I love being a nurse for various reasons, one is the interactions I have with my patients and their families, of course the pleasure of caring for those in need and being a voice for the voiceless some days. As more and more is shared about the new Shingles vaccine, I wondered if it was really something I needed to promote with my patients. I have taken care of patients with shingles, but more prominent in my memory are those patients I took care of with post herpetic neuralgia. PHN, as it is called, is a common complication from shingles and it is terribly painful. Some people suffer with this complication for decades after having a shingles outbreak which is often worse than the initial outbreak. Knowing that, I decided to look into Shingrix, the two shot wonder vaccine that is somewhat impressive at this point.
Many millions of Americans, especially those older than 40, are susceptible to an eventual attack of shingles, caused by the same virus that causes chickenpox. Once this virus, varicella zoster, infects a person, it lies dormant for decades in nerve roots, ready to pounce when the immune system is weakened, by stress, medication, trauma or disease. One-third of Americans eventually get shingles, but the risk rises with age, and by age 85 half of adults will have had at least one outbreak of shingles. Half of adults older than 85 if a large number these days with people living longer.
In my research, I learned a few things. Like how much it costs, which seems like a lot when you are used to your insurance covering the older vaccine-Zostavax. The list price is $280 for the two-part shot without insurance. But if you have a prescription from your doctor, even if his office does not have it to administer, many pharmacies do. Pharmacists anywhere that stocks the vaccine can administer the vaccine. Certain Medicare Part D insurance covers it with a $40 co-pay for each part. Although, it can be a higher co-pay when given in a doctor’s office due to the cost of the visit incorporated in that.
Cost is definitely not a reason not to get it, with the success rate compared to the previous vaccine offered, it is a great vaccine. You just have to remember to come back and get the second shot 2-6 months later. Studies have indicated that more than 99 percent of Americans aged 40 and older have had chickenpox even if they don’t remember it. The Centers for Disease Control and Prevention recommends that people 50 and older get the new shingles vaccine whether or not they remember having had chickenpox as a child.
Those who never had chickenpox but did get the vaccine for it may also be susceptible to shingles because the vaccine contains a weakened live virus. However, the risk of shingles for those who had the chickenpox vaccine is much lower than for people who had the natural infection. I tell patients, that if you are uncertain about your disease or vaccine history, you can get a blood test to check for immunity to chickenpox, though the result does not distinguish between protection via the disease or the vaccine. So really, if the test result is positive, you would be wise to get the shingles vaccine because you could be harboring the live virus.
Shingles is a painful infection of a single sensory nerve on one side of the body that can occur almost anywhere but most commonly involves the torso or face. Initial symptoms of tingling or burning pain within days develop into a red bumpy rash and very painful blisters. The blisters heal in a week or two to form crusty scabs that eventually fall off. But for about 15 percent of people, shingles does not end there. Instead, it leaves them with deep, searing nerve pain — a condition called post herpetic neuralgia, or PHN — that can last for months or years and has no treatment or cure. More than half the cases of PHN affect people over 60. Other possible complications of shingles include pneumonia, hearing problems, blindness and encephalitis. Those are scary complications when you consider how easy getting a vaccine is.
Zostavax, the previous vaccine reduces the risk of shingles by 51 percent and of PHN by 67 percent. According to the C.D.C., Shingrix can protect 97 percent of people in their 50s and 60s and 91 percent of those in their 70s and 80s. It also reduces the risk of PHN by 86 percent, and it appears to last longer than Zostavax, which starts to lose its protection after three years.
Most possibly, Shingrix is better because of the inclusion of a substance called an adjuvant that boosts the body’s immune response to the vaccine. Another difference is that Zostavax contains a live, weakened virus, making it unsuitable for people with poor immunity, whereas Shingrix contains a nonliving virus particle and may eventually be approved for those with compromised immunity, who are especially susceptible to a severe case of shingles.
That all together makes me do a double take, “what the Shingrix”…may be worth the hype.