Transcription:
Shingrix - New Shingles Vaccine

Melanie Cole (Host): According to the CDC, almost one of every three people in the United States will develop shingles, also known as herpes zoster, at some point in their lifetime, but when it comes to preventing the painful rash and blisters of shingles, a new vaccine has arrived that promises to be more effective at protecting people from these agonizing symptoms. My guest is Dr. Elizabeth Wright, she's a family medicine physician with Hendricks Regional Health. Dr. Wright, why don't we start with a little explanation or definition of shingles? What is it, and what causes it?

Dr. Elizabeth Wright, MD (Guest): Shingles is caused by the virus chicken pox, which almost everyone over the age of forty has had at some point in their life. When we get chicken pox, the immune system fights it, it then lays dormant in our nerves, and as our immune systems starts to wane as we get older, that virus comes back out and can cause these painful and burning blisters in a certain part of the body.

Melanie: Dr. Wright, I know this is a little bit of an area of controversy, but if you did not get chicken pox as a child, are you then not subject to shingles? Or if you got the chicken pox vaccine as a lot of kids now are, will they not be subject to shingles?

Dr. Wright: Well those children who receive the chicken pox vaccine are not yet at the age that we can really say that they will not be susceptible to shingles, but that is our belief that if you did not have chicken pox, or you had the vaccine as a child, that you will not suffer from this disease.

Melanie: Thank you for clarifying that. So who is at risk as far as the age group? And are there certain genders? And also, does stress exacerbate? Because we've also heard that stress can kind of help cause the shingles. Is that true?

Dr. Wright: Yes, so shingles does not discriminate based on gender, it does become more frequent as people get older. However in my practice I'm seeing at a younger age, people in their late-thirties to forties who are even seeing this disease, but it becomes much more common as you get into the eighties. And as far as stress is concerned, certainly that increases the risk of shingles. So anytime that the body is stressed, whether that be emotional or because of other diseases, you are much more likely to break out in a shingles rash.

Melanie: So what are the symptoms, and who would diagnose it? Because sometimes I've heard of dermatologists being the one to catch it, or do you go to an internist? How do you even know?

Dr. Wright: Most people are going to be diagnosed either an immediate care setting, or by their family practitioner, or internal medicine doctor.

Melanie: What's the treatment? Is there any treatment available?

Dr. Wright: It is treated with a couple of medicines. They are Acyclovir and Valacyclovir, and those are anti-viral medicines that we use for several diseases, but they are good at treating shingles.

Melanie: So now onto prevention, and possible prevention. There's been a vaccine that's been around for quite a while, Zostavax, but now there's Shingrix. Tell us about the difference and about who should be getting this vaccine.

Dr. Wright: Zostavax has been with us for quite some time and was really the only thing that we had to prevent shingles. It prevented about 51% of cases of the shingles rash, but more importantly it prevented 67% of postherpetic neuralgia, which is a debilitating pain that can last long after the rash has resolved. Shingrix, however, prevents 97% of shingles cases, which is obviously much better than the Zostavax, and prevents 86% of cases of postherpetic neuralgia.

Melanie: So at what age do you think that people should start asking about this new vaccine and possible be getting it?

Dr. Wright: Shingrix is approved down to fifty years old, so that's a big change from the Zostavax as well. With Zostavax, we were only approved down to the age of sixty. The CDC started recommending it to be done earlier, but it wasn't being covered. So now we have Shingrix that is approved down to the age of fifty and should be covered by insurance down to the age as well.

Melanie: Who should not receive this vaccine?

Dr. Wright: The same as Zostavax, anyone who is immunocompromised should not receive Shingrix, however that's really just because we don't have the safety information on it yet, because it's not been in the market long enough. It is quite possible because Shingrix is not attached to- it's not a live vaccine, there's no live virus in it, it's quite possible that the immunocompromised will be able to receive this vaccine once we have the safety data.

Melanie: Are you and your fellow physicians asking your patients who have been vaccinated with Zostavax to come back in and receive this new vaccination?

Dr. Wright: We are, and that's really because in recent years we have found that Zostavax, its effectiveness has started to decrease after about three years after receiving the vaccine, and the Shingrix does not appear to do the same thing. So we believe that Shingrix is going to last a lot longer because the immune response is so much better after receiving Shingrix, so we are asking that people come in and receive this new vaccine.

Melanie: Will it need a booster do you think?

Dr. Wright: So the Shingrix is a two-part immunization. You get one at the first visit, and then you get a second immunization two to six months following that, so you do have to get both shots to be completely effective, but then we don't believe it's going to need a booster; time will tell, however.

Melanie: If somebody does unfortunately get shingles, and you mentioned the postherpetic neuralgia before, that pain and that rash, and you mentioned the anti-viral treatment, but what about the pain and the fact that some people report that that pain lasts six months or even longer. What do you tell them about dealing with it and things that they can do at home to help kind of deal with some of the pain of shingles?

Dr. Wright: The pain during the rash can be aided by Prednisone, which is a prescription medicine. So oftentimes we use that to decrease the pain in addition to the anti-viral. Anti-inflammatories and Tylenol can help to some extent. Really this is why this vaccine is so important, because the pain is very difficult to treat. I have several patients of mine who have this lasting pain. I have a couple patients who have postherpetic neuralgia that has been ongoing for years, and it's very difficult to treat. So learning how to manage that pain with behavioral techniques has been very important for them. But medication-wise there's often not a lot to be done.

Melanie: And people can also try calming modalities such as meditation, wet compresses, Calamine lotion, or colloidal oatmeal baths, and so many other things. Dr. Wright, wrap it up for us with your best advice so that hopefully people don't have to deal with the pain of shingles. What you really want them to know about possibly preventing it, the Shingrix vaccine, and what they can do if they do come down with shingles.

Dr. Wright: I think that it is a very important thing for us to be discussing. Shingrix is new on the market, most people are going to think that because they've already had the shingles immunization, that they are covered, and that they don't need anything else, but it's important for us to be talking about how effective Shingrix is, and how important it is to get this vaccination so that we no longer have to deal with the post-shingles pain that our medicines are really limited in being able to deal with.

Melanie: Certainly true, and thank you so much for joining us today, Dr. Wright. This is Health Talks with HRH, Hendricks Regional Health. For more information please visit www.Hendricks.org. That's www.Hendricks.org. This is Melanie Cole, thanks so much for tuning in.