shingles vaccine

Shingles Vaccine Highly Effective Over 4 Years

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Two-dose Shingrix vaccine also provided long-term protection in people taking corticosteroids

A photo of the packaging and vials of Shingrix

The two-dose recombinant zoster vaccine (RZV; Shingrix) remained highly effective at preventing shingles over a 4-year period in real-world settings, according to a prospective cohort study.

Over 4 years, the two-dose regimen was 76% effective (95% CI 75-78), with one dose of the vaccine just 64% effective over the same time period (95% CI 62-67), underscoring the need for people to get both doses, Nicola P. Klein, MD, PhD, of Kaiser Permanente Northern California in Oakland, and colleagues reported in the Annals of Internal Medicineopens in a new tab or window.

“The study findings are reassuring in confirming that the recombinant zoster vaccine is highly effective for at least 4 years,” Klein told MedPage Today in an email. “The study also reaffirms the importance of getting the second dose of vaccine to maximize protection against shingles, which can be a painful and potentially dangerous condition.”

Klein noted that vaccine effectiveness was the same in patients who received the second vaccine dose later than the recommended interval of 2 to 6 months between doses. “One of the main messages is that everyone for whom the vaccine is recommendedopens in a new tab or window should get two doses, but not to panic if the second dose ended up being delayed beyond 6 months.”

The study included about 2 million people over the age of 50 who had never received RZV. During the study period from 2018 through 2022, 38% received at least one vaccine dose and 29% received two doses of RZV. After both doses, vaccine effectiveness was 79% during the first year, 75% during the second year, and 73% during the third and fourth years.

Although vaccine effectiveness after one dose was 70% effective during the first year, effectiveness waned substantially after that to 45% during the second year, 48% during the third year, and 52% after the third year.

Effectiveness also varied by age. The vaccine was slightly more effective in people who were vaccinated when they were younger than 65 years of age (81%) versus those who were older (74%).

Notably, in people who received corticosteroids — a group at significantly higher risk for shingles — the vaccine exhibited lower but substantial effectiveness (65%). The authors pointed out the number of shingles cases per 100 recipients prevented by the vaccine was about the same in corticosteroid users and nonusers.

“Our analysis can give clinicians additional support for urging adults in the recommended categories — over age 50 or immunocompromised — to get vaccinated against herpes zoster,” Klein said.

The study’s estimates of vaccine effectiveness were lower than those observed in the ZOE-50opens in a new tab or window and the ZOE-70opens in a new tab or window clinical trials, the authors noted. ZOE-50 found that the vaccine was 97% effective in people ages 50 and older and ZOE-70 found that the vaccine was 90% effective in those 70 years of age or older. A long-term follow-up study of those trials concluded that vaccine effectiveness held steady for at least 7 years, but long-term effectiveness of the vaccine in real-world settings hasn’t been extensively evaluated, the authors said.

The prospective cohort study gathered data from patients in four healthcare systems within the Vaccine Safety Datalink, a collaboration between the CDC and nine integrated healthcare systems. RZV was offered free of charge to most eligible patients. Researchers excluded those who received a diagnosis of shingles in the year before the study began. Among participants, 38% were 65 years of age or older, 53% were female, and 59% were white. The outcome was incident herpes zoster infection.

During the study follow-up over 45,000 cases of shingles were diagnosed and most (94%) were in unvaccinated participants. Unadjusted incidence of herpes zoster was 1.7 per 1,000 person-years in fully vaccinated people versus 6.7 per 1,000 person-years in unvaccinated people.

One of the potential limitations of the study was that a diagnosis of shingles required both a herpes zoster diagnosis ICD code and an antiviral prescription, rather than PCR testing. This may have lowered vaccine effectiveness estimates, researchers wrote. Also, patients with milder illness may have not sought care, potentially overestimating vaccine effectiveness.

2018 Adult ACIP Schedule includes New Shingles Vaccine

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https://speciality.medicaldialogues.in/2018-adult-acip-schedule-includes-new-shingles-vaccine/

Shingles Vaccine Seems Safe for Patients with Immune-Related Diseases.

