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Ask the Pharmacist
by Ron & Marla Chapleau

December 9, 2016
www.saugeentimes.com
www.kincardinetimes.com

Health

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Q) I understand there will be a new type of shingles vaccine that will be coming out soon. What can you tell me about it and should I hold off on getting the current one (Zostavax ll) in order to wait for it?

A) The new shingles vaccine, which is expected to be available to the general public sometime in late 2017 at the very earliest, is called Shingrix.

While it’s still a long way from being readily available it is still generating a lot of press since preliminary studies seem to indicate that it is likely to be more effective than its predecessor. This is because Shingrix includes an extra ingredient known as an adjuvant which is designed to boost your immune response to the vaccine.

An adjuvant is any substance that, when added to a vaccine, serves to either accelerate, prolong or enhance the response of your immune system making the vaccine more effective.

Adding an adjuvant is hardly ground breaking territory as they have been undergoing development and testing since at least the 1920’s. The downside of adding an adjuvant is that local injection site reactions such as arm pain or redness seem to be more common and more painful than they are in vaccines that are adjuvant free. It has been noted that it is relatively common for these types of reactions to somewhat interfere with your normal activities for one to three days afterwards.

This trade off may be worth it in the long run though as Shingrix looks to be substantially stronger than Zostavax. The raw data seems to indicate that vaccination with Shingrix prevents one case of shingles for every 37 people vaccinated whereas Zostavax would prevent one case for every 59 people it was administered to. There is also early data that indicated that Shingrix’ protective effects may last longer than those of Zostavax although it is still too early to confirm if this is indeed the case. That would be great news if it turns out to be true as one of the drawbacks to Zostavax is the relatively short period of time that it appears to offer protection against shingles for.

A study published in March of 2015 followed 2067 people for 11 years after they received a single dose of Zostavax. It was found that the vaccine’s effectiveness declined gradually with time and that after eight years it looked like it no longer worked in most recipients to prevent disease.

Another difference between the two vaccines is that Shingrix is an inactivated vaccine whereas Zostavax ll is a live vaccine.

Live vaccines contain a version of the living microbe that has been weakened in the lab so that it cannot cause disease. This tends to make for a better immune response (although once again, not in this case) but also means that these types of vaccines cannot be administered to those with weakened or impaired immune systems (such as someone with HIV or undergoing chemotherapy) due to the small but serious risk that the vaccine will harm them.

 Inactivated vaccines such as Shingrix do not pose this same risk to this significant subset of people. Both vaccines seem to work equally well at preventing post-herpetic neuralgia (PHN), the uncommon but potentially life altering pain that goes on indefinitely in an unlucky few long after the rash of shingles has disappeared.

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For every 350 vaccinated with either vaccine, one case of PHN is prevented over 3 to 4 years. That number is far from awesome, but again, PHN can be a brutal ordeal to go through.

One last point to consider, Zostavax requires only one injection whereas Shingrix is likely to involve a booster dose on top of the initial shot.

So, should you wait for the new vaccine or go ahead and get the Zostavax now? The answer probably depends a lot upon your age, your insurance and your health status.

 If you are between the ages of 65 and 70 (or if you’re 71 and can get to your doctor’s office before December 31st) the government will pay the full cost of the Zostavax for you. To me, between saving the cost of the vaccine (approximately $200 for those without private insurance coverage) and the opportunity to start being protected at least one year earlier than were you to wait for the official release of Shingrix, the Zostavax is a no brainer for this age group.

The vaccine works relatively well in this age group and for those who actually develop shingles the course of the infection tends to be tougher to get through as we age. For those over the age of 70, it probably makes sense to go with Zostavax for the earlier onset of protection but keep in mind that there is a reason the government does not pay for it. The vaccine quite simply is not nearly as effective in this age group.

For those in relatively good health who are younger, a case could be made to wait for the more effective and possibly longer lasting agent in late 2017 (hopefully) but it is definitely a nuanced decision.

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For more information about this or any other health related questions, please contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination in Port Elgin and Kincardine


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