Shingles is a painful condition that affects more than a million people each year, and it primarily strikes those over 60 years old. Until late last year, only one vaccine was available, and it was only moderately effective.
Now, there’s a new one on the market. In October, the FDA approved Shingrix for those 50 and older.
This is good news on several fronts. First, of course, is that Zostavax is no longer the only shingles vaccine on the market. You have a choice. Second, compared to placebo, Shingrix is more effective than Zostovax. Third, because it’s not a live vaccine, more people can receive it.
But does this mean it’s the right choice for you? Only you can decide. But before we discuss both vaccines in detail, let’s review what shingles is.
The Virus Behind Shingles
The varicella zoster virus cause shingles. As you probably know, that’s the virus that also causes chickenpox. Here’s how it works: You contract chickenpox as a child and you recover. But the virus never really leaves your body–it remains dormant, hiding out in nerve tissue near your spinal cord and brain. Then, decades later, it reactivates, causing shingles. What triggers this reactivation? Researchers haven’t really figured it out.
Shingles Isn’t Pretty
In the US, roughly a million cases of shingles are reported each year. It isn’t life-threatening, but you may wish you were dead. Those who’ve endured it say it’s exceptionally painful.
The first symptom is often skin pain and sensitivity. It appears in a narrow band around one side your body. It then–typically– turns into a blistery rash that lasts about 14 days to a month. The effects can linger for much longer though.
About 20 percent of those who develop shingles experience a nasty complication: ongoing nerve pain. It’s called postherpetic neuralgia. It can last for months or in some cases years. Other complications include eye infections and gastrointestinal ulcers.
It’s a condition that’s associated with age, and more than half of all adults age 85+ have experienced shingles. In addition, people who are immunocompromised–for example those who are undergoing chemo, have HIV/AIDS, or have certain forms of cancer, such as leukemia–are more susceptible.
Comparing the Vaccines
Here are some of the ways in which the two vaccines differ:
Living vs. nonliving virus: Zostavax contains a live virus. Shingrix does not. This is important for immunocompromised people. They are more susceptible to shingles, but they generally advised against live-virus vaccines.
- Effectiveness: The research found that, compared to a placebo, Shingrix is about 97 percent effective. Zostavax is just over 50 percent effective, but–unlike the newer vaccine–it becomes less effective in those 70 and older. Keep in mind, the two have not been tested head-to-head: Each has just been compared to placebo.
- Administration: Shingrix is administered in two separate intramuscular injections, several weeks apart. Some experts, including Evelyn Granieri, MD, a geriatrician at Columbia University Medical Center, warn the two-shot schedule could be a hurdle for some older people. Zostavax is a single dose injected under the skin, not into the muscle.
- Cost: Shingrix is expected to be covered under Medicare Part D; Zostovax already is. Not everyone with Medicare has a Part D plan. For those paying out of pocket, Shingrix’s manufacturer, GlaxoSmithKline, says the cost for the two-shot series will be around $280 vs. $213 per dose for Zostavax.
- Timing: Shingrix is approved and recommended for those over 50–including individuals who’ve already received the Zostavax vaccine. Although Zostavax is approved for those 50 and older, the CDC recommends getting it at 60.
The Bottom Line
Factoring in the costs and efficacy rate, researchers writing in JAMA Internal Medicine concluded that Shingrix was the better value. In addition, the CDC’s immunization advisory committee has recommended Shingrix over Zostavax for adults over 50, including those who’ve already received Zostavax.
There are few caveats, though. Shingrix is only a better value if you get both shots, so if you tend to be a bit flakey about your healthcare, or you have an elderly relative who has trouble getting to the doctor’s office, you may want to consider the options carefully in conversation with your provider. And if you are paying out of pocket, be sure to shop around. You may find the vaccine for a lot less at your local drug store.
If you are over 60, unless you have medical or profound religious/ethical reasons to avoid vaccines, this is probably one you need. Ask anyone who’s had shingles. It’s miserable.
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