Shingles vaccine?

[Skeptic Ginger]

I need to add a caveat to the shingles not occurring twice in immunocompetent persons, when a person had their initial chicken pox infection very young, especially under age one, shingles can then occur much younger including in teens. IIRC, in such cases a person may have shingles again later in life.

 

[Skeptic Ginger]

I would rarely go against the CDC ACIP guidelines and while they state:

Special Populations
Persons with a history of herpes zoster. Herpes zoster can recur. Adults with a history of herpes zoster should receive RZV. If a patient is experiencing an episode of herpes zoster, vaccination should be delayed until the acute stage of the illness is over and symptoms abate. Studies of safety and immunogenicity of RZV in this population are ongoing.

I find myself looking for the supporting data. I have seen HSV misdiagnosed as shingles and done a fair amount of literature review because of it. I wonder if that CDC recommendation isn't made because... why not?

Frequency of Herpes Zoster Recurrence

To the Editor: We read with great interest the study by Yawn et al,1 published in the February 2011 issue of Mayo Clinic Proceedings, which found that the frequency of herpes zoster (HZ) recurrence in a community population was higher than previously reported. The reported results are somewhat unexpected. It is generally accepted that the lifetime incidence of a second episode of HZ in immunocompetent individuals is between 1% and 5% and that the recurrence is typically many years after the first episode. A number of issues need to be clarified about the study by Yawn et al before the relevance of these findings can be determined.

First, the diagnosis of HZ in the study by Yawn et al1 was established clinically. The clinical diagnosis of HZ can be difficult and is subject to error. In a zoster prevention study,2 HZ was ruled out by laboratory testing (polymerase chain reaction or viral culture) in 24% of patients with a clinical diagnosis of HZ, suggesting that clinical diagnosis can on occasion be incorrect.

IOW unless you culture the site and obtain a proper specimen, you will see misdiagnosed cases.

Similarly, a prospective study of HZ diagnoses by general practitioners in the United Kingdom found 17% of diagnoses to be incorrect.3 More specifically, of the 230 patients diagnosed clinically as having HZ, only 204 cases were confirmed by immunofluorescence and/or polymerase chain reaction. Of the 26 patients who had no evidence of HZ on laboratory tests, 10 patients had herpes simplex, and the rest had other dermatological diseases.3 In the study by Yawn et al,1 only 25% of the recurrent episodes were confirmed by laboratory analysis, but it is unclear whether the first episode was also confirmed by laboratory results.

I am unconvinced that confirmed recurrent zoster in immunocompetent patients is occurring as opposed to misdiagnosing explaining the cases. Not all that many doctors are aware that herpes type one and two are not confined to lips and genitals. This explains a lot of misdiagnosing, IMO. And, these professionals agree but also agree that it's fine for the CDC to recommend the vaccine anyway.

Given the ready availability and the safety profile of the HZ vaccine, we agree that it is important to identify additional categories of people who could benefit from it. However, in our opinion, well-designed prospective studies are needed to ascertain the real likelihood of recurrences in the general population.

I'll see what I can find about HSV misdiagnosis and post an update.

 

[Arisia]

I need to add a caveat to the shingles not occurring twice in immunocompetent persons, when a person had their initial chicken pox infection very young, especially under age one, shingles can then occur much younger including in teens. IIRC, in such cases a person may have shingles again later in life.

Oooh, I'll need to keep that in mind, I got chicken pox at 6 months of age or so (thanks, older brothers ). Should I be asking my doctor about vaccination even though I just turned 50?

 

[ArmillarySphere]

Is there a minimum age when it's effective? I had the chicken pox when I was 5 and am closing in on 45 now.

 

[Skeptic Ginger]

Oooh, I'll need to keep that in mind, I got chicken pox at 6 months of age or so (thanks, older brothers ). Should I be asking my doctor about vaccination even though I just turned 50?

Yes.

 

[Skeptic Ginger]

Is there a minimum age when it's effective? I had the chicken pox when I was 5 and am closing in on 45 now.

You might want to look up the stats. Zoster/shingles is rare in younger people vs how long the vaccine immune duration lasts. Getting chicken pox at five does not put you at an unusual risk like getting it at 6 months would.

There are complicating factors. We don't know yet what role exposure to wild varicella (zoster virus) plays in natural boosting. Will vaccinating all kids mean the elderly are not getting the natural boosting effect they would have gotten in the past?

We have nothing but hypotheticals at the moment, and we don't know how long the vaccine immunity will last because it hasn't been in use long enough to know.

You test new drugs on a thousand people and you don't find out what happens to 100,000 people until the drug is on the market. That's OK, mind you. We wouldn't want to wait until a drug was tested on 100,000 people before we put it to use. That's why after-market experiences are part of the research process.

Shingles is treatable if, and that's a critical if, you can start an anti-viral within 24 hours of onset.

Not saying not to get vaccinated, mind you. Just saying if you learn the symptoms and know you have to get treatment urgently, you have options.

 

[bruto]

So as long as we're asking the experts here....I had the older type shot a few years ago. My wife just got it recently. Should we go ahead and get the new one too? I am 70, had chicken pox at 3, no shingles.

 

[SusanB-M1]

So, I am curious. In my case I believe that sleep deprivation, stress, hyper activity, brought on my shingles. Can anyone else pin point a trigger for theirs. Tanya seemed to have a flu, weakened immune system, as a trigger.

Yes, I'm afraid so: I had been diagnosed with breast cancer in April, was (still am) on Letrozole, and one of my brothers, who had been deteriorating considerably, although remaining philosophical throughout, died in July.

I think I will make further enquiries about having the vaccine.

 

[Skeptic Ginger]

So as long as we're asking the experts here....I had the older type shot a few years ago. My wife just got it recently. Should we go ahead and get the new one too? I am 70, had chicken pox at 3, no shingles.

