| New Shingles Vaccine Available |
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by Timothy Gieseke, MD, CMD As a senior physician, I have cared for many 80+ y/o’s with Shingles (HSV). In this age group it’s common to become severely depressed and lose > 10% of their weight. In addition, if the feared post herpetic neuralgia (PNH) develops, many of their lives are forever altered despite applying current therapies to mitigate the pain. For this reason, I highly recommended the Zostavax live vaccine when it became available in 2006. Unfortunately, this vaccine has not been very effective in 70+ y/o’s (18%) and immunity starts to wane after 3 years. In addition, as a live vaccine, it couldn’t be used in immunocompromised hosts, the very patients who are at greatest risk for Shingles. For this reason, I am pleased that the FDA and ACIP (Advisory Committee on Immune Practices) have approved and recommended the new subunit recombinant vaccine, Shingrix, for use in the United States in those > 50 y/o. This vaccine is a non-live, lyophilized vaccine which is reconstituted by an immune modulator. The data shows impressive efficacy for prevention of Shingles and PNH even in the 70+ y/o population. In addition, no fall off in immunogenicity has been detected at 4 years. Being more immunogenic, there is more redness and swelling at the injection site and more transient fever, fatigue, and myalgias. The improved efficacy is the basis for the ACIP recommendation to use this new vaccine to replace the old vaccine. Those who have received the Zostavax vaccine should receive this new vaccine. The new vaccine is a 2 shot vaccine with 2nd dose given 2-6 months after the first dose. Next month, the ACIP will likely make recommendations on this vaccines appropriateness for immunocompromised patients. The new vaccine is now available in pharmacies and will likely be covered by private insurance. The private pay cost is ~ $295. The old vaccine was quickly covered by Medicare Part D, but experts note CMS has never approved a 2 dose vaccine that costs > $200. Stay tuned. For more information about this vaccine, see the below references. (I particularly like the Consumer Reports article which is written in patient friendly language.) Resources:
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