Effectiveness of shingles vaccine

What Everyone Should Know about Zostavax

Your risk of shingles and postherpetic neuralgia (PHN) increases as you get older. CDC recommends that people 60 years old and older get shingles vaccine (Zostavax®) to prevent shingles and PHN. Shingrix (recombinant zoster vaccine) is the preferred vaccine, over Zostavax® (zoster vaccine live), a shingles vaccine in use since 2006. Zostavax may still be used to prevent shingles in healthy adults 60 years and older. For example, you could use Zostavax if a person is allergic to Shingrix, prefers Zostavax, or requests immediate vaccination and Shingrix is unavailable.

Zostavax (zoster vaccine live) was licensed by the FDA in 2006. This vaccine reduces the risk of developing shingles by 51% and PHN by 67%. It is given in one dose as a shot, and can be given in a doctor’s office or pharmacy.

Who Should Get Shingles Vaccine?

People 60 years of age or older should get shingles vaccine (Zostavax). They should get the vaccine whether or not they recall having had chickenpox, which is caused by the same virus as shingles. Studies show that more than 99% of Americans aged 40 and older have had chickenpox, even if they don’t remember getting the disease. There is no maximum age for getting shingles vaccine.

Two vaccines are licensed and recommended to prevent shingles in the U.S.. Zoster vaccine live (ZVL, Zostavax) has been in use since 2006. Recombinant zoster vaccine (RZV, Shingrix), has been in use since 2017 and is recommended by ACIP as the preferred shingles vaccine.

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Even if you have had shingles, you can still receive shingles vaccine to help prevent future occurrences of the disease. There is no specific length of time you must wait after having shingles before receiving shingles vaccine, but generally you should make sure the shingles rash has disappeared before getting vaccinated. The decision on when to get vaccinated should be made with your healthcare provider.

Zostavax is approved by the Food and Drug Administrationexternal icon for people aged 50 years and older. However, CDC does not have a recommendation for routine use of Zostavax in people 50 through 59 years old. Protection from this shingles vaccine lasts about 5 years, so adults vaccinated before they are 60 years old might not be protected later in life when the risk for shingles and its complications are greatest. Adults 50 through 59 years who have questions about shingles vaccine should discuss the risks and benefits with a healthcare provider.

Talk with your healthcare provider if you have questions about shingles vaccine. Shingles vaccine is available in doctor’s offices and pharmacies. To find doctor’s offices or pharmacies near you that offer the vaccine, visit Zostavaxexternal icon or HealthMap Vaccine Finderexternal icon.

Who Should Not Get Shingles Vaccine?

Some people should not get shingles vaccine (Zostavax):

Vaccine for Those 60 Years and Older

The Shingles Prevention Study involved individuals age 60 years and older and found that Zostavax significantly reduced disease in this age group. The vaccine is currently recommended for persons 60 years of age and older.

  • A person who has ever had a life-threatening or severe allergic reaction to gelatin, the antibiotic neomycin, or any other component of shingles vaccine. Tell your doctor if you have any severe allergies.
  • A person who has a weakened immune system because of:
    • HIV/AIDS or another disease that affects the immune system,
    • treatment with drugs that affect the immune system, such as steroids,
    • cancer treatment such as radiation or chemotherapy, or
    • cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma.
  • Women who are or might be pregnant. Women should not become pregnant until at least 4 weeks after getting shingles vaccine.

Someone with a minor acute illness, such as a cold, may be vaccinated. But anyone with a moderate or severe acute illness should usually wait until they recover before getting the vaccine. This includes anyone with a temperature of 101.3°F or higher.

This information was taken from the Shingles Vaccine Information Statement (VIS) dated 10/06/2009.

What Are the Types of Shingles Vaccine?

Zostavax® was licensed by the FDA in 2006 for use in the United States. It is given in one dose as a shot, and can be given in a doctor’s office or pharmacy.

