reaction are more likely to post here, so I am writing to add some balance. Discuss it with your doctor and pharmacist. And no, there are no “live cells” in this vaccine; viruses are not cells in any case.

    Get the vaccine is what my wife and I’d say, and so does my brother, who is still being cared for at a pain-control clinic several years after having shingles!

  25. MJBR
    glastonbury, ct
    Reply

    I appreciate this article and the comments of those who have actually had the injections. I would like more articles and many more comments before husband and I decide if we even want to have these injections. We are really undecided and not convinced .about taking this new two dose Shingles vaccine. The articles you publish are very helpful. Thank you.

  26. Ginny
    60659
    Reply

    I know two people who got the shingles shot and they both have herpes now.

    • Sally
      WA
      Reply

      They had herpes before they had the shot.

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