New Shingles Vaccine: Everything You Need to Know to Protect Yourself

• Our immune systems begin to deteriorate once we reach the age of 50, leaving more than 90% of those over age 50 who have previously been infected with chickenpox with increased risk of developing shingles.
• The most common complication of shingles is postherpetic neuralgia (PHN), which results in constant nerve pain. Some severe but less common complications include encephalitis, death of brain tissue, and Ramsay Hunt syndrome.
• The new shingles vaccine is 97% effective in preventing shingles and 91.2% effective in preventing PHN symptoms. It is recommended as a 2-dose vaccine, spaced 2-6 months apart, for adults aged 50 and older.

Shingles is caused by the varicella zoster virus (VZV), which is the same virus that causes chickenpox. Shingles typically affects adults aged 50 and above who have previously had chickenpox, because when the body recovers from chickenpox the VZV remains hidden in nerve cells. When the immune system weakens due to age or other factors, the virus can be reactivated, leading to the condition known as shingles.

• Individuals aged 50 and above have weakened immune systems, and 90% of them have had chickenpox putting them at greater risk of shingles.
• Patients with chronic conditions, such as diabetes, lung disease, kidney disease, and those who have previously had a COVID-19 infection.
• Immunocompromised individuals, such as those who have undergone bone marrow or organ transplants, individuals with autoimmune diseases like SLE, HIV sufferers and patients receiving immunosuppressive medications.

The initial symptoms of shingles include the development of a red rash in an area where the patient is experiencing pain, which later turns into clear fluid-filled blisters. These blisters often appear grouped or along a nerve path. Subsequently, they break open into sores and crust over, accompanied by a burning or stinging sensation on the skin. Some individuals may experience skin pain for 4-5 days before the appearance of these fluid-filled blisters.

• The most common complication of shingles is postherpetic neuralgia (PHN), characterized by constant nerve pain. This pain can be a short term symptom or it may be severe enough to persist as chronic pain even after the rash has healed.
• Severe complications include bacterial skin infections leading to ulceration, herpes zoster ophthalmicus (HZO) infection, and increased risk of stroke or cardiovascular disease.
• Some less common but highly severe complications include encephalitis, death of brain tissue, and Ramsay Hunt syndrome.

Individuals who have had shingles have a recurrence risk of approximately 6.2%, with risk factors including stress, inadequate rest, being over 50 years old, receiving immunosuppressive medications, and having immune system deficiencies, such as a HIV infection or cancer.

• Managing stress, maintaining good personal hygiene, getting sufficient rest and avoiding close contact with individuals who have symptoms.
• The shingles vaccine is considered the most effective method for preventing shingles.

1. The new shingles vaccine - the recombinant subunit zoster vaccine (RZV) - does not contain live varicella-zoster virus (VZV) but uses specific proteins from the virus known as glycoprotein E.
   • It is highly effective in preventing shingles with a 97% efficacy rate, and 91.2% efficacy in preventing post herpetic neuralgia (PHN) in adults aged 50 and older.
   • 10-year follow-up studies have found it to have 89% effectiveness in preventing shingles.
   • It is recommended for adults aged 50 and older, administered as two injections into the upper arm muscle, spaced 2-6 months apart.
   • It is also recommended for individuals over 18 years old at higher risk of shingles than the general population, such as those with compromised immune systems, those taking steroids and those undergoing radiotherapy or chemotherapy treatment, as they are more vulnerable due to weakened immune systems. For these groups, the vaccine should be administered into the upper arm muscle, with two injections spaced 1-2 months apart.
   • Since the new shingles vaccine does not contain live virus, it is safe for individuals with weakened or compromised immune systems.
2. The original type of shingles vaccine - the live-attenuated zoster vaccine (ZVL) - refers to a vaccine produced using the disease-causing agent that has been weakened to the point where it can no longer cause the disease, but can still stimulate the body's immune response.
   • It is effective in preventing shingles in individuals aged 60 and older. The vaccine can prevent the occurrence of the disease by 51% and reduce the incidence of postherpetic neuralgia by 39%.
   • Administering a 0.65 mL dose of ZVL under the skin may be considered for individuals aged 60 and older.
   • Do not administer the live-attenuated zoster vaccine (ZVL) to individuals with severe immune deficiencies or pregnant women.

In the case of having previously received the live-attenuated zoster vaccine (ZVL), you can receive the recombinant subunit zoster vaccine (RZV) in 2 doses but waiting at least 2 months after the previous vaccine.

1. You can receive the shingles vaccine whether or not you have previously had chickenpox. It is not necessary to check for immunity to chickenpox (varicella IgG).
2.  In cases where you have had shingles before, you can receive the shingles vaccine with a minimum waiting period of at least 6 months after the shingles episode.
3. If you have not yet reached the age where you are recommended to receive the shingles vaccine, consider getting the chickenpox vaccine instead. It is not advisable to get the shingles vaccine to prevent chickenpox.