Is Shingrix Worth the Poke?

• With vaccine fatigue gaining inertia during the pandemic, a patient may not be as compliant with other “standard” vaccines. 
• If one once had chickenpox, they now have a 1 in 3 chance of developing shingles if left unvaccinated. 
• Shingrix is widely available and has a high efficacy rate. This is not a vaccine you want to skip. 

Two and a half years have passed since the onset of Covid-19 and discussions on vaccinations have remained fervent. And we can forgive Americans for thinking that COVID-19, and in part, the seasonal flu vaccines were the important and prevalent vaccines available.  

The two vaccines have proven efficacious. Yet with vaccine fatigue gaining inertia within the long tail of the pandemic, a diverted patient focus may alter compliance with other noteworthy vaccines in vulnerable populations.  

To bridge a potential vaccination lag, nurses and medical professionals can help close the gap and foster vaccination compliance. How do we advance the issue? Patient education offers healthcare professionals the opportunity to discuss the potential of shingles, as well as its complications by re-prioritizing the vaccine on the pertinent population. 

Who Is at Risk?

Those with earlier chickenpox infections can develop shingles. Ninety-nine percent of people born before 1980 have had chickenpox. Providers encourage those over the age of 50 to receive the Shingrix vaccination. As well as age, immunosuppressed patients, including those receiving chemotherapy, steroids, or patients with HIV, are at a greater risk for shingles. 

What Is Chickenpox?

Most people have familiarity with chickenpox, a contagious disease caused by the varicella-zoster virus. Chickenpox causes an itchy blister (pox) rash. The vesicles develop, rupture, and release fluid. The raised papules progress from the chest, back, and face, spreading across the entire body with upwards of 250 blisters. 

Future healthcare providers may be less apt to see chickenpox thanks to GSK’s deployment of a vaccine in the U.S. in 1995. Though most cases are mild in children, they can be fatal.

Since vaccination began in the U.S., deaths from chickenpox have decreased 90% (Fewer than 20 people die from chickenpox a year), hospitalizations have decreased 84% and less than 350,000 people get chickenpox every year. 

I Have Had Chickenpox. Now What?

If you are unvaccinated, you have a 1 in 3 chance of developing shingles. Shingles are more than a rash. Yet individuals consider the infection to be a self-limiting irritation. But, a reactivation of the chickenpox (varicella-zoster virus) after decades of dormancy, causing a mild viral infection in younger individuals, can lead to serious sequelae and morbidity in our aging population.

For those aged 60 years or older, half a million will develop shingles. Half of those over the age of eighty had shingles. The specific trigger of viral reactivation is unknown. 

Shingles often present as a rash on the trunk (below the neck and above the waist) but can present in other locations. Frequent complications of shingles include pneumonia, encephalitis, blindness, postherpetic neuralgia, and death.

One in five people with shingles will develop postherpetic neuralgia, with those over fifty being at higher risk. Postherpetic neuralgia can affect quality of life and need prolonged pain management. Those with postherpetic neuralgia often make a full recovery within a year, but for specific individuals’ symptoms can last years, or worse, be permanent. 

The Shingrix Vaccine

GlaxoSmithKline (GSK) launched the Shingrix vaccine in 2017, with better-than-expected performance. The company experienced supply shortages because of higher-than-expected demand. Through March 2020, 17 million people had received the Shingrix® vaccine, becoming the preferred vaccination against shingles. 

Unlike the influenza vaccine, Shingrix is not a seasonal vaccination. Per recommendations, the vaccine is the current best method to prevent herpes zoster reactivation. Shingrix is a recombinant zoster vaccine (RZV) designed to provoke an immune response and proven safe and encouraged within the ongoing pandemic.  

No contraindications exist with the Shingrix vaccine in people recovered from COVID-19, as long active infection has subsided. 

Active shingles infection offers no herd protection, negating the need for factors of social distancing or risk of disease transmission. Shingrix, an inactive vaccine, needs to be considered in the immunosuppressed population.  

Individuals aged 19 and older who are immunodeficient or immunosuppressed secondary to disease or therapy are now eligible for the vaccine. Who should not get the vaccine? Pregnant individuals need to wait to get the Shingrix vaccine. The earlier vaccine, Zostavax was a live, weakened virus. Shingrix provides strong efficacy in individuals age 50 and older. 

I Recieved the Shingrix Vaccine. Now What?

Post Shingrix individuals experience mild-to-moderate arm pain, redness, and swelling. Reports of fatigue, headache, fever, and nausea have occurred. The side effects are less severe than a shingles outbreak. Protection from Shingrix requires two doses, separated by 2 to 6 months. 

Read More