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Thread: New shingles vaccine (Shingrix) recommended if you're over 50

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    Distinguished Community Member agate's Avatar
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    Default New shingles vaccine (Shingrix) recommended if you're over 50

    Even if you've already been vaccinated against shingles (herpes zoster) with Zostavax, it's recommended that people over 50 get the new Shingrix vaccine, which is given in two separate doses.

    If you look at the prescribing instructions, this new vaccine isn't indicated for anyone on an immunosuppressant.

    Also, this recommendation passed by a narrow margin, and the dissenters had concerns about long-term safety issues.

    From NEJM Journal Watch, October 26:





    CDC Advisers Recommend New Herpes Zoster Vaccine over Zostavax

    By Kelly Young

    Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

    The CDC's Advisory Committee on Immunization Practices voted on Wednesday to recommend use of the newly approved herpes zoster vaccine, Shingrix.

    The inactivated, recombinant subunit, two-dose vaccine was recommended in a 12-to-1 vote for adults aged 50 years and older. The other shingles vaccine on the market, Zostavax, is recommended only for those aged 60 and older.

    Here are some of the data presented to the committee:


    • Shingrix had 97% efficacy in those aged 50–69 and 91% efficacy in older adults.
    • Efficacy was at least 85% at 4 years post-vaccination in patients aged 70 and older.
    • Thirteen people in their 50s — and 11 in their 60s — would need to be vaccinated to prevent one zoster case.
    • Shingrix was more efficacious than Zostavax, particularly for older adults.

    The committee also voted to recommend Shingrix for patients who've previously received Zostavax, with at least 8 weeks between vaccines.

    The vote to recommend Shingrix over Zostavax narrowly passed by 8 to 7. Dissenters expressed concerns about supply, unknown long-term safety issues, and lack of head-to-head comparisons.

    ACIP meeting information (Free)
    Shingrix prescribing information (Free PDF)
    Background: HIV and ID Observations blog post about Shingrix (Free)
    Last edited by agate; 10-26-2017 at 09:55 AM.
    MS diagnosed 1980. Avonex 2002-2005. Copaxone 6/07 - 5/10.
    Member of this MS board since 2001.

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    Distinguished Community Member Sunshine's Avatar
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    I should talk to PCP about it. I too worry about unknown long term effects.

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    Distinguished Community Member agate's Avatar
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    More on the new shingles vaccine:

    http://www.berkeleywellness.com/self...53aea-87925361
    MS diagnosed 1980. Avonex 2002-2005. Copaxone 6/07 - 5/10.
    Member of this MS board since 2001.

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    Distinguished Community Member Cherie's Avatar
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    We had a lengthy discussion about this on the Multiple Sclerosis Nurses forum about 4 years ago when it was recommended that anyone with a negative zoster titer be given vaccine. The nurses said , almost as one, that they use one dose of chicken pox vaccine prior to patients going onto a disease modifying therapy (Gilenya and Lemtrada currently require this) (generally it is 2 doses of either chicken pox or shingles vaccine) because it is a live virus in both vaccines and if someone has been on any of the disease modifying therapies they could actually develop chicken pox or shingles from the vaccine and are at much higher risk of herpes encephalitis which is often deadly. They did not recommend anyone with MS and on a disease modifying therapy get the shingles vaccine. I had a negative titer when drawn to see about trying Gilenya but I had the chicken pox in 1958 (major!) and have also had shingles confirmed three times in adulthood. My neuro recommends I NOT get a shingles vaccine.

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    As long as I have been on the MS therapies I do not think that I would even consider it. My PCP is letting me keep a few Valtrex capsules, so if I think I am coming down with it I can start taking them right away and then contact her. But in case it is week-end or Holliday we thought I should have some on hand.
    Virginia

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    Distinguished Community Member Sunshine's Avatar
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    Quote Originally Posted by Virginia View Post
    This quote is hidden because you are ignoring this member. Show Quote
    As long as I have been on the MS therapies I do not think that I would even consider it. My PCP is letting me keep a few Valtrex capsules, so if I think I am coming down with it I can start taking them right away and then contact her. But in case it is week-end or Holliday we thought I should have some on hand.
    I have taken Valtrex daily for many years to prevent HSV2 outbreak since it triggers MS flare for me.

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    Distinguished Community Member Sunshine's Avatar
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    Quote Originally Posted by Cherie View Post
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    We had a lengthy discussion about this on the Multiple Sclerosis Nurses forum about 4 years ago when it was recommended that anyone with a negative zoster titer be given vaccine. The nurses said , almost as one, that they use one dose of chicken pox vaccine prior to patients going onto a disease modifying therapy (Gilenya and Lemtrada currently require this) (generally it is 2 doses of either chicken pox or shingles vaccine) because it is a live virus in both vaccines and if someone has been on any of the disease modifying therapies they could actually develop chicken pox or shingles from the vaccine and are at much higher risk of herpes encephalitis which is often deadly. They did not

    recommend anyone with MS and on a disease modifying therapy get the shingles vaccine. I had a negative titer when drawn to see about trying Gilenya but I had the chicken pox in 1958 (major!) and have also had shingles confirmed three times in adulthood. My neuro recommends I NOT get a shingles vaccine.
    Do they know if the new vaccine is a live or killed virus?

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    Quote Originally Posted by BBS1951 View Post
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    Do they know if the new vaccine is a live or killed virus?
    Shingrix is a non-live, subunit vaccine
    http://www.cnn.com/2017/10/25/health...ine/index.html

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  17. #9
    Distinguished Community Member Sunshine's Avatar
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    Hey suz Q— great to see you. How are you. I missed you :)

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