New Shingles Vaccine: Great News for RA Community

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,
Lisa

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
  1. https://www.cdc.gov/shingles/vaccination.html

Comments

View Comments (12)
  • DCSharon
    5 months ago

    Posting a caveat emptor for those considering the Shingrix vaccine. While the vaccine contains a deactivated virus, and has been shown to be more effective than Zovarax, it has a powerful, never before used adjuvant known as QS-21. Adjuvants are often added to vaccines to boost the immune system, ensuring an immune response to the attenuated pathogen. For people with weakened immune systems, such as the elderly, this can be beneficial. HOWEVER, for those of us with RA, whose immune systems are hyperactive and hyper-reactive, the QS-21 adjuvant may induce a flare. As an N=1, I received the first Shingrix vaccine in April. While I experienced side effects for 2-3 days afterward (mild fever, headache, muscle/joint pain), what followed about a week later was the WORST RA flare I have ever experienced. Literally every joint, from my jaw to my toes, was aching and swelling. Increasing prednisone as well as DMARDS did nothing to help. Lab work showed I had presence of anti-ds DNA (usually only found in lupus patients), and low levels of complement C3c and C4c (again, low levels typically only found in lupus), in addition to elevated anti-CCP, RF, CRP, and Sed Rate, clearly demonstrating that my immune system was in overdrive. I can’t help but associate the flare with the adjuvant in the vaccine, and after some sleuthing, discovered a genetic variant that is correlated with autoimmune reaction to adjuvants that is also associated with RA. (HLA-DRB1*0404). Since QS-21 is so powerful and is new, please consult your rheumatologist prior to administration and proceed with caution. I will be reporting the reaction I experienced to the Vaccine Adverse Event Reporting System of HHS.

  • RAWarrior
    6 months ago

    Does anyone know if Shingrix – the non-live shungles vaccine is OK to take while on a biologic like orenica?

  • SenSen
    11 months ago

    I was not informed before I got the shingles shot that it was developed using cells from an aborted baby. Had I known that, I would not have gotten the vaccine; I would have preferred the physical pain of shingles (and yes,I know how horrible it is; m grandmother had it). I feel terrible knowing that I benefitted from an aborted child’s death. It is against my faith and my ethics. We deserve to be informed before these vaccines are given.

  • bagglady
    11 months ago

    I am not sure this is correct information. I am a nurse and I do not follow how this could be correct. Where did the information come from.

  • Kay
    12 months ago

    This is such great news! I developed shingles in April of this year and it covered my whole left side front and back chest-it was excruciating. The pain lasted for nearly 5 months, and the scarring from the rash is still visible, though it is fading and occasionally itches. I will definitely discuss this with my Rheumy because I don’t want to have it that severe ever again if possible. Thanks!

  • Lisa Emrich author
    12 months ago

    Hi Kay,

    I’m so sorry that you experienced such a bad case of shingles this year. I hope that any remaining pain continues to go away. It took some time for my own post-herpetic neuralgia after shingles to finally go away.

    –Lisa

  • Richard Faust moderator
    12 months ago

    This is great news. Thanks for writing this up Lisa. I’m going to let Kelly know. She already had shingles once and it would be great to remove that cloud. Plus, I never had chicken pox, which creates problems sharing a house with someone with shingles. Best, Richard (RheumatoidArthritis.net Team)

  • Lisa Emrich author
    12 months ago

    Hi Richard,

    I hope that you are able to avoid chickenpox and that Kelly avoids any further episodes of shingles. Best wishes to you both.

    –Lisa

  • Lawrence 'rick' Phillips
    12 months ago

    I had an unfortunate turn a few years back and had to go off of my biologics. Since i had a rather nasty case of Shingles, my rheumatologist decided I could do it provided i gave up some months of a biologic. I got it and am thankful. Shingles have not returned, thank God.

    This is great news. I am happy for the many people who had wait.

  • Lisa Emrich author
    12 months ago

    Hi Rick,

    I’m sorry that you had to go off your meds, but glad that the vaccine has seemed to work for you. Awesome!

    –Lisa

  • Carla Kienast
    12 months ago

    Lisa: Thanks so much for this great news. I’ve resisted getting the live shingles vaccine for the reasons you outlined in your article. I had an aggressive case of chicken pox as a child and, since my teens, regularly battle massive cold sores (another cousin virus). I’ve worried about an outbreak of shingles, which can be painful and debilitating. I see my rheumy right after the first of the year and will discuss with her. (Intramuscular injections are not my idea of fun, but better that than shingles!)

  • Lisa Emrich author
    12 months ago

    Hi Carla,

    After thinking for so many years that the shingles vaccine would not be an option, it’s a little strange to know that it will be. The time I had shingles in 2005 was not too horrible, but I think that’s because I started antiviral treatment almost immediately.

    –Lisa

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