April 23, 2018
New Shingles Vaccine: Take Two
Be Well

New Shingles Vaccine: Take Two

by John Swartzberg, M.D.  

Shingles, medically called herpes zoster, is a miserable disease. It’s caused by the same virus (varicella-zoster) as chickenpox, and once you’ve had that disease, the virus lies dormant in nerve tissue and can reactivate as shingles decades later. People often describe the pain under and around the blistering rash as a penetrating, continuous burning or aching. Typically, the older you are, the longer it takes for the pain from the nerve damage to go away. In a significant number of people over 65, the pain persists for at least a year, and in some it never goes away. Though there are antiviral drugs that can shorten the duration and severity of shingles, treating it and its complications was always frustrating for me as a practicing physician.

So I was thrilled 12 years ago when a vaccine for shingles, called Zostavax, became available for people ages 60 and older. That first year, I rolled up my sleeve and got vaccinated. But research made it clear that Zostavax is just modestly effective: It reduces the risk of shingles only by about half, though it also reduces the severity and duration of those cases that do occur. What’s more, its protection starts to wane during the first few years and ends within about a decade, and it is less effective in people over 70. But, still, I encouraged everyone over 60 to get it, as did the UC Berkeley Wellness Letter and BerkeleyWellness.com.

Now that a new and improved shingles vaccine, Shingrix, has been approved by the FDA and by the CDC’s Advisory Committee on Immunization Practices, I’m even happier. When insurance (including my Medicare drug plan) starts to cover it, I’ll be in the front of the line to get it.

Because of its better protection, the CDC committee recommended Shingrix even for the 20 million Americans like me who already got the Zostavax shot and also for people who’ve previously had shingles (this was true for Zostavax). And the agency recommends it starting at age 50, not 60. In clinical trials, Shingrix, which is given in two doses two to six months apart, was about 98 percent effective for the first year and about 93 percent effective over four years. It’s not known how long the protection will last, but apparently much longer than Zostavax and, what’s most exciting, continuing past age 70, when people are at greatest risk. As far as I can tell, there’s no reason for anyone to get Zostavax anymore.

While Shingrix is very safe, it is more likely to cause short-term adverse reactions—including soreness at the injection site, flu-like symptoms, and muscle aches—than Zostavax. And unfortunately, like Zostavax (but unlike other adult vaccines), Shingrix is not covered by standard Medicare, but rather by Medicare Part D drug plans, which not everyone has. If you don’t have insurance coverage, the two Shingrix shots will cost a total of about $280. They’ll be worth every penny.

Also see Ask the Experts: Shingles and Ask the Experts: Catching Shingles?