Dear Dr. Roach: Today, we heard about a new vaccine for shingles. However, very little was discussed about what it does that the older version does not do, nor was there any advice as to a safe period of time between administering the older version and the current version of the shingles vaccination.
Should we proceed with the new shingles vaccination? Should we be concerned about the time between the first and second versions of the vaccination? What does the second version do differently or better than the first?
A: The subunit vaccine (Shingrix) appears to have better and longer-lasting protection against shingles and its feared complication, post-herpetic neuralgia. In studies, the vaccine was about 97 percent effective at preventing shingles (3 people per 10,000 in the vaccine group versus 90 people per 10,000 in the placebo group over three years). At the time of this writing, the Centers for Disease Control and Prevention is recommending this vaccine for adults over 50 with normal immune systems and for those who have previously received the older Zostavax vaccine. The side effects are mostly local, such as a sore arm, and last a few days. Serious side effects are rare.
The studies were done on adults who had received the Zostavax vaccine more than five years previously. I don't know if the CDC will make a different recommendation from that, but I will write an updated column when I know. Unfortunately, there are no 100 percent guarantees in medicine, but 97 percent effectiveness is very, very good. I expect to ask my doctor about getting this vaccine at my next visit.
Vaccines, no spleen
Dear Dr. Roach: A recent column was from a woman who's had her spleen and three-fourths of her pancreas removed. She was reluctant to get pneumonia and flu vaccines. I'm writing to add my plea to this woman to please at least get the pneumonia vaccine.
In 2006, I had my spleen removed to treat my ITP -- immune thrombocytopenia, an autoimmune disease causing low platelets. That worked but, obviously, my immune system was compromised by the surgery. In April 2010, I contracted a pneumococcal pneumonia bacteria that sent me into septic shock. I survived that septic infection, but it cost me my hands and lower legs. I had had a pneumonia shot in 2006 after the spleen removal, to prevent just this type of infection. However, I was told that that vaccine did not have a long enough life to prevent my 2010 infection. Since then, I've had both the Prevnar 13 and Pneumovax 23 vaccines, and flu shots every year. I've been healthy ever since. So, my advice to this woman is to get any and all vaccines, or this could happen to her.
A: I thank E.U. for writing. Pneumococcal sepsis is rare, but it's a very serious infection. Vaccination can reduce the risk of sepsis by 75 percent. Both the PCV 13 and PPSV 23 are recommended for someone with no spleen: Ideally, the PCV 13 should be given first, followed a year later by the PPSV 23. I hope some readers will be motivated by E.U.'s experience to get these vaccines, which are recommended and important for most people over 65, but critically important in people with no spleen.
Readers: The booklet on heart attacks, America's No. 1 killer, explains what happens, how they are treated and how they are avoided. Readers can order a copy by writing: Dr. Roach, Book No. 102, 628 Virginia Dr., Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 with the recipient's printed name and address. Please allow four weeks for delivery.