The Latest on Shingles Prevention

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Studies estimate that over 99% of Americans over 40 years of age have had chickenpox.1 This means that a significant number of individuals are at risk for developing shingles. Shingrix®, a vaccine indicated to prevent herpes zoster (shingles), was approved by the FDA in October 2017 and was made available to the public shortly thereafter.2

What is shingles?

Approximately 1 million Americans are affected by shingles each year and approximately 1 in every 3 people will develop shingles during their lifetime.3 Shingles occur as a result of a person having previously been infected with chickenpox. The virus that causes chickenpox (the varicella zoster virus) lays dormant in the body after an episode of chickenpox. The virus may be reactivated at any time to produce shingles. Several factors may influence whether or when this reactivation occurs, including increasing age, a weakened immune system from conditions such as cancer or HIV/AIDS, or immunosuppressive drugs (such as those used after transplant, or for autoimmune diseases).3

Children in the US receive vaccination for chickenpox as a part of the recommended Advisory Committee on Immunization Practices (ACIP) childhood vaccination series. Shingles can result in individuals who have had chickenpox infection, or in those who were vaccinated for chickenpox, although the risk for shingles is thought to be reduced in the latter group.4

Shingles generally presents as a painful rash on one side of the face or body. The rash commonly consists of blisters which may take several weeks to fully clear. It may also be preceded by tingling, pain, or itching in the area of the rash. Fever, headache, chills, and upset stomach may also occur during an episode of shingles. The most common long-term complication that can arise after an episode of shingles is postherpetic neuralgia (PHN), a type of severe pain that persists at the site of the rash.3



Hasn’t there been a vaccine for shingles already available?

Zostavax® (Herpes Zoster Live- Attenuated Vaccine [ZVL]) was approved in 2006 for the prevention of shingles. It is recommended by the Centers for Disease Control and Prevention (CDC) for those 60 years of age and older as a one-dose vaccination.  As a live attenuated vaccine, patients who are pregnant or have a weakened immune system cannot receive Zostavax®.1

What is this “new shingles vaccine”?

Shingrix® (recombinant zoster vaccine [RZV]) was approved in 2017 and indicated for individuals 50 years and older. It is a two-dose series, with the second dose given 2-6 months after the first. Studies for Shingrix® have shown it to be over 90% effective at preventing shingles and over 88% effective at preventing PHN.  This is largely improved over Zostavax®, which was estimated to be only 51% effective at preventing shingles and 67% effective at preventing PHN.1,2 

Who should get Shingrix®?

Since its approval, Shingrix® has become the preferred shingles vaccine recommended by ACIP at the CDC.  Shingrix® is recommended by the CDC for healthy adults 50 years of age and older. Shingrix® should be given even if you have had shingles, as it will lessen the chance for future reoccurrence. Patients who are unsure if they have had chickenpox, or those who previously received Zostavax® should still receive Shingrix®.  If you previously received Zostavax®, you should wait at least eight weeks before getting Shingrix®. If you have questions about whether you should receive Shingrix®, it is recommended to speak with your physician or pharmacist.1

I’m having trouble finding a pharmacy/doctor that has Shingrix®!

If you have tried to receive your first or second dose of Shingrix® in the past few months, you may have been told that your physician or pharmacy is out of stock. With the vaccine being recommended for a larger age group, requiring two doses, and exhibiting a much greater efficacy than Zostavax, the demand has been very high. The manufacturer of Shingrix, GlaxoSmithKline, has responded by increasing the distribution of the vaccine to manage the current out of stock issue.  A “SHINGRIX Vaccine Locator” is available at https://www.shingrix.com/shingles-vaccine-locator.html. However, patients should be warned that this locator is not up-to-date with current in-stock vaccines and only lists providers that have received shipments at some point in time. Therefore, it is recommended to first call your provider to see if they have Shingrix® in stock. Most providers and pharmacies have waiting lists. At current time, ACIP does not recommend restarting the series if the second dose is given after 6 months (due to delays in supply of the vaccine). Therefore, the patient may receive the second dose as soon as it becomes available.5

Final thoughts

Shingrix® is the newest vaccine available for shingles, which has demonstrated significant improvements in efficacy over the previous vaccine (Zostavax®). If you think you are eligible for this vaccine, call your physician or pharmacist to discuss further, and ask to put your name on a waiting list if necessary. 

References:

  1. Centers for Disease Control and Prevention. Shingles vaccination. Available at: https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html. Accessed 10/29/2018.
  1. Pharmacy Times. 4 things pharmacists should know about the Shingrix vaccine. Available at: https://www.pharmacytimes.com/contributor/jennifer-gershman-pharmd-cph/2018/01/4-things-pharmacists-should-know-about-the-shingrix-vaccine. Accessed 10/29/2018.
  1. Centers for Disease Control and Prevention. Shingles (herpes zoster). Available at:  https://www.cdc.gov/shingles/about/overview.html. Accessed 10/29/2018.
  1. Centers for Disease Control and Prevention. Chickenpox (varicella) vaccine safety. Available at: https://www.cdc.gov/vaccinesafety/vaccines/varicella-vaccine.html. Accessed 10/29/2018.
  1. Centers for Disease Control and Prevention. Frequently Asked Questions About Shingrix. Available at: https://www.cdc.gov/vaccines/vpd/shingles/hcp/shingrix/faqs.html. Accessed 10/29/2018.

This article was written by Abigail Will, a student pharmacist at Duquesne University School of Pharmacy, and reviewed by her faculty advisor, Dr. Jordan Covvey.

Abigail is currently a sixth-year pharmacy student at Duquesne University School of Pharmacy. She currently works as an intern at CVS Pharmacy. She is an active member of the professional pharmacy sorority Lambda Kappa Sigma, the American Pharmacist Association (APhA), and the American Society of Health-System Pharmacists (ASHP). She is looking forward to a career that is focused upon improving the health of her patients.

Dr. Covvey is an Assistant Professor in Pharmacy Administration at the Duquesne University School of Pharmacy. She earned her Doctor of Pharmacy from the University of Kentucky in 2010, and then completed residency training at Virginia Commonwealth University Health System in 2011. She subsequently passed her board certification in pharmacotherapy (BCPS) and was selected as a recipient of a Fulbright grant to complete a Doctor of Philosophy at the University of Strathclyde Institute of Pharmacy and Biomedical Sciences in Scotland. She currently teaches in the public and global health curriculum for pharmacy students at Duquesne, and her research area is in health outcomes and the utilization of healthcare data, such as electronic medical records, for quality improvement in clinical care.