by Dr. C.H. Weaver M.D. updated 4/2022
Shingles is a reactivation of the herpes zoster virus in individuals who previously had chicken pox. Reactivation may occur at a higher frequency among cancer patients with a suppressed immune system.
The Shingrix vaccine is a recombinant protein vaccine that was approved by the US Food and Drug Administration in 2017 for use in individual over the age of 50. The vaccine is highly effective in more than 95% of recipients up to the age of 70.1,2 The 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
The Food and Drug Administration expanded the approval of Shingrix for the prevention of herpes zoster in adults 18 years of age and older who are or who will be at increased risk of herpes zoster due to immunodeficiency or immunosuppression caused by known disease or therapy.
Shingrix was found to be 68.2% effective against the development of herpes zoster in immunocompromised adults who received a stem cell transplant 50 to 70 days prior to the first dose and who were expected to receive prophylactic antiviral therapy for at most 6 months post-transplant. In hematologic malignancies Shingrix was 87.2% effective against herpes zoster development.
In adults who are or will be immunodeficient or immunosuppressed due to known disease or therapy and who would benefit from a shorter vaccination schedule, the second dose may be administered 1 to 2 months after the first dose.1,2
What is “Shingles”
Shingles is an infection of an individual nerve and the skin surface that is supplied by the nerve. It is caused by reactivation of the varicella-zoster virus, the same virus that causes chickenpox which can remain latent in the nerves along the the spine. Reactivation usually occurs decades after primary “chicken pox” infection.
Older adults are most at risk of shingles, which is a painful, often debilitating blistering rash that results from reactivation of the varicella-zoster virus and remains latent in those who have had that disease.
There is an estimated 1 million cases of shingles each year in the United States, and 1 in 3 people develop shingles during their lifetime. Anyone who has recovered from chickenpox can develop shingles. It is not possible however to have shingles if you have never been exposed to chickenpox or the varicella virus that causes it.
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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 post-herpetic neuralgia which is a severe pain that can last for months or even years in the area of the healed rash. Serious complications with vision may also occur if the rash appears around the eye can and partial weakness/paralysis of the areas served by the affected nerve has been reported.
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 Shingles and related complications. Two doses of Shingrix separated by 2 to 6 months for immunocompetent adults age 50 years and older are recomended.2
- 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 adjuvant vaccines, such as Shingrix and Fluad, have not been evaluated.
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 post-herpetic neuralgia; it reduced overall complications by nearly 78%.
Frequently Asked Questions
Does the Shingrix vaccine have side effects?
The most common side effects are:
- Pain, redness, and swelling at the injection site.
- Muscle pain.
How soon after shingles can I get Shingrix?
After a person recovers from chickenpox, the virus stays dormant (inactive) in the body. It can reactivate years later and cause shingles. If you had Zostavax in the recent past, you should wait at least eight weeks before getting Shingrix. Talk to your healthcare provider to determine the best time to get Shingrix.
- Shingrix approved in the US for prevention of shingles in immunocompromised adults. News release. GlaxoSmithKline. Accessed July 26, 2021. https://us.gsk.com/en-us/media/press-releases/shingrix-approved-in-the-us-for-prevention-of-shingles-in-immunocompromised-adults/.
- Shingrix [package insert]. Triangle Park, NC: GlaxoSmithKline. 2021.
- 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.