Flu/shingles Shot Combo May Hurt Future Flu Vaccine Uptake
People who got the zoster vaccine the same day as their annual influenza shot were more likely to skip their flu shot the following year than people who got the two shots on separate days, according to results from a new study.
Evidence suggests that people mistakenly think adverse effects commonly related to the zoster vaccine including chills, fever, pain, and nausea are caused by the flu vaccine, researchers write in an original investigation published in JAMA Network Open.
The work by Benjamin Rome, MD, MPH, a primary care physician from the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital in Boston, and colleagues was November 19.
The study involved 89,237 people with an average age of 72 years. Researchers used Optum’s deidentified Clinformatics Data Mart Database, a national, commercial health insurance claims database that contains information on 17 million patients with commercial insurance and Medicare Advantage plans in all 50 states.
The cohort consisted of people at least 50 years of age who received the influenza vaccine between August 1, 2018 and March 31, 2019, and received the shingles vaccine on the same day or separately in the previous 6 months.
Those who had both shots the same day were significantly less likely than those who got them on different days to get their annual flu shot the next flu season . Results were similar across subgroups.
Who Should Get Shingrix
Adults 50 years and older should get two doses of Shingrix, separated by 2 to 6 months. Adults 19 years and older who have or will have weakened immune systems because of disease or therapy should also get two doses of Shingrix. If needed, people with weakened immune systems can get the second dose 1 to 2 months after the first.
You should get Shingrix even if in the past you:
- Had shingles
- Received varicella vaccine
There is no maximum age for getting Shingrix.
If you had shingles in the past, Shingrix can help prevent future occurrences of the disease. There is no specific length of time that you need to wait after having shingles before you can receive Shingrix, but generally you should make sure the shingles rash has gone away before getting vaccinated.
Chickenpox and shingles are related because they are caused by the same virus . After a person recovers from chickenpox, the virus stays dormant in the body. It can reactivate years later and cause shingles.
Shingrix is available in doctors offices and pharmacies.
If you have questions about Shingrix, talk with your healthcare provider.
* A shingles vaccine called zoster vaccine live is no longer available for use in the United States, as of November 18, 2020. If you had Zostavax in the past, you should still get Shingrix. Talk to your healthcare provider to determine the best time to get Shingrix.
What Are The Pros And Cons Of Being Vaccinated
The benefits of vaccination generally far outweigh any risks, Privor-Dumm says. Although vaccines do have some side effects, most are mild and temporary.
The bigger con is getting disease, which may lead to further health complications, she adds. For instance, people who are hospitalized with influenza have a greater likelihood of heart attack or stroke following their illness, and the economic consequences of a serious illness can be catastrophic for some. Thats why its best to prevent disease in the first place.
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Its Best To Have Shingrix Vaccine And Flu Shot On Different Days
- Dr. Keith Roach
DEAR DR. ROACH: Is it advisable to get the Shingrix vaccine at the same time as the annual influenza vaccine? T.H.
ANSWER: It can be done, but whenever possible, you should get the new Shingrix vaccine by itself. The side effects of this vaccine are more pronounced than with most approved vaccines, and more people may not feel well and will have low grade fever, muscle aches and fatigue that can last a day or two. Anecdotally, it seems that getting multiple vaccines the same day may worsen that reaction. I advise patients to get the Shingrix vaccine on a day where they have nothing critical planned that day or the next, just in case.
If you havent gotten this years flu vaccine, get it right now. Today, if possible.
DEAR DR. ROACH: I saw your recent article about a 57-year-old womans question about herpes, and thought it would be good to reach out to see if you could help me. I am struggling to find good information about my new condition.
A recent partner did not tell me he had HSV-2, and now I have it in my throat. I cannot find what precautions I need to take, unlike this unscrupulous person, to protect other partners. A nurse practitioner I spoke with suggested it could be passed by saliva, so even kissing and sharing forks, for example, are risky. Im not saying I dont believe that, but it is gloomy news that I have been unable to verify.
Dr. Keith Roach is a
Shingles Vaccine Has Well
The recombinant zoster vaccine, approved in 2017, has replaced the live attenuated zoster vaccine. The previous vaccine caused fewer adverse effects but was far less effective in preventing shingles in older adults.
The recombinant vaccine is now recommended for most adults at least 50 years of age as a one-time, two-dose series.
It is critical to discern the reasons people are not getting their flu shots because fewer than half of American adults get an annual flu shot. Of those, 30% cite potential adverse effects as the reason for hesitation.
However, only injection-site symptoms, such as pain, redness, and swelling, are known to be caused by the influenza vaccine.
Researchers adjusted for factors that could differ between the two study groups, including demographic, clinical, and healthcare use variables.
They also adjusted for insurance type, month, and location of the 2018/19 influenza vaccination, and concurrent administration of any additional vaccines besides the zoster vaccine.
