If you're a healthy adult age 50 or above, you should get vaccinated against shingles, medical experts say. The vaccine they recommend is Shingrix. The issue is whether it's available.
Shingrix -- a relative newcomer to the vaccine market -- is in high demand. With its more than 90 percent success in preventing shingles, older adults are impatient to roll up their sleeves. However, Shingrix shortages and wait lists have been going on for months. Now, pharmacists say Shingrix supplies are being replenished.
Here's why seniors are so eager to get the Shingrix vaccine -- despite reports of injection discomfort -- and why experts strongly recommend taking steps to protect yourself from shingles.
Nearly one in three people in the U.S. develops shingles at some point, according to the Centers for Disease Control and Prevention. Pain, rash, itching and first fluid-filled, then eventually crusting blisters, are hallmark shingles symptoms. Some people become hypersensitive to touch or light, and experience headaches and fevers.
Shingles pain tends to come first, ranging from mild to intense. Pain is usually most severe in the first one or two weeks, sometimes making it difficult to work, sleep and perform daily tasks. People may need prescription pain medicine when shingles is at its worst.
The shingles rash of reddish-purple clusters tends to show up on one side of the back, chest or abdomen. Typically, shingles looks like stripes across the skin. This pattern corresponds to areas known as dermatomes. A dermatome is an isolated skin section that receives sensation from a single nerve. Shingles usually affects one or a few adjacent dermatomes.
The appearance of shingles can be distressing to those who have it, particularly when a bright rash or crusting lesions occur on one side of the forehead or surrounding an eye. Shingles can lead to permanent scarring.
To prevent shingles, healthy adults ages 50 and older should get two doses of Shingrix, spaced two to six months apart, according to the CDC.
The Food and Drug Administration approved Shingrix in late 2017. Shingrix is one of two approved shingles vaccines. Zostavax, available since 2006, is the other.
U.S. health officials support Shingrix over Zostavax. "Shingrix provides strong protection against shingles and (postherpetic neuropathy). Shingrix is the preferred vaccine," the CDC website states.
Dr. Barbara Yawn, an adjunct professor in the department of family and community health at the University of Minnesota, is a shingles expert. "Protection from developing shingles is much higher with Shingrix than it is with Zostavax," she says.
Zostavax effectiveness is about 66 percent, Yawn says, and protection appears to wane fairly quickly, over three to five years. "With Shingrix, we're talking in the 90 percent protection -- 92, 94 or 96 percent -- depending on which one of the studies you read. But really, (there are) amazingly high levels of protection against shingles," she says. "And the duration of protection appears to be considerably longer with Shingrix than with Zostavax."
Yawn has served as a consultant both for the pharmaceutical companies that make Zostavax (Merck) and Shingrix (GlaxoSmithKline).
During most of 2018, demand for Shingrix was higher than manufacturers expected, says Heather Free, a practicing pharmacist and spokesperson for the American Pharmacists Association. Shingrix ran out in many pharmacies and doctors' offices, and Zostavax supplies were sometimes depleted as well.
Some people who wanted to start the Shingrix series, or who had only received the first dose, had to be put on waiting lists. "The pharmacies have been doing their due diligence to call these patients and try to get them in, especially if it's for the second dose," Free says. Even if you return for your second dose past the ideal time frame, she says, it still has a potent effect.
Pharmacies are back to receiving Shingrix supplies. "The end of 2018 is when we started seeing shipments going to various large chains," Free says. "They are pretty well caught up." The challenge, she adds, is getting the word out: If you didn't get your second dose, or still want to start the shingles vaccine series, now is a good time to check with your local pharmacy or health care provider.
If you're having difficulty locating a source of Shingrix, the CDC site provides a link to the interactive Vaccine Finder.
Paying for Shingrix
Your private health insurance may cover Shingrix. However, coverage might not apply for plan enrollees younger than 60. Check for individual coverage details.
Medicare Part D covers commercially available vaccines like shingles shots, according to Medicare.gov. Because Medicare Part D encompasses prescription drugs rather than preventive services, people who haven't met their deductible may have to pay some or all of the roughly $280 cost to receive both shots.
