Shooting for that shingles shot

Despite ongoing shortages, Spokane doctors say it’s worth a shot to seek the newer Shingrix vaccine to prevent shingles if you’re 50 or older.

Shingles occurs when the chickenpox virus resurfaces in adulthood and causes skin rashes, blisters and possible long-term pain. About 1 in 3 U.S. residents will get shingles in their lifetime, and about 15 percent develop severe pain from a complication called postherpetic neuralgia.

In fall 2017, the FDA approved Shingrix. Maker GlaxoSmithKlin didn’t anticipate the high demand during 2018, and supplies got used up quickly. The Centers for Disease Control and Prevention says GSK is increasing production for the U.S. market this year, but supply gaps are expected throughout 2019.

“For people who have had chickenpox, or presumably have had chickenpox, and are 50 years and older, they can ask their providers about Shingrix,” said Dr. Joanna Breems, clinical assistant professor at the WSU Elson S. Floyd College of Medicine. “It seems to protect for a longer period of time.

The CDC says Shingrix as a two-shot series provides more than 90 percent protection against shingles and postherpetic neuralgia. That compares with a lower effectiveness rate for the older shingles vaccine, Zostavax, which reduces the risk of developing shingles by about 51 percent and postherpetic neuralgia by 67 percent, the CDC says.

The agency recommends Shingrix as the preferred shingles vaccine. Its protection after both doses lasts for about five years. Another difference is the new vaccine is inactivated, meaning it uses a dead version of the virus, while Zostavax contains a weakened live virus.

“Because Shingrix can be used in younger people, and because it’s not a live-virus vaccine, it was pretty well received by the medical community that quickly adopted it and used up initial supplies,” Breems said.

“I think the maker has set up a little bit of an allotment system and is working with different health systems and pharmacies so we can budget who gets it and prioritize. But it’s still in shortage and unclear when a full supply for the demand will be available.”

So depending on your medical clinic or pharmacy, you might get on a waiting list.

Breems, also a doctor at Spokane’s Mann-Grandstaff VA Medical Center, specializes in internal medicine and infectious disease. She said the single-shot Zostavax still can be given to healthy adults 60 and older, and it might be an option in some cases.

“If Shingrix was not available because of the shortage and they’re over 60 and at risk, they can still get the Zostavax. It’s still available and does work.”

If Shingrix is an option, make sure of availability for that second shot given two to six months after the first, said Dr. Gretchen LaSalle, a family medicine doctor at MultiCare Rockwood Quail Run clinic. Rockwood sets aside that second dose per patient, she said.

“About a million people a year develop shingles, so people are definitely aware of the new vaccine,” LaSalle said. “They see the commercials and talk to friends. It’s frustrating that it’s hard to find. I think the manufacturer underestimated how popular the vaccine would be, and it takes six to nine months to make the shingles vaccine.

“Hopefully, we will be catching up in the coming year, but right now we’re only getting it here and there and not getting a reliable schedule.”

Chickenpox and shingles are related because they are caused by the same virus, varicella zoster virus. After a person recovers from chickenpox, the virus stays dormant in the body and can reactivate years later and cause shingles.

The CDC offers a few other recommendations about shingles vaccination:

Zostavax may still be used to prevent shingles in healthy adults 60 years and older, such as if a person is allergic to Shingrix, prefers Zostavax, or requests immediate vaccination and Shingrix is unavailable.

There is no specific time length you need to wait after having shingles before you can receive Shingrix, but generally, you should make sure the shingles rash has gone away.

You can get Shingrix even if you don’t remember having had chickenpox in the past. Studies show that more than 99 percent of Americans 40 and older have had chickenpox, even if they don’t remember having the disease.

If you’re older than 70, the effectiveness of Shingrix drops slightly. In adults 50 to 69 getting two doses, Shingrix was 97 percent effective in preventing shingles; among adults 70 years and older, Shingrix was 91 percent effective.

You can get the Shingrix vaccine even if you have had shingles in the past, or received Zostavax. If you had Zostavax in the recent past, you should wait at least eight weeks before getting Shingrix.

“The CDC is recommending that even if you have had Zostavax previously, you can still get the Shingrix vaccine and maybe should because it is more effective,” Breems said.

The older you are, the higher your risk for shingles and the complications from it. That’s tied to how the immune system declines with aging, notably for people in their 60s, 70s and 80s, Breems added.

“It allows a latent virus like varicella to reactivate and cause shingles,” she said. “But I would say with the shortage going on, if somebody recently got the Zostavax, they probably are well protected for at least several years as compared with someone who has never been vaccinated.”

Pending research outcomes, Shingrix isn’t yet recommended for people who have suppressed immune systems, perhaps because of chemotherapy treatment or disease.

While Shingrix is covered by most health insurance plans, that’s another important question to clear up, LaSalle said. People ask her almost on a daily basis about the new vaccine, so she mentions confirming insurance coverage or out-of-pocket costs.

“I usually counsel people to check with their insurance company first,” LaSalle said. “It’s probably close to $300 for the two shots if you have to pay out of pocket.”

She agrees that patients should seek out the vaccine if they think they’re at risk.

While shingles causes a rash that can be quite painful, a bigger concern is the potential for a lasting impact.

“What we’re mostly worried about is a condition called postherpetic neuralgia. The pain of shingles can last. The rash usually goes away within a couple of weeks, but the nerve pain is terrible. We’re trying to prevent both shingles and the pain from happening.”

Breems echoed that prevention is better than hoping it doesn’t happen.

“What I counsel my patients particularly around postherpetic neuralgia is that shingles is very painful and for some people it can last well beyond after the sores of the skin are gone,” she said.

“The side effects of Shingrix are just like any vaccine. You can be a little sore for a day, or to be feeling a little under the weather two to three days is not unusual. The overall effects are limited.”