Why should we get the herpes zoster vaccine now?

I am 65 years old and this year I have already been vaccinated against covid, influenza and pneumococcus … And on top of that, now they tell me that I have a herpes zoster shot? Is it really necessary?

The answer is a firm yes. One in three people develop shingles, and it is important to take steps to prevent it. Especially in old age.

What is herpes zoster?

After adolescence, most people around the world have either had chickenpox or been vaccinated against it.

This disease is caused by the varicella-zoster virus (VZV), a herpes virus that, after chickenpox has passed, has the ability to remain “dormant” or latent in our bodies. When the defenses weaken, the virus reactivates and causes shingles.

In particular, the varicella-zoster virus settles in the dorsal ganglia, nests formed by clusters of sensory neuron bodies, that is, those that transmit sensations such as pain or warmth.

When the virus reactivates, it travels along sensory nerves, causing skin lesions similar to those that occur with chickenpox. The difference is that they are located in the area that innervates the nerve. In addition to damaging the skin, it causes irritation of the nerves, causing neuropathic pain that is not relieved by conventional analgesics.

Intense and prolonged pain

In Spain, between 150,000 and 200,000 cases of herpes zoster are diagnosed each year. More often happens with reduced protection. And this can happen as a consequence of certain diseases or simply as a consequence over the years. Especially at the age of 50 or 60, when there is an age-related loss of immunity, called immunosenescence. It is more pronounced in women and in people with chronic conditions such as diabetes, respiratory, kidney or heart disease.

Shingles can cause severe pain that greatly affects the quality of life. One of the first cases I saw was of a 60-year-old woman who told me that she was afraid to go to bed because the mere contact of a sheet with a cold sore area caused her severe pain, as if she had been splashed with boiling water. . How could it be otherwise, this was accompanied by insomnia and difficulty in performing daily tasks, which ended in social isolation, as he did not want to leave the house and led to significant depression.

Shingles pain can last from 15 days to 3 months. Sometimes it lasts longer and is what is called postherpetic neuralgia, a neuropathic and disabling pain that can last even one or two years. It is a common and dangerous complication that affects the lives of those who suffer from it and is the most common cause of neuropathic pain treated in pain clinics. And the likelihood of this complication increases with age: in people older than 80 years, it can develop in every second patient with herpes zoster.

In addition to postherpetic neuralgia, there are other important neurological complications such as encephalitis. To make matters worse, herpes zoster has recently been described as causing vascular changes that increase the risk of cerebral vascular accidents by 55% within a year of onset of zoster and more than 30% of myocardial infarctions. Herpes can also cause deafness or blindness.

Why do we need to protect ourselves?

A new vaccine, Hz/su (Shingrix), has recently been licensed for the prevention of herpes zoster. It carries an antigenic component, which is a glycoprotein similar to that of a virus, and an adjuvant that acts as an immune enhancer. Thus, the reaction of the body to the antigen is higher and more durable.

In clinical trials in which Spain has been very active, it has been shown to prevent 9 out of 10 cases of herpes zoster in people over 50 years of age. Another detail to consider is that it is equally effective at any age, meaning that immune aging does not affect the effectiveness of the vaccine. Its high efficiency has also been proven in people with diseases that cause severe immunosuppression.

In addition, the duration of protection is high. At follow-up for ten years, it was observed that the protection practically does not decrease over time.

Given the high efficacy of the vaccine and the impact of herpes zoster, the Spanish Ministry of Health has recommended the vaccination of all people with severe immunodeficiency (HIV, solid organ transplants, solid tumors undergoing chemotherapy treatment…) and people aged 65 years as of 2022. Depending on the availability of doses, those who turn 80 years of age will be recruited and vaccinated in subsequent years, and the age will be reduced to those who were vaccinated at 65 years of age.

This vaccine has been used in the US for 5 years, showing high age-maintaining efficacy with a very good safety profile.

The vaccine must be given in two doses for it to work. The recommended interval between doses is 2 to 6 months, although in people with severe immunodeficiency it may be one month.

The adjuvant causes inflammation, which improves the response to the vaccine. This explains why the vaccine causes some reaction, mostly redness and pain at the injection site. Side effects such as mild fever, headache, or muscle aches are also common, but these are short-lived and improve with paracetamol.

This vaccine, due to its high potency and duration of action, is the first adult vaccine that behaves like a pediatric vaccine. If we vaccinate all children to improve their health, why don’t we adults get vaccinated?

Javier Diez, Head of Vaccine Research, Fisabio

This article was originally published on The Conversation. Read the original.

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