To find doctor’s offices or pharmacies near you that offer the vaccine, visit Zostavaxexternal icon or HealthMap Vaccine Finderexternal icon.

For more information about the vaccine, visit Zostavax®. pdf iconexternal icon

How Well Does Shingles Vaccine Work?

Zostavax®, the shingles vaccine, reduced the risk of shingles by 51% and the risk of post-herpetic neuralgia by 67% based on a large study of more than 38,000 adults aged 60 years or older. Protection from shingles vaccine lasts about 5 years.

While the vaccine was most effective in people 60 through 69 years old, it also provides some protection for people 70 years old and older.

Adults vaccinated before age 60 years might not be protected later in life when the risk for shingles and its complications are greatest.

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What Are the Possible Side Effects of Shingles Vaccine?

A vaccine, like any medicine, could possibly cause serious problems, such as severe allergic reactions. However, the risk of a vaccine causing serious harm, or death, is extremely small.

No serious problems have been identified with shingles vaccine.

Mild side effects of shingles vaccine:

  • Redness, soreness, swelling, or itching at the site of the injection (about 1 person in 3).
  • Headache (about 1 person in 70).

It is safe to be around infants and young children, pregnant women, or people with weakened immune systems after you get the shingles vaccine. There is no documentation of a person getting chickenpox from someone who has received the shingles vaccine (which contains varicella zoster virus).

Some people who get the shingles vaccine will develop a chickenpox-like rash near the place where they were vaccinated. As a precaution, this rash should be covered until it disappears.

Like all vaccines, shingles vaccine is being closely monitored for unusual or severe problems by CDC and FDA.

Signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and weakness. These would start a few minutes to a few hours after the vaccination. If you have a severe allergic reaction or other emergency that can’t wait, call 9-1-1 or get the person to the nearest hospital. Otherwise, call your doctor.

Afterward, the reaction should be reported to the Vaccine Adverse Event Reporting System (VAERS). Your doctor might file this report, or you can do it yourself through the VAERS websiteexternal icon, or by calling 1-800-822-7967.

The shingles vaccine does not contain thimerosal (a preservative containing mercury).

This information was taken directly from the Shingles Vaccine Information Statement (VIS) dated 10/06/2009.

For more information on possible side effects from vaccination, visit CDC’s Possible Side Effects from Vaccines page.

How Can I Pay For Shingles Vaccine?

There are several ways shingles vaccine may be paid for:

Medicare

  • Medicare Part D plans cover the shingles vaccine, but there may be a cost to you depending on your plan. There may be a copay for the vaccine, or you may need to pay in full then get reimbursed for a certain amount.
  • Medicare Part B does not cover the shingles vaccine.

Medicaid

  • Medicaid may or may not cover the vaccine. Contact your insurer to find out.

Private health insurance

  • Most private health insurance plans cover the vaccine for people 60 years of age or older. Some plans cover the vaccine for people 50 through 59 years of age.

Vaccine assistance programs

  • Some pharmaceutical companies provide vaccines to eligible adults who cannot afford them. See more information on the patient assistance programexternal icon that includes Zostavax® (shingles vaccine).

If you do not currently have health insurance, learn more about affordable health coverage optionsexternal icon.

To find doctor’s offices or pharmacies near you that offer the vaccine, visit Zostavaxexternal icon or HealthMap Vaccine Finderexternal icon

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Related Pages

  • Shingles Vaccine Information Statement
    In English | Other languagesexternal icon
  • Shingles information on vaccines.govexternal icon
  • Pictures of Shingles
    Warning: Some of these photos are graphic.

You’ve likely heard there is a new shingles vaccine, Shingrix, that is more effective than our existing vaccine Zostavax. However, as recently as June 2018, Shingrix was in short supply, and by estimates from manufacturer GlaxoSmithKline, order limits and shipping delays will continue through 2018. Shipments of Shingrix are making their way to clinics, but you might wonder whether it’s worth the wait or if you should just go with Zostavax.

