Background: Herpes Zoster, colloquially referred to as “Shingles” is a painful skin rash that is caused by a prior infection of the same virus that is known to cause Chicken Pox, varicella zoster.
The varicella zoster virus remains dormant after infection but can be reactivated especially in older adults who have weaker immune systems. The rash typically presents with erythema and blistering that wraps around the left or right torso. Triggers of Herpes zoster include but are not limited to: use of immunosuppressants, emotional stress, exposure to virus, and presence of malignancy.
Currently, there are two vaccines that can help prevent Shingles, Shingrix and Zostavax. Shingrix is the newer and preferred vaccine due to it being superior to Zostavax in preventing Shingles and complications associated with it such as postherpetic neuralgia.
Why Get Vaccinated?
- Roughly 1 in 3 individuals will get shingles in their lifetime
- Risk of getting shingles and serious complications goes up as you get older
- Roughly 1 in 10 individuals who get shingles will develop postherpetic neuralgia, which can cause long term nerve pain that can last for months to years.
- Shingles can cause blindness in rare instances
Who Should Get the Vaccine?
- Shingrix is recommended in adults age 50 and older.
Who Should Not Get the Vaccine?
- Have had an allergic reaction to any component of vaccine
- Currently have a temperature greater than 101.3 degrees
- Currently pregnant
- Patients with an acute episode of Herpes Zoster
- Serologic evidence of susceptibility to varicella
Administration
- Shingrix is a two-dose series to be given two to six months apart
- Shingrix should be injected intramuscularly
- If more than six months have passed, a second dose should be administered as soon as possible
- Shingrix Vaccine needs to be reconstituted and stored in a refrigerator if not administered immediately
Considerations for Patients With Past History of Zostavax
As of November 18, 2020, Zostavax is no longer available in the United States. There are no theoretical or data concerns to indicate that Shingrix would be less safe or effective if administered less than five years after a patient received Zostavax. Studies have shown waning effectiveness of Zostavax as time passes, leaving recipients with reduced protection against herpes zoster. You should wait at least 8 weeks after a patient received Zostavax to administer Shingrix.
