The New Shingles Vaccine and Your Neurology Practice
The newest shingles vaccine, Shingrix®, is good news for just about everyone who grew up in the age where we got our immunity to chicken pox the old-fashioned way—by actually contracting the disease. Unlike the younger crowd who now receive the varicella vaccine, almost all of us had the wild virus—and we still do.
That latent virus comes back to bite one in three of us with a case of shingles at least once in our lifetime. The vesicular rash pops up as a result of reactivation of the latent varicella virus in our nerve cells. It can be itchy or painful, but it typically resolves on its own. And if that were all there was to it, it wouldn’t be more than a nuisance disease.
Complications can arise from shingles, and as a neurologist, you may be the one who deals with them. Often, those complications disproportionately affect those who are already vulnerable—the elderly and ill.
The primary complication is well known to the neurologist. Post-herpetic neuralgia (PHN) is nerve pain that persists after the herpes zoster outbreak resolves. It can cause pain for months and the risk increases with age. Thirteen percent of those over 60 years old develop PHN after a shingles outbreak.
In addition to the elderly, the sick are more vulnerable to the complications of herpes zoster. Those who have cancer or are immunocompromised from HIV or other diseases suffer disproportionately from these complications. These people may already struggle with nerve pain due to their illness or its treatment, so shingles represents a real setback for them.
Other complications include involvement of the eyes after a facial zoster outbreak, bacterial infection, nerve palsy, and even visceral involvement such as hepatitis or encephalitis.
So the new shingles vaccine offers some relief, particularly for those neurology patients who stand to suffer most after a round of shingles.
Is the shingles vaccine for everyone?
CDC recommends everyone 50 and over receive the two shot series of Shingrix. There is no upper limit on this recommendation.
This broad recommendation comes from studies that show the vaccine has a strong safety profile, and it is more than 90% effective in preventing shingles and PHN in individuals over 50. This number drops to slightly below 90% after age 70. For neurology patients, who may already be struggling with nerve pain or other chronic disorders, significantly lowering the potential for shingles can provide some peace of mind.
There is still a lot of information floating around on the internet about the lower efficacy of Zostivax, an older shingles vaccine. Be aware that patients may have read this and not be aware that the newer vaccine exists and has a much higher rate of efficacy. The CDC offers a public information page with up-to-date information on the newest shingles vaccine.
When the Millennial generation hits retirement age, the shingles vaccine may become a relic of days gone by. After all, most of that generation and those that follow will have been vaccinated for varicella and never had chicken pox. They won’t be at risk for shingles. But in the meantime, this vaccine can provide relief for the nearly one-third of Baby Boomers (and the often overlooked Gen X’ers!) who would otherwise develop shingles at some point.