Let’s talk about it.

Shingles is common, affecting one in three adults. It causes painful blisters, and in 20% of folks who get them, an even worse complication known as “postherpetic neuralgia” that consists of chronic shooting nerve pain can occur.

With any new vaccine, there are always questions and concerns: cost, side effects, and when or if you should get it. Given this year’s Shingrix shortage, there are also questions about whether Zostavax is good enough.

Is Shingrix THAT much better than Zostavax?

Yes. Shingrix is 97% effective at preventing herpes zoster (shingles) in folks over 50 whereas the Zostavax shot is 50-64% effective in preventing shingles in those 50-70 and even lower for those over 70. Shingrix also stays effective for longer.

When should I get the shingles vaccine?

The CDC (Centers for Disease Control and Prevention) recommends that people 50 years of age and older receive Shingrix in a series of two vaccines. Zostavax can be given to those 50 years of age and over with a medical condition or anyone 60 years of age and older.

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What if I’m not sure if I’ve had chickenpox?

First, know that almost everyone born before 1980 tests positive for exposure to Varicella zoster, the virus that causes chickenpox and reactivates later to cause shingles. All published recommendations suggest that whether you remember having chickenpox or not, you should receive the Shingles vaccine, either Zostavax or Shingrix.

Are side effects of Shingrix and Zostavax different?

There is where the issue arises. Yes, the side effects are quite a bit different, and I’ve been seeing this in my patients who get Shingrix.

These are adverse reactions of Zostavax (given as a single vaccine):

These are adverse reactions of Shingrix (given a series of two vaccines):

To sum it up, Shingrix is a much better vaccine than Zostavax, but with a twist. That twist? Shingrix has many more adverse reactions. This means we need to keep an eye on this vaccine because it is still new. If you get Shingrix, stay alert to any adverse effects you may feel; a 500 mg acetaminophen (Tylenol) after the shot has helped for some of my patients.

Dr. O

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  • A reduced immune response to ZOSTAVAX was observed in individuals who received concurrent administration of PNEUMOVAX®23 (Pneumococcal Vaccine Polyvalent) and ZOSTAVAX compared with individuals who received these vaccines 4 weeks apart. Consider administration of the two vaccines separated by at least 4 weeks.

    Serious vaccine-related adverse reactions that have occurred following vaccination with ZOSTAVAX include asthma exacerbation and polymyalgia rheumatica. Other serious adverse events reported following vaccination with ZOSTAVAX include cardiovascular events (congestive heart failure, pulmonary edema). Common adverse reactions occurring in ≥1% of vaccinated individuals during clinical trials include injection-site reactions (erythema, pain/tenderness, swelling, hematoma, pruritus, warmth) and headache.

    Transmission of vaccine virus may occur between vaccinees and susceptible contacts.

    Deferral should be considered in acute illness (for example, in the presence of fever) or in patients with active untreated tuberculosis.

    Before administering ZOSTAVAX® (Zoster Vaccine Live), please read the accompanying Prescribing Information. The Patient Information also is available.

    Why the latest shingles vaccine is more than 90 percent effective

    The trial included more than 15,000 participants across 18 countries in Europe, North America, Latin America, Asia and Australia. Participants in the trial received two doses of the vaccine, with the doses given two months apart.

    Lead researcher Professor Tony Cunningham from the Westmead Institute for Medical Research said the study shows that the vaccine stimulates production of a specific immune memory cell (CD4 T cells), generating a strong and sustained protection against the virus.

    “The body has two types of immunity: protein antibodies and white blood cells known as T cells. As the virus circulates around the body, antibodies block it from entering cells. But when the virus does get into cells your T cells try to kill those infected cells.

    “Our research shows that the vaccine stimulates your immune system to produce more antibodies and it generates a 24-fold increase in T cells. This is 12 times higher than other less effective shingles vaccines.