“We also adjusted for several comorbidities known to increase the risk of complications from influenza, including hypertension, diabetes, cardiovascular disease, chronic obstructive pulmonary disease or asthma, chronic kidney disease, or liver disease, and immunocompromising conditions,” the authors write.
They also took into account whether people in the study had had the flu vaccine in the year prior to the study.
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Flu Vaccine For Older Adults
Flu short for influenza is a virus that can cause fever, chills, sore throat, stuffy nose, headache, and muscle aches. Flu is very serious when it gets in your lungs. Older adults are at a higher risk for developing serious complications from the flu, such as pneumonia.
The flu is easy to pass from person to person. The virus also changes over time, which means you can get it again. To ensure flu vaccines remain effective, the vaccine is updated every year.
Everyone age 6 months and older should get an annual flu vaccine, but the protection from a flu vaccine can lessen with time, especially in older adults. Still, you are less likely to become seriously ill or hospitalized with the flu if you get the vaccine. A flu vaccine is especially important if you have a chronic health condition such as heart disease or diabetes.
Ideally, you should get your vaccine by the end of October each year so you are protected when the flu season starts. It takes at least two weeks for the vaccine to be effective. However, if you have not received your flu vaccine by the end of October, its not too late flu season typically peaks in December or January. As long as the flu virus is spreading, getting vaccinated will help protect you.
Shingrix Dosage And Schedule
Shingrix should be administered to immunocompetent adults aged 50 years and older and adults aged 19 years who are or will be immunodeficient or immunosuppressed because of disease or therapy as a two-dose series , 2 to 6 months apart . However, for persons who are or will be immunodeficient or immunosuppressed and who would benefit from completing the series in a shorter period, the second dose can be administered 12 months after the first. See more detailed clinical guidance.
If more than 6 months have elapsed since the first dose of Shingrix, you should administer the second dose as soon as possible. However, you do not need to restart the vaccine series.
If the second dose is given less than 4 weeks after the first dose, the second dose should be considered invalid. A valid second dose should be administered 2 months after the invalid dose .
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Will There Be Any Side Effects From The Shingles Vaccination
There are 2 shingles vaccines: Zostavax and Shingrix .
With both vaccines it’s quite common to get redness and discomfort at the vaccination site, headaches and fatigue, but these side effects should not last more than a few days. See a GP if you have side effects that last longer than a few days, or if you develop a rash after having the shingles vaccination.
Read more about the shingles vaccine side effects.
When To See A Doctor For The Possible Side Effects Of A Shingle Vaccine
Most side effects of the shingles vaccine will resolve on their own within a few days of vaccination or can be treated with over-the-counter medications like acetaminophen or ibuprofen.
In the rare case that you develop a more serious reaction after vaccination, you should call a doctor or go to a health clinic.
Its rare but possible to have a serious allergic reaction to a shingles vaccine. Call emergency services or go to the nearest emergency room if you experience the following symptoms after a vaccination:
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Tetanus Diphtheria And Pertussis Vaccines
Tetanus, diphtheria, and pertussis are diseases caused by bacteria that can lead to serious illness and death.
- Tetanus is caused by bacteria found in soil, dust, and manure. It can enter the body through a deep cut or burn.
- Diphtheria is a serious illness that can affect the tonsils, throat, nose, or skin. It can spread from person to person.
- Pertussis, also known as whooping cough, causes uncontrollable, violent coughing fits that make it hard to breathe. It can spread from person to person.
Getting vaccinated is the best way to prevent tetanus, diphtheria, and pertussis. Most people get vaccinated as children, but you also need booster shots as you get older to stay protected against these diseases. The CDC recommends that adults get a Tdap or Td booster shot every 10 years. Ask a health care provider when you need your booster shot.
Extra Doses Of Vaccine Antigens
Administering extra antigens contained in a combination vaccine should be avoided in most situations . Using combination vaccines containing certain antigens not indicated at the time of administration to a patient might be justified when 1) the extra antigen is not contraindicated, 2) products that contain only the needed antigens are not readily available, and 3) potential benefits to the patient outweigh the potential risk for adverse events associated with the extra antigens. An extra dose of many live-virus vaccines and Hib or hepatitis B vaccine has not been found to be harmful . However, the risk for an adverse event might increase when extra doses are administered at an earlier time than the recommended interval for certain vaccines .
A vaccination provider might not have vaccines available that contain only the antigens needed as indicated by a childs vaccination history. Alternatively, although the indicated vaccines might be available, the provider might prefer to use a combination vaccine to reduce the required number of injections. In such cases, the benefits and risks of administering the combination vaccine with an unneeded antigen should be carefully considered and discussed with the patient or parent.
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Are There Any Restrictions After A Shingles Shot
You should not receive the shingles vaccine if you are pregnant, if you have an active shingles infection, or if you previously had an allergic reaction to any component of the vaccine. If youre eligible for the vaccine and receive the vaccination, there are no restrictions afterward and you can leave the doctors office or pharmacy as soon as the shot is complete.
