If you have ever had chicken pox as a kid, you are at risk for shingles as an adult. That’s because the virus that causes this childhood illness is varicella zoster, the same virus that causes shingles. Even though we get over chicken pox, the virus remains in our bodies. It migrates up nerve cells to the trigeminal and dorsal root ganglia near the brain and spinal cord. The virus goes dormant for decades and can reemerge when our immune system lets down its guard. This can happen as we age or after immune suppressing drugs. The key question: how effective is the Shingrix vaccine in preventing a shingles attack? That’s what this reader wants to know.
Shingles Suffering Can Be Horrific!
Q. My older brother suffered from long-lasting pain after shingles. This is something my late mother experienced as well. Consequently, I decided to go ahead and get the Shingrix vaccine.
For most people, it seems, the side effects of the vaccine are likely to be less troubling than the suffering resulting from shingles. My wife and I both had the vaccine. We had sore arms, with warmth at the injection site, but that was it. My brother is still receiving care at a pain-control clinic several years after having shingles. I would like to avoid that fate!
How Good is the Shingrix Vaccine Really?
A. The Centers for Disease Control and Prevention estimate that the Shingrix vaccine is about 97 percent effective in people 50 to 69 years old. Effectiveness drops a bit in people over 70, to about 91 percent. That’s still impressive.
Protection remains high for at least four years after vaccination. That’s also impressive.
Shingles is a painful rash caused by the virus that causes chickenpox. Sometimes after the rash fades, the patient is left with excruciating nerve pain and tenderness in that area of the skin. That complication is called postherpetic neuralgia.
It can be extremely hard to treat. Two doses of the Shingrix vaccine were 86 percent effective in preventing the development of postherpetic neuralgia, the lasting pain your brother has suffered.
Comparing Shingrix to Zostavax:
Before Shingrix, doctors offered shingles prevention with the Zostavax vaccine. It is not as effective as Shingrix, and the protection fades after four or five years. Shingrix does not seem to suffer from that drawback. Still, many readers wonder about the differences between the two vaccines, as this one does.
Q. I had a shingles vaccine about six years ago, but I did have a mild outbreak of shingles several months ago. I’m seeing ads on television for Shingrix. How effective is this newer vaccine for preventing outbreaks?
A. The trial data for Shingrix shows a relative risk reduction of 97 percent. Research indicates that for every eleven people getting vaccinated, one would be spared a shingles outbreak. This is considered a very favorable result. To prevent a single longer-lasting painful episode of post-herpetic neuralgia, 34 people would need to get the shot (Applied Health Economics and Health Policy, June 28, 2019).
The Two-Shot Shingrix Vaccine Dilemma!
Shingrix is given as two shots two to six months apart. After its introduction in 2017, the vaccine was in short supply, so many people who wanted to receive it had trouble finding it.
We received a number of complaints from people who got the first Shingrix vaccine but then discovered they could not get the follow-up injection.
Betty in Richmond, VA ran into that exact problem:
“In today’s column newspaper column you mentioned that the Shingrix vaccine is in short supply. I have been on the waiting list for 8 months. What happens when I finally get my shot if I can’t get the followup shot within the 6 month time frame?”
The CDC Answers About the Shingrix Vaccine Shortage:
Here is what the CDC had to say about the delay dilemma:
“Q: Is Shingrix currently on backorder?
A: Yes. Due to high levels of demand for GSK’s Shingrix vaccine, providers should anticipate ordering limits and intermittent shipping delays for Shingrix. It is anticipated order limits and shipping delays will continue throughout 2019. GSK increased the US supply available for 2018 and plans to make even more doses available in the US in 2019. Additionally, GSK will continue to release doses to all customer types on a consistent and predictable schedule during 2019.
Q: What is the clinical guidance during the Shingrix delay?
A: Shingrix is the preferred shingles vaccine. You and patients should make every effort to ensure that two doses are administered within the recommended interval. If more than 6 months have elapsed since the first dose, administer the second dose as soon as possible. Do not restart the vaccine series, and do not substitute Zostavax® (zoster vaccine live) for the second dose of Shingrix.”
Dr. William Schaffner is one of the country’s leading vaccine experts. He is professor of preventive medicine and infectious disease at Vanderbilt School of Medicine.
In an article for Consumer Reports, Dr. Schaffner stated:
“The CDC’s recommendation, based on evidence from clinical trials, is to get your second dose of Shingrix anywhere from two to six months after the first.
“But if it takes longer than that to locate a second dose, don’t worry, Schaffner says. The CDC advises simply getting that second dose as soon as you can find it—and no, you don’t have to start the series over.
“’The timing is not critical,’ Schaffner notes. ‘You just don’t want to get it sooner than recommended because then the body’s immunity is still working on the first dose, so you don’t get the full benefit of the second.’”
As of this writing, there is no longer such a shortage of the Shingrix vaccine. During the pandemic, fewer people have made routine doctor visits or gotten routine vaccinations. In addition, GSK continued production. As a result, the supply has been replenished. When the COVID-19 pandemic ends, however, the company may once again find it difficut to keep up.
Individuals who received the older shingles vaccine, Zostavax, at least five years ago can still benefit from the newer Shingrix vaccine.
Read more about Shingrix in this post by our consultant, Karen Berger, Pharma, RPh:
There are 57 comments from other readers following Karen’s article. You may find them of interest.
Please share your own experience with Shingrix in the comment section below.