Internal Medicine, Lipid & Wellness of Fort Myers Newsletter

Dr. Kordonowy

Dr. Marconi

Review of Therapy:

Shingles Vaccination

From Dr David Marconi MD

As I am now completing my first year in private practice with Dr. Kordonowy, many of my patients are due for their annual review. All patients of the practice have or will received our annual health maintenance letter about one year after your last physical. This letter highlights topics that Dr Kordonowy and I have discussed as relevant points for health maintenance, prevention of disease, or early disease detection. Many of you have had questions regarding recommended vaccines especially considering the recent COVID Vaccine debacle. We must keep in mind that other vaccines have provided significant benefit, limiting disease and complications for other illnesses. Dr. Kordonowy and I both understand that your trust has been shaken by many leaders in the medical society, but we aim to remain pillars of honest guidance in your healthcare.

The focus of this newsletter is the shingles vaccination as that question has been presented frequently.

** Click the links within the text for more information and references.

What Vaccines are available?

Shingrix

Two-dose series recombinant vaccine

(current recommendation)

Zostavax

Single-dose live attenuated vaccine

(No longer offered as of 2020)

Purpose of vaccination

Shingles is a contagious rash caused by the herpes zoster or chickenpox virus. It is a reactivation of the chickenpox virus also known as the herpes zoster virus. The rash from shingles usually starts as tingling or itching in a well-defined area of skin, progressing to an eruption of a painful burning and blistering rash. Unfortunately for many patients the pain can persist even after the rash is gone. This ongoing pain is called postherpetic neuralgia. The shingles rash usually blisters and scabs over within 7-10 days and clears within 2-4 weeks. Often patients only get shingles once, however for the unfortunate few it can recur. Shingles affects approximately 1 in 3 adults in their lifetime. Vaccination against shingles is recommended for adults aged 50 and over to prevent an outbreak of shingles or reduce the complications related to the rash.

Effectiveness of the vaccine

The prior vaccine, Zostavax was given as a single dose and recommended for patients 60 years and older. The newer formulation of the shingles vaccine called Shingrix is given in a 2-dose series for patients 50 and older. Shingrix was approved for use after a large randomized, placebo-controlled, observer-blind clinical study of nearly 30,000 patients across 18 countries. Shingrix was shown to be more effective than placebo at preventing shingles. Shingrix was able to prevent ANY outbreak of shingles in 96% of persons aged 50-69, and 91% of persons aged 70 and older for at least 3 years. Immunity seemed to be durable for up to 7 years. Furthermore, if shingles was to occur the disease severity was less. Specifically, Shingrix vaccination was able to limit the risk of ongoing pain after resolution of the rash called postherpetic neuralgia. There was a 91% reduction in risk of ongoing pain or postherpetic neuralgia for patients aged 50 and older, and an 89% reduction of ongoing pain or postherpetic neuralgia for patients aged 70 and older who received the vaccine and yet still got shingles. In contrast the older Zostavax was only 51% effective at preventing shingles and 67% effective at preventing ongoing pain following a shingles outbreak.

Side effects

The most common side effects of shingles vaccination are local reactions. Patients who received the vaccine reported injection site pain redness and swelling with most reactions resolving in 1 to 3 days. Some patients reported body aches, fatigue, dizziness, or headaches. In the clinical trial more than 95% of patients completed the 2-dose series, while only about 5% discontinued due to intolerable side effects. Rare side effects may also include allergic reactions or muscle weakness called Guillain-Barre syndrome.

What to do if you have side effects?

Over-the-counter medications that reduce pain and inflammation can limit most common side effects of shingles and other vaccines. For most patients taking a few doses of Tylenol/acetaminophen or ibuprofen/Advil can help to reduce symptoms. Always follow package instructions or contact the office for recommendations if unsure how to manage symptoms.

If symptoms are not controlled with over-the-counter (OTC) medications or are severe in nature please contact the office for further evaluation and recommendations.

Administration

Shingrix is a 2 dose vaccine series injected into the muscle of the upper arm.

The second dose is administered 2 to 6 months following the first.

Zostavax was a single dose vaccine also injected into the muscle of the upper arm.

Price

The Shingrix vaccine cost approximately $320 for the 2-dose series.

Subject to price fluctuation.

Who should consider vaccination?

Adults age 50+

Adults age 19+ with weakened immune systems from a disease or medical therapy.

Who Should not receive the vaccine?

Anyone with an active shingles rash.

Anyone with a history of Guillain-Barre Syndrome.

Anyone currently pregnant should defer vaccination until after pregnancy.

Anyone who has had an allergic reaction to the first dose of Shingrix.

FAQ:

-Can I receive the Shingrix vaccine if I have already received Zostavax?

Yes

-Can I receive the vaccine if I have already had Shingles

Yes, once the rash has resolved.

-How long it is shingles contagious?

Herpes zoster or shingles virus can be transmitted from direct contact with fluid from the blisters until they dry and crusted over. Active lesions should be covered until they are dry and scabbed.

-Can I receive the Shingrix vaccine if I have an active shingles outbreak?

No, you are recommended to hold off until shingles has resolved.

-Is there other treatment for shingles?

Yes, if you have an outbreak, you should contact the office quickly to consider treatment, earlier treatment offers better outcomes.

-Is shingles vaccination included in the membership?

No, while we do administer shingles vaccination in the office, it is offered at an additional cost. We will order the medication at wholesale pricing and pass that cost to you without markup. Vaccines are ordered in batches for patient administration when requested. Please contact the office for up-to-date pricing and availability.

-Is shingles vaccine covered by insurance?

Yes, many insurance companies may cover the shingles vaccine when appropriate criteria is met. To utilize insurance coverage you will need to visit your local pharmacy for administration.

Internal Medicine Lipid & Wellness Practice of Fort Myers

Thank you for reading, please reach out if you have further questions regarding shingles vaccination. If you would like to schedule an appointment please contact the front office.

Here at Internal Medicine Lipid and Wellness we pride ourselves on providing excellent patient centered preventative and diagnostic care for patients aged 16 and up.

The best compliment you can offer a doctor is a patient referral. I look forward to helping your friends and family!

Sincerely,

Dr David Marconi MD

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