Can The Shingles Shot Cause Guillain
Though rare, but Guillain-Barré syndrome can occur with both the shingles vaccine and the shingles virus itself.
Symptoms of this serious autoimmune disorder include a loss of sensation and muscle paralysis that tends to come on quickly, typically spreading up from your lower extremities.
It can be life-threatening, so contact a healthcare provider immediately if you think you may have symptoms.
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When Should You Schedule Your Vaccines
Older adults should get their flu shots in September or October, ideally by the end of October, according to the CDC. That’s because people lose immunity over time, and the vaccine components are updated annually to reflect which strains will be seen in the upcoming year.
You can get pneumococcal, shingles, and Tdap vaccines year-round. If you want to get them in the fall when you get your flu shot, talk to your doctor. These vaccines can be given with most types of flu vaccines.
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When They Start How Long They Last
The shingles vaccine is given in a two-shot series. You may experience side effects after the first, second, or both shots. Most of the time, these symptoms are mild and occur immediately following vaccination. They typically only last for two or three days.
Side effects of the shingles vaccine are more common in younger people, and might interrupt your normal daily activities for a few days.
This may seem like a downside of the shingles vaccine, but remember that these symptoms are a result of the creation of a strong shingles defense within your body.
It is OK to take Tylenol or Advil after a shingles vaccine to relieve symptoms. Rest and plenty of fluids may help, too.
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Who Should Not Get Shingrix
You should not get Shingrix if you:
- Have ever had a severe allergic reaction to any component of the vaccine or after a dose of Shingrix.
- Currently have shingles.
- Currently are pregnant. Women who are pregnant should wait to get Shingrix.
If you have a minor illness, such as a cold, you may get Shingrix. But if you have a moderate or severe illness, with or without fever, you should usually wait until you recover before getting the vaccine.
Who Can Give The Vaccine
There is not much you need to do to prepare to get a shingles vaccine. You dont even necessarily need an appointment.
A doctor can schedule a time to give you the vaccine, but licensed pharmacists are also allowed to administer it. Some pharmacies offer shingles vaccines on a walk-in basis. Check with your healthcare professional or pharmacy to be sure.
Whether youve made an appointment or walked into a pharmacy for vaccination, the next steps are simple.
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Who’s Most At Risk Of Shingles
People tend to get shingles more often as they get older, especially over the age of 70. And the older you are, the worse it can be. The shingles rash can be extremely painful, such that sufferers can’t even bear the feeling of their clothes touching the affected skin.
The pain of shingles can also linger long after the rash has disappeared, even for many years. This lingering pain is called postherpetic neuralgia .
How Do I Get The Shingles Vaccination
Once you become eligible for the shingles vaccination, a GP or practice nurse will offer you the vaccine when you attend the surgery for general reasons.
You can have a shingles vaccine at the same time as most other vaccines. But try to leave 7 days between the shingles vaccine and a coronavirus vaccine, so that if you have any side effects you’ll know which vaccine they were from.
If you are worried that you may miss out on the shingles vaccination, contact your GP surgery to arrange an appointment to have the vaccine.
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What Everyone Should Know About The Shingles Vaccine
CDC recommends that adults 50 years and older get two doses of the shingles vaccine called Shingrix to prevent shingles and the complications from the disease. Adults 19 years and older who have weakened immune systems because of disease or therapy should also get two doses of Shingrix, as they have a higher risk of getting shingles and related complications.
Your doctor or pharmacist can give you Shingrix as a shot in your upper arm.
Shingrix provides strong protection against shingles and PHN. In adults 50 years and older who have healthy immune systems, Shingrix is more than 90% effective at preventing shingles and PHN. Immunity stays strong for at least the first 7 years after vaccination. In adults with weakened immune systems, studies show that Shingrix is 68%-91% effective in preventing shingles, depending on the condition that affects the immune system.
Conjugate Vaccine Carrier Proteins
Protein conjugates used in Hib conjugate vaccines produced in the United States include tetanus toxoid which is also used as a component of DTaP and Tdap vaccines . Simultaneous or sequential vaccination with Hib and these tetanus-toxoid containing vaccines is recommended when both are indicated . MCV4 and PCV13 both contain diphtheria-toxoid conjugates. There has been concern about simultaneous administration of vaccines containing like conjugates. One brand of MCV4, MenACWY-D , demonstrates reduced immunogenicity of the antibody response to Streptococcal pneumonia strains when administered simultaneously with PCV13 compared with separate administration. It is recommended to space these vaccines by 28 days in a person with anatomic asplenia . Simultaneous or sequential vaccination of MCV4-CRM , PCV13, and Tdap , all of which contain diphtheria toxoid, is not associated with reduced immunogenicity or increase in local adverse events.
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