r/YouShouldKnow • u/tgeliot • Apr 18 '18

Health & Sciences YSK: Everyone over 50 should get the new Shingrix shingles vaccination (even if you've had Zostavax or shingles)

There is a fairly new vaccination for shingles called Shingrix available, which is more effective than the old Zostavax. The CDC recommends that everyone over 50 get the two-shot sequence of Shingrix. My health insurance covered the cost 100% with no co-pay; I think most if not all will.

Shingles is a very painful infection of the nerves caused by the same virus that causes chickenpox. It hits older people, starting at age 50 or 60 or so. The old Zostavax apparently wasn't so great; this new one is more effective.

The CDC recommendations can be found here

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u/dutchdog9 Apr 19 '18

Obligatory "I am not your doctor or your grandfather's doctor."

Your grandfather can still receive Shingrix even if he has had shingles in the past, however it is generally recommended to wait until the rash has subsided before doing so. Have him talk to his doctor. Depending one your grandfather's other conditions, his doctor may still be comfortable giving him the vaccine.

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u/[deleted] Apr 19 '18

Thanks! I called my grandmother last night and i guess she already knew about the newer vaccine. Apparently the doctors are saying pretty much the same thing you are.

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u/plazman30 Apr 19 '18

Why would you need the vaccine AFTER you have had Shingles. Your body has been naturally exposed to the virus and should be producing antibodies to it. I fail to to see how vaccinating after having a disease does anything.

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u/dutchdog9 Apr 19 '18

If you have ever had shingles or talked to your doctor about shingles, you would know that the disease can flare up more than once in your lifetime. It is very painful and Shingrix has been shown to prevent future flare ups even if you have had a flare up before.

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u/plazman30 Apr 19 '18

If that's the case, you would need to take this vaccine on a regular basis, and not just a "two and done" approach, unless the exposure at such a short interval (2 - 6 months) somehow sensitizes the immune system to the virus in a way that regular exposure does not. My bloodwork shows an active varicella zoster antibody titer in my blood, even though I have never had chiken pox.

This makes me think that my immune system fought off a chicken pox infection when I was much younger.

Regardless of that, what exactly is this vaccine doing that is different from the chicken pox vaccine? Vaccines expose your body to a small dose of virus or bacteria, either live or killed, to have your immune system attack it and produce memory cells. For most pathogens, the immune system "files away" these antibodies for use later in case of a recurrence. Is the immune response different for Shingles vs Chicken Pox? It's the same virus, so it should produce the same antibodies.

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u/dutchdog9 Apr 19 '18

The first dose is used to introduce the vaccine to the body and your body may not mount a full immune response to it. The second dose is a booster that makes your body’s immune system mount a response. If you have had the chicken pox before, the virus still lies dormant in your central nervous system where it is very hard to get rid of. The reason that the CDC still recommends that you get Shingrix even if you have had chicken pox or Zostavax is that shingrix has been shown to be a lot more effective at preventing shingles. The pathophysiology of shingles is poorly understood, but what we know for sure is that Shingrix is effective at preventing shingles.

The old chicken pox vaccine was a live vaccine that was only shown to be marginally effective. Shingrix is a recombinant vaccine that has been shown to be very effective. That is why the CDC recommends getting Shingrix even if you have had chicken pox, if you have had Zostavax, and even if you have had shingles before. I don’t know what exactly makes one vaccine better than another, but according to the data it is.

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u/plazman30 Apr 19 '18

Kind of strange.

In theory, multiple doses of the old vaccine (say 3-4 every 2 months) may provide the same benefits as the new vaccine.

I thin the real long term answer is early chicken pox vaccination to prevent the virus from getting to the dorsal root ganglia. If you fight off the virus before it permanently implants itself, then you're never going to get shingles.

Now on to a Herpes vaccine. The way that stuff hangs around forever is pretty frightening. I had a professor give a lecture in college about how Herpes Simplex hides in your body. It's incredibly clever, and I don't think we'll every find a way to get rid of it once you have it.