Let’s go way back to your childhood.  Remember having chicken pox?  Sitting in the bathtub for relief, and then mom rubbing orange lotion all over your body?  Or even chicken pox parties?  Wild!  Well if you thought the chicken pox was gone, out of your body, you were terribly wrong.  Some of the chicken pox virus set up shop inside the nerve cells than run along your spinal cord.  There, the virus remains inactive, dormant, and very happy for many decades.  Then, one day, out of boredom, either because you’re ill, or tired, or your immune system is altered, or for no identifiable reason at all, the chicken pox virus wakes up and says “hey guys, let’s have a wild party today!”  They wake up, they become active, and like crazy unsupervised teenagers, they leave the nerve cell, and travel along the nerve fiber all the way to its end.  Guess where that is.  Yup. Your skin!  The virus then wreaks havoc in your skin, producing tingling, pain, blisters, and redness. We call that shingles.

 

Shingles is very common.  About one third of us will develop shingles at some point in our lives.  If you’re lucky enough to become a thorough octogenarian (live to 85), then the chance that you have, or will develop shingles at some point in your life approaches fifty percent.  That’s a lot of shingles!  So, that means, if you get the vaccine, there is a very high chance that it will improve your life. (That can’t be said for most of the other vaccines that we receive in our lifetime.)

We want to prevent shingles. Why?  Because you’ll have a rash for a week or two?  Because your skin may be tender for a week or two?  Trick question!  Did I get you?  No that’s not why.  Here’s the real answer:  We want to prevent shingles so that you don’t get ‘Post-herpetic neuralgia’ a chronic pain syndrome which can develop after the rash heals.  If shingles were as simple as an uncomfortable rash for two weeks, then perhaps we wouldn’t need a vaccine.  The main reason to prevent the rash, is to prevent the chance that you will develop this awful chronic pain syndrome.

The original shingles vaccine is called Zostavax.  The new vaccine, approved by the FDA last fall, is called Shingrix.  Shingrix is an amazingly effictive vaccine which prevents shingles and post-herpetic neuralgia.  It is recommended by the FDA for just about everybody fifty and older.  You should get one.

What is amazing about the new shingles vaccine?

Shingrix is over 90% effective at preventing shingles.  This is as good as a vaccine gets.  In the phase 3 clinical trials, about fifteen thousand people received the vaccine, and an equal number received a placebo.  During the follow-up period, only thirty people in the vaccine group developed shingles, but a whopping five hundred people in the placebo group developed shingles!

The story is even more amazing for post-herpetic neuralgia.  For those between fifty and seventy years old who received the vaccine, guess how many people got post-herpetic neuralgia.  ZERO!  A GOOSE EGG!

What is ugly about the shingles vaccine?

Okay.  Here’s the part of this blog that I didn’t want to write.  Some critical readers may even feel that I should downplay (not lie) about the adverse effects, but I want to be honest.  The incidence of side effects from the vaccine is very high.  Depending on age, approximately 70 to 90% develop some side effect. That’s a lot.  The likelihood that you will develop pain, redness, or swelling at the injection site is between 25 and 40%.  Headache – 30-50%.  Fever 15-30%.   There is a caveat though, some news to mitigate this a bit.  The majority of patients report the side effect to be mild, and the duration only 2 to 3 days.

So should I get the new vaccine?

Yes!  Just be prepared for the reality that you may develop pain, swelling, or redness at the injection site, and you may even develop a headache, fever, or other side effect.  Don’t have the vaccine right before your big tennis game, your golf outing, or your daughter’s wedding.  Remember, a couple of days of mild discomfort in your arm beats the heck out of lifelong pain from shingles.

Also, your doctor, nurse practitioner, pharmacist, or other vaccine provider should diligently screen you for contraindications to the vaccine.  For example, those with compromised immune systems should not receive it, nor should those with an allergy to its ingredients.  It hasn’t been studied in pregnant or breastfeeding women, and there are a few other populations that likewise should not receive it.

That’s everything you need to know about Shingrix I suppose.

Off to give some vaccines!

Dr. Van Dam