Shingrix is a non-live, recombinant vaccine that is manufactured using only a specific piece of protein from the shingles-related virus. That's different than Zostavax, which is a live vaccine.
Storage and administration differences between Shingrix and Zostavax led to initial confusion among some vaccine providers like doctors' offices. Shingrix, unlike Zostavax, should be refrigerated rather than frozen when stored. You should get the Shingrix vaccine in the muscle of your upper arm. Zostavax is injected just under the skin, or subcutaneously.
Shingrix Side Effects
Shingrix is a safe vaccine, according to the CDC, but it has temporary side effects, with most recipients complaining of a sore arm with mild to moderate pain at the injection site.
In addition to redness and swelling at the injection site that can come with either vaccine,, some people receiving Shingrix have reported generalized muscle pain, tiredness, headache, fever, shivering, nausea or stomach pain lasting two or three days after the injection. Symptoms can occur after the first, second or both vaccine doses.
"There's no question in anyone's mind, and the makers clearly state, that this is a vaccination that is more uncomfortable than some other vaccinations," Yawn says. "But we're talking 24, 36 or maybe 48 hours of a red, uncomfortable arm. Most people do not find that they can't continue their usual activities. It's uncomfortable but it's not debilitating."
What Causes Shingles?
The varicella-zoster virus causes chickenpox when it first infects the body, usually in childhood. Later, the virus lies dormant in the body, often for decades. If the virus is reactivated in adulthood, it causes herpes zoster, commonly known as shingles.
With the early, initial infection, the body's immune system launches a response to clear varicella-zoster virus from cells and prevent the virus from duplicating. This immunity lasts long after chickenpox is gone. Unfortunately, however, the body's immunity tends to wane as people age, which can pave the way for the virus to reactivate in the form of shingles. That's what makes vaccination so important.
Is shingles contagious? Not exactly. Someone with shingles in the blistering stages can spread the varicella-zoster virus to someone who has never had chickenpox or the chickenpox vaccine. That person might then get chickenpox -- not shingles. People with shingles should avoid direct contact with people with weakened immune systems, pregnant women and newborn babies.
Shingles pain can persist well after skin lesions have healed. Chronic, severe pain that lasts weeks, months or years after shingles is called postherpetic neuralgia. Up to 15 percent of people with shingles develop postherpetic neuralgia, according to the CDC, and the risk increases with age.
Pain is often described as aching, burning, stabbing or shooting. Discomfort may also involve excess sensitivity to temperature changes and touch, itching and numbness.
With shingles involving the eye, vision loss is a possible complication. In rare cases, shingles can lead to blindness. Hearing problems may also occur. Muscle weakness or paralysis are possible complications. Encephalitis, or inflammation of the brain, is a rare long-term complication.
Inability to work, exercise or socialize because of continual pain takes a physical and emotional toll. People with postherpetic neuralgia may develop depression or other signs of mental distress.
Shingles, Cancer and Chronic Diseases
A recent study encompassing more than 240,000 Australian adults, average age 62, followed them over a decade to look at the relationships among cancer diagnosis, treatment and shingles infection risk. The major finding was that cancer patients are more vulnerable to shingles, says Yawn, who wrote a commentary accompanying the study, also published Dec. 13, 2018, in the Journal of Infectious Diseases.
"People with malignancies are at increased risk of not only just getting shingles, but of getting more severe shingles and longer-lasting shingles," Yawn says. "They are more likely to get the complications of shingles, like the postherpetic lesions and some of the neuropathies." While people with cancer aren't more likely than others to have eye involvement with shingles, she says, eye problems tend to be more prolonged when they do occur.
Certain chronic conditions can also increase the risk of shingles. For instance, people with chronic obstructive pulmonary disease are more vulnerable, says Yawn, who is also the chief science officer for the COPD Foundation. "Many people with shingles cough daily, multiple times," Yawn says. "Can you imagine coughing and having shingles on your trunk? We're talking lots of pain and increased shortness of breath."
The shingles vaccine itself doesn't appear to pose any additional health risks or injection-related discomfort for patients with serious medical conditions, including auto-immune diseases, Yawn says. "There is not any evidence of that," she says, "That's obviously been studied very closely and there does not seem to be a concern."