    The research, published in the Journal of Infectious Diseases, shows that Shingrix offers protection for up to four years, but Professor Cunningham believes it will last much longer.

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    “The second dose of the vaccine is important to ensure long-term protection,” Professor Cunningham said.

    “The efficacy is approximately 90% for all age groups — even for those over 70 years of age.

    “This is quite remarkable because there are no other vaccines that perform nearly so well for people in their 70s and their 80s. We are seeing results comparable to those of childhood vaccinations.

    “What’s particularly exciting, though, is that 90% of recipients had an increased immune response sustained across the 3-year duration of the study.

    “We anticipate that this protection will actually last much, much longer. We are now measuring the efficacy of the vaccine over the next 10 years and are very optimistic about the results,” he said.

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    Shingrix is different from most other vaccines. Many vaccines are made from a weakened form of the virus, but Shingrix is made from just a single protein — known as glycoprotein E — that comes from the outer shell of the herpes zoster virus.

    The vaccine also contains an adjuvant — a substance that helps your body fight off the virus. It is the first shingles vaccine to combine a non-live antigen with a specifically designed adjuvant.

    Shingles is a viral infection, caused by the herpes zoster virus — the same virus that causes chickenpox. The incidence of shingles increases as we get older, because the body’s natural immunity declines.

    “When people reach their 50s and 60s, T cell immunity declines allowing shingles to strike. That’s why our adult vaccine is directed specifically at T cell immunity,” Professor Cunningham said.

    Most Australian adults have been infected with the herpes zoster virus and are at risk of shingles, even if they do not remember having chicken pox. By age 85, approximately 50% of the population will develop shingles. Vaccination is the only way to protect against shingles.

    New shingles vaccine is highly effective, long-lasting — and in short supply


    The new shingles vaccine, Shingrix, made by GlaxoSmithKline, is the preferred vaccine for shingles, which is caused by the chickenpox virus. (GlaxoSmithKline/AP) By Lena H. Sun Lena H. Sun National reporter focusing on health June 20, 2018

    A national shortage of a new and more effective vaccine to protect adults older than 50 from the painful rash known as shingles is prompting retailers to create waiting lists and the manufacturer to delay additional promotion.

    Shingrix, licensed in the fall by the Food and Drug Administration, is the preferred vaccine recommended by the Centers for Disease Control and Prevention for protection from a disease that affects 1 in 3 adults in their lifetime. By recommending that healthy adults start receiving the vaccine at age 50 — a decade earlier than the previous recommendation — federal health officials are hoping that millions more people will be protected from shingles, which is caused by the reactivation of the same virus that causes chickenpox.

    One of the most common complications of shingles in those 50 and older is nerve pain that can last for months or even years after a shingles rash goes away and can be so debilitating that the touch of clothing on skin can cause searing pain. It has no treatment or cure.

    The new two-dose vaccine provides greater protection — more than 90 percent — and lasts longer than the older single-shot vaccine that has been in use since 2006. The CDC recommends that people should get the new vaccine if they have had shingles, have previously received the old vaccine or have had or are unsure if they have had chickenpox. There are an estimated 1 million cases of shingles in the United States each year; the risk of the disease increases as people age.

    Since the new vaccine became broadly available in the United States earlier this year, demand has soared. Supply has not kept pace. Manufacturer GlaxoSmithKline “implemented order limits and providers have experienced shipping delays,” according to a note posted on the CDC’s vaccine shortage list earlier this month. Even though GSK is working to increase supply, those order limits and shipping delays will continue through 2018, the note said. The CDC began reporting shortages in early May.

    The scarce supply of Shingrix is likely to be mentioned at a regularly scheduled meeting Wednesday of the federal panel that advises the CDC on immunizations.

    Drugstore chain CVS said it began offering the vaccine to patients broadly in mid-March. But because of high demand, “it has become challenging to keep an ample supply across all of our more than 9,800 stores due to supply restrictions from the manufacturer,” CVS spokeswoman Amy Lanctot said in an email on Tuesday. “We are still getting shipments intermittently,” she wrote. She said patients should call their local store to find out if the vaccine is in stock.