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Patients vaccinated against herpes zoster while under treatment for immune-related diseases do not face increased hazards for herpes zoster, a JAMA study suggests. Current guidelines consider vaccination contraindicated in such patients while on immunosuppressive drugs.

The retrospective cohort study comprised over 450,000 Medicare patients with immune-related diagnoses such as rheumatoid arthritis and inflammatory bowel disease. Roughly 20,000 received the vaccine — over 600 of whom were on immunosuppressive treatment around the time of vaccination. The investigators found no increase in risk for herpes zoster among vaccinated patients, even those vaccinated during treatment.

Writing in Journal Watch Infectious Diseases, Dr. Richard Ellison comments that the results “suggest both a benefit from the vaccine and relatively low risk.”

Source: JAMA

Many seniors shun chance to get shingles vaccine.

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Shingles is a potentially preventable, sometimes excruciatingly painful, potentially debilitating disease. And it effects an estimated 1 million Americans each year.

Yet most seniors who are advised to get the shingles vaccine don’t.

Less than 15 percent of seniors in the recommended age group of 60 and up had gotten the shot as of last year, according to the Centers for Disease Control and Prevention.

Why not? Logistics, insurance and awareness, health-care providers say. The vaccine is expensive (more than $200), it has to be kept frozen and it’s in short supply. As if that weren’t enough, insurers place restrictions on coverage.

For Remsen resident Elaine Knasick, awareness was the key issue. Knasick, who came down with shingles in November, said she didn’t know the vaccine was available. Her doctor never mentioned it, she said.

Shingles is caused by the varicella-zoster virus, the same one that causes chickenpox. Anyone who has had chickenpox could get shingles decades later, with the disease becoming more common with age. It causes a rash on one side of the body, blisters, a tingling pain in many cases and possibly fever, headache, fatigue and chills. It can affect vision or hearing, and sometimes leads to postherpetic neuralgia, a long-lasting pain condition.

Knasick, 76, came down with a relatively mild case of the shingles in November. She had almost recovered three weeks later, she said. Knasick’s worst problem came from her shingles medicine, which caused her to hallucinate.

Knasick probably would have gotten the shot is she’d known about it, she said.

Of course, she still could have gotten shingles. The vaccine prevents shingles 51 percent of the time among seniors age 60 and older, according to the CDC. It is most effective on younger patients, preventing 64 percent of cases in the 60-to-69 age group and only 38 percent in ages 70 and up.

The vaccine is also approved, but not yet recommended, for people in their 50s. It reduces cases by 70 percent in that population, according to the CDC.

If you do get shingles, however, having had the vaccine still lowers your odds of developing the painful postherpetic neuralgia.

“I’m not sure why more seniors aren’t getting it,” said Dawn DeGironimo, vaccine manager for the Oneida County Health Department. “I think it goes back to client-doctor education.”

“The biggest hindrance is the insurance,” she added.

ä Many doctors don’t keep the vaccine on hand because they don’t have freezers for proper storage, it’s too expensive or there isn’t enough demand. Doctors with freezers will order it for individual patients whose insurance allows it, but that means the shot has to be planned in advance.

* Most insurers demand prior approval.

* Some insurers require patients to pick the vaccine up from the pharmacy even if their doctor has it. But doctors can’t be sure patients have handled the vaccine correctly and may refuse to inject it.

* There’s not enough vaccine to go around. Manufacturer Merck has put more of its resources into keeping up the supply of Varivax, the childhood vaccine for chickenpox.

Logistically, the easiest way to get the shot is to go to a clinic, but clinics might not have enough. The county health department only offers the shots to people without insurance coverage because it doesn’t have enough vaccine to offer shots to everyone, DeGironimo said. But patients can have a pharmacy deliver the vaccine to the clinic and then staff will inject it, she said.

Source:St. Luke’s Healthcare: