The fields of medicine, health, and well-being seem to be moving targets. The more we learn, the better our treatment and lifestyle choices can be. New developments often change the landscape of how we manage our diseases.
Last week I visited my rheumatologist for a routine appointment. Although with recent illnesses (e.g., multiple respiratory infections), my routine appointments have become much more frequent. Additional fallout of increased disease activity and infections has included changes in medication (switching from oral to injected methotrexate), rearranging my usual rituximab infusion schedule, and multiple rounds of antibiotics. Needless to say, the past six months have been crazy in balancing health and sickness.
Are Your Vaccines Up To Date?
During last week’s doctor visit, my rheumy and I reviewed some of my more recent (within the past 10 years) vaccination history. Most importantly she wanted to make sure that I’ve had both of the two pneumonia vaccines, one of which I do need to have repeated because it’s been more than 5 years.
Here’s the brief rundown of my current vaccinations:
- Tetanus vaccine, every 10 years (due next year) — check
- Diphtheria, tetanus, pertussis 1-time adult booster shot, aka Tdap — check
- Pneumococcal polysaccharide vaccine, aka PPSV23 or Pneumovax23 — check
- Pneumococcal conjugate vaccine, aka PCV13 or Prevnar13 — check
- Shingles (herpes zoster) vaccine — nope
For both Pneumovax23 and the tetanus vaccine, I am due for repeat vaccinations next year. For the Prevnar13 vaccine, I’m good for awhile longer. But the shingles vaccine has not been an option because until now, it has only been available in a live virus form.
Avoid Live Virus Vaccines With RA
It’s important to remember that those of us living with rheumatoid arthritis who use immunosuppressant medications, such as one of the biologics or methotrexate, should avoid receiving live virus vaccines for risk of developing the infection. This is why the shingles vaccine has been off limits.
I haven’t been concerned with the shingles vaccines because I developed a case of the disease in 2005 after a 5-day course of high-dose intravenous steroids and shortly before my diagnosis with multiple sclerosis. Developing shingles, which is a recurrence of the same virus that causes chickenpox, is believed to provide some level of immunity against the virus for a small number of years.
The original shingles vaccine, called Zostavax, was approved by the Food and Drug Administration (FDA) in 2006 for use in adults aged 60 years and older. In 2011, the FDA expanded the use of the vaccine to adults 50 and older. Zostavax contains a live virus and is not appropriate for people using immunosuppressant medication. In either case, it is not an option for me.
New Shingles Vaccine – News To Me
However, my rheumatologist has now recommended that I receive a shingles vaccine. My eyes got a little large when she told me this. “There’s a new vaccine that doesn’t contain a live virus,” she stated. My response was — “wow, now that’s news to me!”
The new vaccine, called Shingrix, was approved on October 20, 2017 by the FDA for the prevention of shingles (herpes zoster) in adults aged 50 years and older. Shingrix is a non-live, recombinant subunit vaccine given intramuscularly in two doses, spaced 2 to 6 months apart. It’s important to complete the course and receive both injections.
On October 25, 2017, the Advisory Committee on Immunization Practices (ACIP) voted that Shingrix is1:
- recommended for healthy adults aged 50 years and older to prevent shingles and related complications
- recommended for adults who previously received the current shingles vaccine (Zostavax®) to prevent shingles and related complications
- the preferred vaccine for preventing shingles and related complications
Once approved by the Center for Disease Control and Prevention (CDC) director, these ACIP recommendations will be published in the Morbidity and Mortality Weekly Report. At that time, the recommendations will become official policy.
Putting Vaccines On The Calendar
With the availability of this new vaccine and my quickly approaching 50th birthday, it’s a good time to begin to map out how I might orchestrate the administration of each of the vaccines that are needed (or desired) next year. With rituximab, it’s best to receive any vaccination at least a month before infusions, but also as long as possible after infusions, to maximize the immune response.
Next year’s health calendar promises to be a challenge as we — doctor and patient — make sure that everything gets done in a timely fashion.
Be well my friends,