Not All Shingles Vaccines Are The Same

I recently discovered not all shingles vaccines are the same. Nor are they equally available in Australia. As I write this, there is talk of changes, but as of right now, it is costing me roughly $600 to be vaccinated against shingles. Why is shingles important to a person with a chronic illness? Because we may be more susceptible, depending on our underlying condition/(s) and our medications. None of us want yet another health issue to deal with.

What is shingles? Essentially, a reactivation of chickenpox. So, you can’t get shingles unless you’ve previously had chickenpox. You can catch chickenpox from someone who has shingles though. Most younger people have been vaccinated against chickenpox, but even my children (now in their forties) had chickenpox before the chickenpox vaccine was available. If you have never had chickenpox and are not vaccinated against chickenpox, get vaccinated!

It is possible to get shingles more than once, so don’t think that if you have already had it you’ll be fine. Talk to your GP.

“But I was vaccinated for free”, you cry. Lucky you. The previous Australian government changed the rules. As it stands at the moment, there is a vaccine, Zostavax, available for free to those aged between 70 and 79. “So just wait until you are 70”, you say? Well, no, that doesn’t work for me either because I can’t have Zostavax. Ever. It contains live virus and because of my medications I cannot have any vaccine that contains live virus. I am not alone, there are many, oh, so many of us. Many medications stipulate the patient must not have live vaccines.

Those under 70 can pay for Zostavax if they want to have it earlier than reaching 70 years of age. The current list price is $192.50 and only one shot is needed. Quite a price variance. But that’s the vaccine a large cohort of the population, of which I am a member, can’t have. There is also, I think (depending how one reads the bureaucratic wording), provision for certain at risk people under 70 to have the free vaccine for free before reaching 70, but the criteria is complicated and I gave up trying to decipher it: talk to your GP!

So where does that leave us? It leaves us paying $281 (cheapest price I’ve found) for each of the required two vials of the Shingrix vaccine. Two shots, between two and six months apart, so $562 for the vaccine. Then there are the GP consultation fees to get the prescriptions, the travel costs to the GP and the pharmacy, possibly another GP fee for the actual injection. For some, it may total more than $600. This vaccine is not (yet) free when we reach 70.

As I can never have the free Zostavax vaccine and once we are over 50 the risk of shingles increases rapidly, I decided to bite the budget bullet and have it now. Stress is also considered a trigger for the onset of shingles and I have been under considerable “life is complicated” stress lately – the last thing I need right now is to be hospitalised with shingles. Shingles can also lead to longer term health problems, such as postherpetic neuralgia (PHN).

Then there is the question of vaccine efficacy. Various numbers are given in various reports, but essentially Shingrix is about twice as effective as Zostavax. This Harvard link cites more than 90% for Shingrix and 51% for Zostavax. The numbers are less for those of us with compromised/suppressed immune systems.

One has to question the logic of using a less effective vaccine when the costs of hospital treatment for shingles and related complications is surely much more expensive that the cost of Shingrix. While I have no doubt chickenpox and shingles will never entirely disappear, it is those of us old enough to have caught chickenpox before a vaccine became available that at risk – so the numbers and therefore the costs reduce over time. I fully support making the more effective vaccine available on the Pharmaceutical Benefits Scheme for those over 50. Talk to your local member of parliament.

As for the photo for this article: some people are squeamish so I didn’t put a photo of the lesions! There is a link below with images for the braver readers!

Information Links you may find useful:

National Immunisation Program Schedule

Shingles (herpes zoster) immunisation service

What Everyone Should Know about the Shingles Vaccine (Shingrix) (CDC)

Shingles: Clinical Overview & Complications (CDC)

Slideshow: A Visual Guide to Shingles

ABC Radio National – Shingles follow-up (podcast with Norman Swan)

Footnote: If you are unlucky enough to develop shingles, there are antiviral treatments, but they must be started within 3 days of the rash developing. Details can be found here. My view is prevention is better than cure.