    People who called their CVS pharmacies in recent weeks and were put on hold were likely to hear a recorded message about the new vaccine, saying that it is up to 97 percent effective and recommended for adults older than 50. “Talk to your pharmacy team today,” the message says.

    Several CVS pharmacies in suburban Maryland reported the vaccine has been on back order for weeks. Shipments are limited to one box of 10 doses. At the CVS pharmacy in a Target store in Rockville, a person who answered the telephone said the pharmacy had not received any doses since a first shipment “a couple months ago.” He offered to put a customer on a waiting list.

    A nearby Harris Teeter grocery store that had signs advertising the vaccine was also low on stock, also limited to receiving one box of 10 doses at a time and also had a waiting list.

    Like other providers, the Kaiser Permanente health system said it has also experienced “high demand” since May. Physicians and pharmacists have been working to “provide vaccine to members most at risk, according to CDC guidelines,” a spokeswoman said.

    GSK spokesman Sean Clements said officials are seeing immunization rates “many times that of previous years,” leading to “extremely high” demand for the vaccine. Since Shingrix became available at the end of October, more than 1.5 million people have received at least one dose as of early May, he said.

    The company is shipping more doses this week, he said. The manufacturer is increasing the U.S. supply available for 2018 and plans to release doses to all customer types on a consistent and predictable schedule for the remainder of the year. “People will be able to plan,” he said.

    He declined to disclose how many doses of the vaccine GSK planned to bring to market this year. For the first quarter of the year, Shingrix had a “strong and fast start” and earned more than $150 million, company officials said in an earnings call in April. Officials suggested annual revenue of about $600 million for the vaccine.

    The company relied on historical demand for shingles vaccine to predict demand for the new vaccine, Clements said. The company has informed the CDC and FDA that there is enough supply to vaccinate more patients in 2018 than were vaccinated against shingles during 2017.

    The CDC recommendation is for two doses of Shingrix, two to six months apart. For patients who received both doses, Shingrix is 97 percent effective against shingles for those ages 50 to 59, compared with about 70 percent effectiveness for the older vaccine, Zostavax, industry-sponsored data show. For those in their 60s, the new vaccine is 97 percent effective, compared with 64 percent for Zostavax. For those in their 70s, Shingrix is 91 percent effective, compared with about 41 percent for Zostavax. (Data have not been provided for the effectiveness of a single dose of Shingrix.)

    For those in their 80s, who are most at risk of developing complications from shingles, the new vaccine is about five times as effective: 91 percent vs. 18 percent. Protection stays above 85 percent for at least the first four years after vaccination.

    Each dose costs $140. Most private health insurance covers recommended adult vaccines, including shingles vaccine. All Medicare Part D plans cover the shingles vaccine. But depending on the plan, individuals may need to pay a portion of the total cost.

    Unlike the older Zostavax, which is injected under the skin, the new vaccine is supposed to be a shot in the muscle of the upper arm, like the annual flu vaccine. That difference has apparently led to some errors in giving the vaccine. During the four-month period from October to February, of 155 reports about problems associated with the vaccine, 13 instances involved at least one error, according to a CDC report last month. Nine involved Shingrix being given under the skin instead of in the muscle; eight of those nine injections caused reactions such as pain, redness and itching at the injection site.

    The remaining 142 reports were patients reporting temporary side effects, such as joint pain, flulike symptoms, headaches, fatigue and soreness in the upper arm.

    GSK said it is focusing its efforts on educating providers and pharmacists to stress the importance of two-dose compliance, and holding off on additional promotion, such as television commercials, until the shortage is under control.

    “We want to make sure there is the right level of things out there for education, making sure we’re not driving excessive demand when we have to catch up with supply,” Clements said.

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