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- Shingles, otherwise known as herpes zoster,
is a reactivation of the virus that causes chicken pox.
Starting in the 1990's,
most children have been routinely immunized
for chicken pox with a vaccine.
Prior to this, the majority of people
acquired the actual chicken pox virus.
And for those that experience chicken pox,
there is a risk of the virus coming back,
in the form of shingles,
and that's what we're talking about today.
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The major updates to shingles
are with regards to vaccines.
In 2006, a shingles vaccine called Zostavax emerged
to help prevent shingles and its complications.
And it's what known as a live attenuated vaccine,
meaning it's not completely dead,
and therefore there is a theoretical risk
of getting the infection from the vaccine itself.
So, since it's been out, since 2006,
or the past 10 years or so,
there was this concern for patients
who had a rheumatic disease,
on high doses of immune-suppressing medications,
that they could get the infection.
However, recently,
at the 2019 American College of Rheumatology annual meeting,
researchers reported Zostavax is safe
for people who are currently receiving
a class of medications known as
tumor necrosis factor inhibitors, or TNF inhibitors.
And this study was a big deal.
These medications are biologic therapies
to treat a whole host of different rheumatic diseases,
such as rheumatoid arthritis, psoriatic arthriitis,
and many others.
There are five different TNF inhibitors approved by the FDA.
These are adalimumab, infliximab, etanercept,
golimumab, and certolizumab.
The name of the study was called the VRV Trial,
and this was a randomized control trial
of more than 600 individuals in the United States
receiving TNF inhibitor therapies.
Now, the goal of the study
was to evaluate how safe and effective Zostavax was
in these patients who might have a not-normal immune system
due to their TNF inhibitor treatment.
The majority of these patients
either had rheumatoid arthritis or psoriatic arthritis.
And what the researchers did
is they gave Zostavax to these patients,
then watched them over a period of six weeks.
And at the end of that six week period, they said okay,
well, who developed shingles during that time.
And at the end of the day,
zero patients developed confirmed shingles.
Thus, this provided evidence that Zostavax is safe,
at least in this particular patient population.
Now, that being said, in 2017,
a new different vaccine called Shingrix was released
that is more than 90 percent effective
in preventing shingles and its complication,
post-herpetic neuralgia,
and at this point is the preferred vaccine
recommended by the Centers for Disease Control, or CDC.
Adults over the age of 50 are approved for the vaccine,
and it is given in a two-shot series,
administered two to six months apart.
Now, Shingrix is different from Zostavax,
in that it is a dead virus, and thus there is no risk
of getting the infection from the vaccine.
However, in order to make the vaccine effective,
it contains what is called a strong adjuvant.
Think of that is an immune stimulator.
And the purpose of this adjuvant
is that your immune system will better recognize the vaccine
and thus provide long-lasting protection.
But because of this, Shingrix can produce a strong response
from your immune system,
so it my produce short-term side effects
that are a little more intense than you're used to
from other vaccines.
These side effects can be uncomfortable,
but they are expected, and typically go away on their own
in about two to three days.
Of note, even if you've had the original shingles vaccine,
Zostavax, you can still get Shingrix.
And if you've had shingles before,
you should still get vaccinated.
Shingrix is covered by most healthcare providers,
and most healthcare insurers,
but you should still call your insurance company
just to make sure you don't have
a lot of out-of-pocket expense.
Lastly, although approved for those over the age of 50,
there are some individuals that are younger than 50
who are at high risk, due to their specific disease
or the treatments they receive.
So they should speak with their rheumatologist
on the utility of receiving either Zostavax or Shingrix.
That's all for now, thanks for watching.
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