Shingles vaccine

[agate]

Shingles and the shingles vaccines have been mentioned recently here. I just ran across this in NEJM Journal Watch (November 13), in the "Summary and Comment" section. It more or less says what the doctor just told me yesterday--that side effects from the vaccine can be bad. This article seems to be saying that the side effects might be so bad that people won't want that second shot they're supposed to have.

FREE FULL-TEXT ARTICLE SUMMARY AND COMMENT | GENERAL MEDICINE, INFECTIOUS DISEASES November 13, 2018 Is the New Zoster Vaccine Better Than the Old One?

Abigail Zuger, MD reviewing Tricco AC et al. BMJ 2018 Oct 25 A meta-analysis suggests more toxicity but better efficacy from the recombinant vaccine. The new two-dose recombinant zoster vaccine (RZV; Shingrix) has been greeted with enthusiasm because of its impressive efficacy rates during clinical trials and its presumed safety in immunocompromised patients (NEJM JW Infect Dis Jul 2015 and N Engl J Med 2015; 372:2087). Still, researchers have not yet assessed RZV's performance in clinical settings or directly compared its performance with that of the older live attenuated vaccine (LAV; Zostrix). To compare the two vaccines indirectly, researchers conducted a meta-analysis of 27 randomized and observational studies that involved more than 2 million patients (age, >50). The investigators were able to conclude that, for preventing both suspected and confirmed herpes zoster, the performance of RZV appeared to be statistically superior to that of the LAV. For preventing ophthalmic zoster, the performance of RZV also appeared to be statistically superior to that of LAV (although the authors cautioned that the data were too sparse to call this conclusion firm). Risk for developing postherpetic neuralgia was slightly lower with RZV than with LAV. Adverse events, both local and systemic, were significantly more likely with RZV than LAV, but neither vaccine affected mortality. Safety and efficacy in immunocompromised patients could not be compared because of inadequate data.

COMMENT RZV certainly looks good on paper, and in theory it should be a boon to immunocompromised patients who cannot receive live vaccines. On the other hand, the toxicity of RZV, (along with the requirement for a second dose of vaccine in patients who might have had a bad experience with the first dose) is likely to limit its real-world performance. A head-to-head trial to compare RZV with LAV is ongoing and should provide interesting data.

[Catdancer]

It's still worth dealing with the side effects. I'm assuming those only last a few days. Shingles side effects can last for the rest of your life!

[Virginia]

So true Cat!! I am still dealing with the side effects on my face. It drives me crazy. Also, I have to be on Gabapentin for a long time. That alone is enough to make me get the shot. Gabapentin is not a good drug to be on.

This is the first I have heard of really bad side effects. Everyone has told me that the only side effect they had was a sore arm for a couple of days. If that is true it is a small price to pay to get 90 percent effective vaccine. I have been lucky with the shingles. It has hurt, itched, burned and much more, but at least it did not blind me. In the beginning, when I was first diagnosed that was a strong possibility.

When I first went to my PCP she pulled up a picture on her computer screen and said I will show you someone with shingles of the same nerve where you have it. I looked over her shoulder at the computer screen and saw someone who had a scab that covered part of their eye. I said in a raised voice "Oh My God". She quickly hit the mouse and made it go away, when she saw how bad it upset me.

I have seen her two times and have to see her again. I have seen my ophthalmologist 3 times. He was concerned enough that each time I called he got me in within hours of my phone call.

Shingles is bad stuff!!!

[agate]

I'm definitely going to get the new shingles vaccine. I was told to keep calling the doctor's office to find out if they have it. Given the side-effects possibility, though, I'm not so terribly disappointed that I'm having to postpone it a while longer.

The doctor mentioned a sore arm, and I said I was very used to very sore arms from flu shots. She said this would be far worse than any flu shot sore arm.

That's hard for me to imagine because some flu shots have made my arm so sore I couldn't lie on it for weeks, and there was sometimes a feverish, aching-all-over feeling to go with it. Tylenol helped though.

And yes, a few side effects are nothing compared to real flu--or shingles.

[Howie]

I won't be getting either vaccine, but I wont explain why because so many here have. We each have to take care of ourselves the way that you choose.

[SuzE-Q]

Does anyone know how long it's good for? And are people just re-immunized once it's no longer effective?

I want to get it, but I want to understand this in case there's a "best time" to get it.

Howie, why don't you want to get it? (LOL, just teasing you )

[agate]

From the CDC Website:

Two doses of Shingrix is more than 90% effective at preventing shingles and PHN. Protection stays above 85% for at least the first four years after you get vaccinated.

https://www.cdc.gov/vaccines/vpd/shi...rix/index.html

This new improved shingles vaccine just came out only a few years ago. It sounds as if they don't know whether it will be effective indefinitely but they know it loses some effectiveness at 4 years.

[SuzE-Q]

Thanks, agate!

I'm interested in the "longer than 4 years" data, though. Not sure I'd want to get it every 4 years.

I really don't like that we don't have better information on this.

[Virginia]

Suze-Q even after 4 years the effects of the vaccine are better than the old vaccine which my Neurologist would not approve because it was a live virus. This one is not. You do not have to have it every 4 years. I think they recommend a longer period of time because it just cuts down on the effectiveness, but not cuts out.

After my experience I would gladly take this vaccine every 4 years if that is what was called for to prevent this happening again.

My husband had shingles around one side of his middle. He was only in his 30s. He said after that that he had never had pain that bad in all his life. He continued to suffer the effects of shingles for years. He was in the military stationed at the Pentagon at the time. He was out of work for a long time. They had to wear dress uniforms or suits with ties at the Pentagon. When he finally returned to work they authorized him to wear a nice sport shirt and slacks for quite awhile. He could not stand a dress uniform touching him, nor could he stand a dress shirt and coat.

I had a female Primary Care Physician a few years ago. She had shingles and she was only in her early 40s. She had it going down her back. She was VERY concerned about me after that because she said it would go very hard with me. She was out of work for 3 full weeks and then tried to return for a few hours a week for several weeks just to take care of some emergencies. This is the Doctor who started me on the road to keeping Valtrex in case I came down with it on a Holiday or weekend when I otherwise could not see a Doctor right away.

A year before this episode I had asked my now PCP to give me a Rx just in case. Much to my surprise she went along with me. I came down on Labor Day morning. I went that afternoon to two Emergency Medical facilities. Both were closed for the Holiday (so much for 24 hour care). I started on Valtrex that afternoon and got two in that night and one the next morning before I saw my Doctor at 9:40. She wrote a new Rx for Valtrex because she was concerned that the old one might have lost some of it's effectiveness.

This is the reason I have done as well as I have and that has not been great. It may very well have saved my eyesight. She has written me another Rx until I can get the vaccine. She said this is not the usual protocol, however she grinned and wrote it anyway.

Now maybe you understand why I advocate for the vaccine.

[SuzE-Q]

Just talked to ny pcp and we're planning on the vaccine in the next couple weeks, just have to clear my schedule to have time that I can be homebound for a week , if I need to, since I reacted to pneumonia vaccine due to increased temp caused by it. So, I'll just expect to be sick for a few days then.

Virginia, thanks for the cautionary advice! I have had an old valtrex prescription in my medicine cabinet too, but it's probably lost all efficacy if your doc was worried about yours after only being a year old. Mine is a number of years old now, I think.

Agate, my doctor's office had shingrix brochures, it says clearly in them that they have no data past 4 years. Or they're not reporting it anyway. Guess I'll just be in the same boat as a lot of other people then. My concern was ensuring I had coverage at times I'll be more at risk, I didn't want to get it early if I might not be able to be protected later on by it, or another one.