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James Hamilton, M. D.
Mike,
That's not being bold, but rather is a good question.
As you may be aware there are two shingles vaccines available: Zostavax, a live-attenuated vaccine approved in 2006 and the new one, Shingrix, an adjuvanted, recombinant vaccine approved in 2017. The live-attenuated vaccine cannot be given to patients with compromised immune systems.
Zostavax is a one shot vaccine whereas Shingrix is administered in two doses at day 0 and then again 2-6 months later. The efficacy of Zostavax is age dependent in that if given in the 50's it is about 70% effective and declines to 41% if given in the 70's, 18% in the 80's. Shingrix's efficacy is 97%, 91% and 91% in those three age groups. However, the duration of Shingrix's protection is unknown but data suggest it will last for at least 9 years. Patients who have received Zostrix in the past can also receive Shingrix.
The main problem with Shingrix is that it causes a higher incidence of side effects than does Zostrix. These include constitutional symptoms such as fever (21%), headache (38%), GI symptoms (17%), muscle aches (45%), fatigue (45%), and shivering (27%) as well as localized effects of injection site pain (78%), redness (38%) and swelling (26%). Due to these effects some patients decide not to get the second dose which decreases its protection.
The American Committee on Immunization Practices recommends that healthy adults >50 years of age receive Shingrix.
Jim
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