by Dr. C.H. Weaver M.D. 2/2021
What is “Shingles”
Herpes zoster, or “shingles” results from the reactivation of latent varicella–zoster virus (VZV) in the dorsal-root or cranial-nerve ganglia, usually decades after primary “chicken pox” infection.
Shingles typically produces a painful rash that blisters and scabs over in 7 to 10 days. People who get shingles experience acute pain, and many describe the pain as aching or burning. The rash is only on one side of the body and may appear as a “band” The rash usually resolves within 2-4 weeks.
The most common complication of Shingles is postherpetic neuralgia (PHN) which is a severe pain that can last for months or even years in the area of the healed rash. A serious complication with vision if the rash appears around the eye can occur and partial weakness/paralysis of the areas served by affected nerve has been reported. (3,6)
The Shingrix vaccine is a recombinant protein vaccine that was approved by the US Food and Drug Administration in 2017. The vaccine is highly effective in more than 95% of recipients up to the age of 70. (1,2) he vaccine can be given to patients with cancer even if they are receiving or have recently received radiation or chemotherapy.
Previously, the only vaccine available for shingles was Zostavax which is an attenuated live virus vaccine. This vaccine is contraindicated for patients with immunodeficiency or immunosuppression and could not be used in patients with cancer or those receiving immune system suppressing treatment. (1-5)
Shingles Vaccination Recommendations
The Centers for Disease Control (CDC) recommends the newer Shingrix (recombinant zoster vaccine) as preferred over the older Zostavax (zoster vaccine live) for the prevention of herpes zoster (shingles) and related complications. CDC recommends two doses of Shingrix separated by 2 to 6 months for immunocompetent adults age 50 years and older. (7)
- Whether or not they report a prior episode of herpes zoster
- Whether or not they report a prior dose of Zostavax
- Who have chronic medical conditions (e.g., chronic renal failure, diabetes mellitus, rheumatoid arthritis, chronic pulmonary disease), unless a contraindication or precaution exists. Similar to Zostavax, Shingrix may be used for adults who are
- are taking low-dose immunosuppressive therapy
- are anticipating immunosuppression
- have recovered from an immunocompromising illness
- Who are getting other adult vaccines in the same doctor’s visit, including those routinely recommended for adults age 50 years and older, such as influenza and pneumococcal vaccines. The safety and efficacy of concomitant administration of two adjuvanted vaccines, such as Shingrix and Fluad, have not been evaluated.
Can Shingrix be administered to immunocompromised individuals?
No specific recommendations for Shingrix use in immunocompromised cancer patients have been made, however a recent study found the vaccine to be effective among autologous stem cell transplant recipients who received the vaccine 50 to 70 days post-transplant. The vaccine was about 68% effective at preventing herpes zoster reactivation and 89% effective at preventing postherpetic neuralgia; it reduced overall complications by nearly 78%. (4,8)
Cohen JI. Herpes zoster. N Engl J Med 2013;369:255-263.
Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2008;57:1-30
de la Serna J, Campora L, Chandrasekar P, et al. Efficacy and safety of an adjuvanted herpes zoster subunit vaccine in autologous hematopoietic stem cell transplant recipients 18 years of age or older: first results of the phase 3 randomized, placebo-controlled ZOE-HSCT clinical trial. Presented at the BMT Tandem Meeting; February 21-25, 2018; Salt Lake City. Abstract LBA2.
Johnson RW. Herpes zoster and postherpetic neuralgia. Expert Rev Vaccines 2010;9:Suppl:21-26.
Efficacy of an Adjuvanted Herpes Zoster Subunit Vaccine in Older Adults | NEJM
BackgroundIn previous phase 1–2 clinical trials involving older adults, a subunit vaccine containing varicella–zoster virus glycoprotein E and the AS01B adjuvant system (called HZ/su) had a clinica...
Efficacy of the Herpes Zoster Subunit Vaccine in Adults 70 Years of Age or Older | NEJM
BackgroundA trial involving adults 50 years of age or older (ZOE-50) showed that the herpes zoster subunit vaccine (HZ/su) containing recombinant varicella–zoster virus glycoprotein E and the AS01B...
Herpes Zoster Shingrix Vaccine Recommendations | Shingles | CDC
Shingrix (recombinant zoster vaccine) recommendations include dosage, timing considerations, contraindications and precautions.