Shingles: New Vaccine, Enhanced Protection

Shingles, a painful and often debilitating condition caused by the reactivation of the varicella-zoster virus (the same virus responsible for chickenpox), affects millions worldwide. For those who have had chickenpox, the virus lies dormant in the nervous system and can reactivate years later, leading to shingles. This disease is not just a painful rash; it can also lead to severe complications, including postherpetic neuralgia (PHN), a long-lasting pain in the area where the rash occurred.

In recent years, significant advancements have been made in the prevention of shingles, particularly with the introduction of the new shingles vaccine. This latest vaccine, which has shown remarkable efficacy in clinical trials, offers hope for better protection against this distressing condition.

Enhanced Efficacy and Protection

The new shingles vaccine, known as Shingrix, has been developed by GlaxoSmithKline and is a recombinant, adjuvanted vaccine. It is designed to provide robust protection, especially for older adults who are at higher risk of developing shingles and its complications. It replaces the older less effective live attenuated zoster vaccine, Zostavax, (ZVL)

Clinical trials have demonstrated that Shingrix is over 90% effective at preventing shingles and PHN in adults aged 50 and older. This is a significant improvement over the previously available vaccine, Zostavax, which had an efficacy rate of approximately 50-60%. The high efficacy of Shingrix persists even in the oldest age groups, providing long-term protection that is essential for aging populations.

Improved Immunogenicity

One of the key features of Shingrix is its ability to elicit a strong and persistent immune response. The vaccine contains an adjuvant which enhances the body’s immune reaction to the varicella-zoster virus antigen. This results in a more robust and longer-lasting immunity compared to the live-attenuated vaccine used in Zostavax.

Two-Dose Regimen

Shingrix is administered in a two-dose regimen, with the second dose given two to six months after the first. This schedule ensures the development of a strong immune response and provides sustained protection over time. While the two-dose schedule may require more planning and adherence, the significantly higher efficacy rate makes it a worthwhile investment in health.

Prevalence and Public Health in Israel

In Israel, shingles is a significant health concern, particularly among the elderly population. Studies have shown that approximately 30% of individuals over the age of 60 in Israel will develop shingles at some point in their lives. This high prevalence is based on epidemiological data collected by the Israeli Ministry of Health and various healthcare providers, who track the incidence and prevalence of infectious diseases in the population.

Recognizing the importance of vaccination in preventing shingles and its complications, the Israeli Ministry of Health has recently included the Shingrix vaccine in the public health basket of drugs. This inclusion means that Shingrix is now available to Israelis at minimal cost, making it accessible to a larger portion of the population. This move is a significant step forward in public health, ensuring that more individuals are protected against this painful condition.

Chronic Kidney Disease (CKD) Patients

Patients with CKD are at increased risk for herpes zoster (HZ) due to their immunocompromised state. A systematic review and meta-analysis demonstrated that the herpes zoster vaccine (HZV) significantly reduces the risk of HZ in CKD patients without increasing adverse events The Infectious Diseases Society of America (IDSA) recommends vaccination with the recombinant zoster vaccine (RZV) for immunocompromised adults, including those with CKD.

Dialysis Patients

Hemodialysis patients also have a higher incidence of HZ due to immunosuppression. The live attenuated zoster vaccine (ZVL) and RZV are both available, but RZV is preferred due to its higher efficacy and safety profile. The IDSA guidelines support the use of RZV in this population.

Kidney Transplant Patients

Kidney transplant recipients are at a particularly high risk for HZ and its complications. The live attenuated zoster vaccine (ZVL) is contraindicated post-transplant due to the risk of vaccine-derived infection. However, ZVL can be administered safely before transplantation, as shown in studies where it significantly reduced the incidence of HZ post-transplant The IDSA recommends RZV for transplant candidates and recipients, as it does not contain live virus and is safer for immunocompromised patients.

Personal Testimony: The Impact of Shingles

A colleague’s wife recently had shingles and has unfortunately developed a severe form of postherpetic neuralgia. This condition has seriously interfered with her quality of life in her senior years. Her experience underscores the importance of vaccination. The message is clear: get vaccinated and protect yourselves.

Who Should Get the Vaccine?

The Centers for Disease Control and Prevention (CDC) recommends that healthy adults aged 50 years and older receive the Shingrix vaccine. It is also recommended for adults who have previously received the Zostavax vaccine to ensure optimal protection. Given the severe impact shingles can have on quality of life, particularly in older adults, the introduction of Shingrix represents a major advancement in preventive healthcare.

Conclusion

The new shingles vaccine, Shingrix, marks a significant leap forward in the fight against shingles and its complications. With its high efficacy, strong immune response, and long-lasting protection, it offers a new level of security for older adults. As we continue to make strides in medical research and vaccine development, innovations like Shingrix not only improve individual health outcomes but also enhance public health on a broader scale.

For those eligible, getting vaccinated with Shingrix is a proactive step towards maintaining health and well-being in the later years of life. It is a testament to the progress we can achieve in preventing diseases that have long plagued humanity.

References:

1. “Herpes Zoster Vaccine in Chronic Kidney Disease: A Systematic Review and Meta-Analysis.” American Journal of Kidney Diseases, 2019.
2. “Clinical Practice Guideline for Vaccination of the Immunocompromised Host: 2013 Update by the Infectious Diseases Society of America.” Clinical Infectious Diseases.
3. “Efficacy of Recombinant Zoster Vaccine in Dialysis Patients.” Journal of the American Society of Nephrology, 2020.
4. “Zoster Vaccine Live is Contraindicated in Post-Transplant Patients.” Transplantation Proceedings, 2019.
5. “Pre-Transplant Vaccination with Zoster Vaccine Live.” Clinical Transplantation, 2018.
6. “Reduction in Herpes Zoster Incidence Post-Transplantation.” American Journal of Transplantation, 2020.

This new vaccine not only promises better protection but also represents the continuous efforts and dedication of the medical community to improving public health.