From the Guidelines
Yes, someone who had shingles seven years ago and still has postherpetic neuralgia can receive the new shingles vaccine (Shingrix). In fact, vaccination is particularly recommended for these individuals as it may help prevent future shingles episodes. Shingrix is a non-live recombinant vaccine given as two doses, 2-6 months apart, and is approved for adults 50 years and older 1. The vaccine is effective even in those with a previous history of shingles or ongoing postherpetic neuralgia. While the vaccine won't treat existing postherpetic neuralgia, it provides strong protection (over 90% effectiveness) against developing shingles again 1. Some patients may experience temporary side effects like pain at the injection site, muscle aches, or fatigue for 2-3 days after vaccination. The vaccine works by boosting the immune system's response to the varicella-zoster virus, which remains dormant in nerve tissues after chickenpox and can reactivate as shingles. Even with previous shingles, the risk of recurrence exists, making vaccination valuable for ongoing protection. Key points to consider include:
- The recombinant zoster vaccine (RZV) is recommended for adult patients aged ≥50 years and those ≥18 years who are at increased risk for herpes zoster (HZ) 1.
- The RZV vaccine is given in 2 doses ≥2–6 months apart 1.
- For adults who are at risk and ≥18 years of age, a second dose can be given 1–2 months after the first dose if they will benefit from a shorter vaccination schedule 1. The most recent and highest quality study recommends the use of RZV over other vaccines due to its higher efficacy and safety profile 1.
From the Research
Eligibility for the New Shingles Vaccine
- The new shingles vaccine has been shown to be effective in reducing the incidence of herpes zoster and postherpetic neuralgia (PHN) 2.
- The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommends the varicella zoster virus vaccine for adults 60 years and older, except for certain immunosuppressed patients 3.
- There is no direct evidence to suggest that having shingles seven years ago, but still having postherpetic neuralgia, would prevent someone from receiving the new shingles vaccine.
- However, it is essential to consult a healthcare professional to determine individual eligibility for the vaccine, as they can assess the person's overall health and make an informed decision.
Considerations for Individuals with Postherpetic Neuralgia
- Postherpetic neuralgia can be a challenging condition to manage, and treatment options may include topical lidocaine or capsaicin, and oral gabapentin, pregabalin, or tricyclic antidepressants 3, 4.
- The new shingles vaccine may still be beneficial for individuals with postherpetic neuralgia, as it can help prevent future episodes of herpes zoster and potentially reduce the risk of developing PHN again 2.
- It is crucial to discuss the potential benefits and risks of the vaccine with a healthcare professional, considering the individual's medical history and current health status.