DEAR DR. ROACH: My son is a kidney transplant recipient. Is it safe for transplant recipients to get the new Shingrix vaccine? — J.O.
ANSWER: Because the Shingrix vaccine is not a live vaccine, it is thought to be safe. It is licensed for immunocompromised people, like your son, but transplant recipients were not included in the published trials. As such, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention has not made an official endorsement as of this writing.
However, many experts do recommend the vaccine for people on the kind of immune-suppression drugs used for solid-organ transplant recipients. People with profound immune system disease, such as those receiving chemotherapy or people with very advanced HIV disease, may not respond to the vaccine. People taking lower-dose immune system modifying drugs (such as a dose of prednisone that’s 20 mg or less a day, low-dose methotrexate or azathioprine) generally should receive the vaccine, but the jury is still out for people with diseases like rheumatoid arthritis, who are taking biologic therapies such as rituximab (Rituxan) or adalimumab (Humira).
Studies are ongoing, and the ACIP and other advisory groups will make new recommendations as data become available. Until then, your son should talk with his transplant doctors about the vaccine.
DEAR DR. ROACH: I am a 58-year-old male who has never had chickenpox. Ten years ago, after bloodwork to confirm no exposure to chickenpox, my doctor gave me the required two sets of the chickenpox vaccine in order to build immunity.
My question is this: Since you can get shingles only if you have had chickenpox in the past, should I consider getting the new Shingrix vaccine? Or would this be a waste of money? I also should say that I am HIV positive for 22 years with no symptoms, and no opportunistic infections. — B.D.
ANSWER: Unfortunately, people who have not had chickenpox but who have had the varicella vaccine (the live vaccine usually given to children to prevent chickenpox) still may get shingles. The risk is low: For every 50 people given the varicella vaccine, about one person will get shingles in 20 years. However, the risk in someone with HIV infection would be expected to be somewhat higher, even in someone who has been as well-controlled as you have.
You definitely should consider the Shingrix vaccine. Whether it’s a waste of money is hard to say. It reduces your risk of shingles from fairly small to very small. You, personally, have possibly less risk because you had the weakened vaccine strain of chickenpox rather than “natural” or “wild-type” chickenpox, but then you have a slightly higher risk due to your HIV infection. The downside of getting it is a sore arm (less likely is a more severe reaction) and some money (though most insurances cover it in the U.S.). The upside is that you’d have a lower risk of getting shingles, which is painful and unpleasant, and which in the rare case can cause serious disease. You also reduce your risk of post-herpetic neuralgia, a potentially devastating complication that lasts weeks to months (sometimes years) and dramatically reduces quality of life.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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