CDC recommendation is yes, get the newer vaccine in addition to your previous vaccine.

From my CDC link above:

RZV use in immunocompetent adults who previously received ZVL. In separate clinical trials, RZV estimates of efficacy against herpes zoster were higher than ZVL estimates in all age categories. The difference in efficacy between the two vaccines was most pronounced among recipients aged ≥70 years. Studies have shown that ZVL effectiveness wanes substantially over time, leaving recipients with reduced protection against herpes zoster. RZV elicited similar safety, reactogenicity, and immunogenicity profiles regardless of prior ZVL receipt; therefore, ZVL recipients will likely benefit from vaccination with RZV.

 

[Fast Eddie B]

Got a link? Previous shingles still getting the vaccine sounds very much like overkill.

https://www.cdc.gov/vaccines/vpd/shingles/public/zostavax/index.html

 

[Fast Eddie B]

You shouldn't. It's incredibly rare to get shingles twice. The outbreak essentially acts as a vaccine against another episode.

From WebMD:

If your immune system is healthy:

Your short-term chances of getting shingles again are very low. One study of people over age 60 found that only 1% got shingles again within about 3 years. Having shingles once lowers your chances of getting it a second time, at least for a while.

Over time, your chances of a second bout go up. Another study found that within 7 years, the odds of getting it again may be almost 6% in people 22 and older. That's about the same as the odds of getting shingles the first time.

 

[casebro]

Hey, if they are both live viruses, why is the one supposed to be better then the other?

 

[bobdroege7]

I had shingles about 10 years ago, age 49, I discuss the vaccine every year with my primary physician.

We debate about getting it, at this point age 59, my insurance doesn't pay for it yet, and it's effective only for about 10 years, and it's expensive.

I haven't gotten it yet, but the idea is to hold off as long as possible since I am in pretty good health and expect to live more than 10 more years.

But I won't wait more than 5 more years, definitely get it before I retire.

Getting shingle sucks.

 

[Skeptic Ginger]

From WebMD:

If your immune system is healthy:

Your short-term chances of getting shingles again are very low. One study of people over age 60 found that only 1% got shingles again within about 3 years. Having shingles once lowers your chances of getting it a second time, at least for a while.

Over time, your chances of a second bout go up. Another study found that within 7 years, the odds of getting it again may be almost 6% in people 22 and older. That's about the same as the odds of getting shingles the first time.

If you look at the link I posted, some of those studies have valid criticisms in that they are based on clinical diagnosis and not based on cultures.

 

[Skeptic Ginger]

I had shingles about 10 years ago, age 49, I discuss the vaccine every year with my primary physician.

We debate about getting it, at this point age 59, my insurance doesn't pay for it yet, and it's effective only for about 10 years, and it's expensive.

I haven't gotten it yet, but the idea is to hold off as long as possible since I am in pretty good health and expect to live more than 10 more years.

But I won't wait more than 5 more years, definitely get it before I retire.

Getting shingle sucks.

This is a reasonable decision process.

 

[Skeptic Ginger]

Hey, if they are both live viruses, why is the one supposed to be better then the other?

Better match. Live vaccines are attenuated. Might also be other factors.

In biologics there are no generics. It's one reason new drugs stay so expensive for so long. It also means different versions are not exactly alike.

 

[casebro]

Better match. Live vaccines are attenuated. Might also be other factors.

In biologics there are no generics. It's one reason new drugs stay so expensive for so long. It also means different versions are not exactly alike.

Okaay- like the way cow pox protected milk maids from small pox, but later small pox vaccines were better.

 

[dann]

Again, recurring and not that severe sounds like a misdiagnosis.

No, it doesn't.

Hate to break it to you boys but HSV can occur and reoccur in places other than lips and genitals. If these cases were on one's butt, it was much more likely HSV 2 than zoster. But by all means, don't accept a diagnosis from some random person on the internet.

I don't. And I already mentioned where the symptoms were: upper left-side torso (heart region) and scalp.

Signs and Symptoms (not the best web site, but I like the clear presentation that they give, and it seems to correspond to what other, more reliable sites say):

Oral herpes symptoms:
Painful sores in or around the mouth
The affected area may itch, tingle, or burn before the sores appear
There may be a fever, sore throat, and swollen lymph nodes in the neck

No.

Genital herpes symptoms:

Sores on penis, buttocks, anus, and around and inside the vagina which may be painful
The affected area may itch, tingle, or burn before the sores appear
Fever, malaise, muscle aches, swollen lymph nodes in the groin, pain or burning upon urination, and vaginal discharge

No.

Shingles symptoms:

First and most common symptom is burning or throbbing pain [Yes]
There may also be headache [Yes], malaise, earache [Yes], sensitivity to light [Yes], and fever
Small, raised, reddish bumps that become fluid-filled blisters then appear, usually on one side of the body and localized to a “strip” of skin [And yes]

I know that these symptoms are by no means as conclusive as lab tests, but shingles still seems to be the most obvious diagnosis in my case. That the pain wasn't so bad the second time around, 15 years later, may have been due to the medicine I got.

 

[Capsid]

Hey, if they are both live viruses, why is the one supposed to be better then the other?

The attenuation (mutation) can affect many factors about the virus biology such as virulence. viral persistence, replication dynamics. It's complicated and not fully understood.

 

[Capsid]

Okaay- like the way cow pox protected milk maids from small pox, but later small pox vaccines were better.

The smallpox vaccine is essentially the cowpox vaccine as first used by Jenner but it got shared by many labs, everyone wanted it. Recent evidence now suggests that the vaccine (vaccinia virus) is really horse pox virus. But it didn't get improved much.