Shingles, also known as herpes zoster, is a viral infection that affects the nerves and the surrounding skin. It is caused by the reactivation of the varicella-zoster virus, the same virus responsible for chickenpox. The symptoms of shingles often resemble those of chickenpox, including a high temperature or fever, headaches and a characteristic rash that can be painful and itchy.
While chickenpox typically occurs once in a lifetime, the virus responsible for it remains dormant in your body. If it becomes active again, it causes shingles rather than a repeat episode of chickenpox.
The risk of developing shingles increases with age, particularly if your immune system is weakened due to illness or medical procedures. It's important to note that you cannot contract shingles from someone with chickenpox or shingles, but you can transmit the chickenpox virus while experiencing a shingles outbreak.
Protecting yourself against shingles is possible with the shingles vaccine, which effectively reduces the risk of developing the condition. It's important to understand that the shingles vaccine is designed to safeguard against shingles and not chickenpox.
Shingrix Vaccine
At Gilbride Pharmacy, we provide shingles vaccination using Shingrix, a highly effective non-live vaccine manufactured by GSK. Shingrix is recommended for adults aged 50 and over to protect against shingles and post-herpetic neuralgia, which is long-lasting nerve pain following a shingles outbreak. It can also be administered to adults aged 18 and over who are at an increased risk of shingles.
Shingrix is an inactivated vaccine with a remarkable effectiveness rate of over 90% in preventing shingles infection and over 88% in preventing the debilitating complication of post-herpetic neuralgia. Unlike Zostavax (see below), Shingrix maintains its effectiveness regardless of age.
Inclusion Shingrix vaccination is indicated for all individuals over the age of 50 to prevent shingles infection. It works by enhancing the body's natural immunity to the varicella-zoster virus.
- Age Range: From 50 years of age
- Method of Administration: Intramuscular injection into the deltoid muscle of the upper arm
- Number of Doses: 2
- Interval between Doses: Ideally 2 months; 2nd dose can be given up to 6 months after the 1st dose
Protection Studies show that immunity persists for up to 4 years after completing the second dose of Shingrix. Research on the duration of protection beyond this timeframe is ongoing, and the need for booster doses remains uncertain.
Exclusions Shingrix should not be administered to:
- Individuals under 50 years of age
- Those with active shingles infection
- Individuals with a severe allergic reaction to a previous dose of Shingrix or any of its components
- Pregnant or breastfeeding women
- Individuals with an acute febrile illness (fever exceeding 38.5 degrees Celsius)
Side Effects Common side effects of Shingrix may include:
- Redness, swelling or pain at the injection site
- Swelling of the vaccinated limb (uncommon)
- Fatigue
- Muscle pain (myalgia)
- Headache
- Gastrointestinal symptoms such as nausea, vomiting and diarrhoea
- Fever
Zostavax Vaccine
The Zostavax shingles vaccine contains a weakened strain of the varicella-zoster virus. Based on a comprehensive study involving over 38,000 adults over 60 years old, it was found to reduce the risk of shingles by 51% and the risk of post-herpetic neuralgia by 67%. In individuals over 70, the reduction in risk was 38% and 66.8%, respectively.
If shingles still develops after vaccination, it is typically milder and of shorter duration than usual. Zostavax currently does not require a booster, suggesting that vaccination against shingles may offer lifelong protection.
Inclusions Zostavax can be administered to:
- Individuals over the age of 50 for shingles infection and post-herpetic neuralgia prevention
Vaccination Schedule
- Age: From 50 years
- Method of Administration: Intramuscular or subcutaneous injection into the deltoid
- Number of Doses: 1
- Booster Requirements: Unknown
The full duration of protection following Zostavax vaccination is not established, but recent data suggests protection for approximately 5 years, with booster requirements currently unknown.
Exclusions Zostavax should not be administered to:
- Individuals with active shingles infection
- Those with a suppressed immune system due to disease or medications
- Pregnant women
- Individuals with a history of a severe allergic reaction to the vaccine or any of its components
- Those with acute infection accompanied by a fever exceeding 38.5 degrees Celsius
- Individuals with active untreated tuberculosis
Special Considerations
- Zostavax is not a treatment for shingles infection or post-herpetic neuralgia but rather a preventive measure.
- It is advisable to wait one year after recovering from shingles before getting vaccinated, as a natural immune boost may affect vaccine effectiveness.
- If you experience two or more shingles episodes in a year, consultation with a specialist is recommended before vaccination.
- If you are taking antiviral treatments by mouth or have received injection treatments like Aciclovir, you should wait 48 hours after stopping the medication before receiving the vaccine, as these medications may reduce vaccine effectiveness. This does not apply to topical antivirals.
Pregnancy The shingles vaccine is contraindicated during pregnancy. It is also recommended to avoid pregnancy for one month after receiving the vaccination.
Breastfeeding The presence of the vaccine virus in breast milk is unknown, so it should not be given to breastfeeding mothers.
Side Effects Common side effects of Zostavax may include:
- Pain, redness, haematoma or skin hardening at the injection site
- Headaches and limb or joint pain
- Fever
- Rarely, a chickenpox-like illness with rash (occurs in less than 1 in 10,000 vaccinated individuals)
If you develop a shingles-like or chickenpox-like rash after vaccination, consult a doctor, and consider a swab test to check if the vaccine virus is responsible.
Risk of Transmission There are no documented cases in clinical trials of vaccine virus transmission to non-immune individuals. However, due to the higher vaccine virus dose compared to the chickenpox vaccine, and isolated cases of transmission following chickenpox vaccination, close contact should be avoided for 6 weeks with specific individuals, especially if a rash is present. These individuals include pregnant women without a history of chickenpox, newborns (0 to 28 days old) born to mothers without a history of chickenpox and individuals with compromised immune systems.
Interactions The shingles vaccine can be administered concurrently with:
- Diphtheria, Polio & Tetanus vaccine
- Influenza vaccine
- Pneumonia vaccine, including PPV-23
- All travel vaccines except Yellow Fever (see below)
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