Castilla-La Mancha has already acquired close to 65,000 herpes zoster vaccines to protect the population over 65 years of age. One in three people will get shingles, and it is essential to take steps to prevent it. Especially in advanced ages. “I am 65 years old and this year I have already received the COVID, flu and pneumococcal vaccines… And on top of that, now they tell me that I have the herpes zoster vaccine? Is it really necessary?” The answer is a resounding yes.
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 herpesvirus that once the chickenpox has passed has the ability to remain “asleep” or latent in our body. When the defenses go down, the virus reactivates and produces shingles.
Specifically, the chickenpox virus settles in the dorsal ganglia, nests produced by the cluster of bodies of sensory neurons, that is, those that transmit sensations such as pain or heat.
When the virus is reactivated, it travels down the sensory nerves, producing lesions on the skin similar to those of chickenpox. The difference is that they are located in the area that innervates the nerve. In addition to skin lesions, it causes nerve irritation, giving rise to neuropathic pain, which does not improve with the usual analgesics.
Intense and long-lasting pain
In Spain they are diagnosed between 150,000 and 200,000 cases of shingles each year. It is more frequent when the defenses are lowered. And that can happen as a consequence of certain diseases or, simply, as a consequence of the passing of the years. Especially from the age of 50 or 60, which is when an age-related loss of immunity called immunosenescence occurs. This is more intense in women and in people with chronic diseases such as diabetes, respiratory, kidney or heart diseases.
Shingles can cause intense pain that greatly affects quality of life. One of the first cases I saw was a 60-year-old woman who told me that she was afraid to go to bed because just the contact of the sheet with the herpes area caused her intense pain, as if she were sprayed with boiling water. As she could not be otherwise, this was accompanied by insomnia and difficulty in performing daily tasks, which ended with social isolation as she did not want to leave the house and led to significant depression.
The pain can last between 15 days and 3 months.
The pain of shingles can last anywhere from 15 days to 3 months. Occasionally it lasts longer and is what is called posherpetic neuralgia, a neuropathic and disabling pain that can last even one or two years. This is a frequent and feared complication for what affects the life of those who suffer from it, being the most frequent cause of neuropathic pain treated in pain clinics. And the likelihood of this complication increases with age: in people over the age of 80, as many as one in two with shingles may develop it.
In addition to postherpetic neuralgia, there are other important neurological complications, such as encephalitis. To make matters worse, it has recently been described how herpes zoster causes vascular alterations that increase by 55% the risk of cerebrovascular accidents in the year following the onset of shingles and more than one 30% of heart attacks. Herpes can also cause deafness or blindness.
Why should we protect ourselves?
A new vaccine has recently been licensed –Hz/su (Shingrix)– for the prevention of herpes zoster. It carries the antigenic component, which is a glycoprotein similar to that of the virus, and an adjuvant that acts as an immunity enhancer. Thus the organism’s response to the antigen is higher and more durable.
In clinical trials, in which Spain participated very actively, it was shown to prevent 9 out of 10 cases of herpes zoster in people over 50 years of age. Another detail to take into account is that it is equally effective at all ages, which means that immunosenescence does not affect the efficacy of the vaccine. Its high efficacy has also been proven in people with diseases that cause severe immunosuppression.
In addition, the duration of protection is high. In a follow-up of up to ten years, it has been seen that protection practically does not decline over time.
Given the great efficacy of the vaccine and the impact of herpes zoster, the Ministry of Health of Spain has recommended vaccination in all people with severe immunodeficiencies (HIV, solid organ transplants, solid tumors undergoing chemotherapy treatment…) and in people aged 65 and over from 2022. Depending on the availability of doses, it will be captured and vaccinated in the following years to those who turn 80 and the age will be lowered until reaching those who were vaccinated at 65.
In the USA they have been administering this vaccine for 5 years, having demonstrated a high effectiveness that is maintained with age, with a very good profile of security.
two doses
For the vaccine to work it must be given in two doses. The recommended interval between doses is 2 to 6 months, although it may be one month in people with severe immunodeficiency.
The adjuvant produces an inflammation that improves the response to the vaccine. That explains why the vaccine causes some reaction, mainly redness and pain in the injection area. It is also common for side effects such as low fever, headache or muscle aches to appear, but they are short-lived and improve with paracetamol.
This vaccine, due to its great efficacy and duration, is the first adult vaccine that behaves like a child vaccine. If we vaccinate all children to improve their health, why don’t we vaccinate adults?
Javier DiezHead of the Vaccine Research Area, Fisabio
This article was originally published on The Conversation. read the original.
