The Shingrix vaccine has been introduced in India to combat the high prevalence of the herpes virus and reduce the risk of shingles and post-herpetic neuralgia. This breakthrough offers preventive measures for a common condition seen in family medicine practice.

New vaccination against shingles (herpes zoster) rolled in India

Pharmaceutical giant GSK has developed the shingles vaccination Shingrix. An infectious disease that may attack any portion of a person's body, it mostly affects the elderly.

Pharma company GSK announced the introduction of Shingrix (Zoster Vaccine Recombinant, Adjuvanted) in India for the treatment of people 50 years of age and over who are at risk for developing shingles (herpes zoster) and post-herpetic neuralgia.

The first non-live, recombinant subunit vaccination administered intramuscularly in two doses is called Shingrix. Shingles are a widespread health issue, according to the World Health Organisation. Shingles affect one in three people, and prevalence and incidence rates differ across different nations and geographic areas. The disease burden of shingles is significant in India and across Asia, with an estimated yearly incidence of 1.5 to 3.9 cases per 1,000 person-years.

In 2017, the U.S. Food and Drug Administration (FDA) authorised Shingrix for use in people 50 years of age or older to prevent shingles. In 2018, the European Commission approved Shingrix for use in people 50 years of age or older to prevent shingles.

By the age of 40, more than 90% of Indian volunteers in seroprevalence research had this virus in their bodies and were at risk for developing shingles. A painful rash results from shingles. In the US and Europe, Shingrix received first approvals in 2017 and 2018, respectively. It is currently accessible in more than 20 nations, including India. Drugs like famciclovir, valacyclovir, and acyclovir are now accessible to treat it, as far as the available therapies are concerned.

After a case study in all age categories, Shingrix showed a high success rate of over 90% in avoiding shingles and associated side effects, including postherpetic neuralgia, a chronic nerve pain that may continue for months or years long after the rash has healed. Particularly among older folks and those with weakened immune systems, this vaccination has the potential to significantly decrease disease burden and related healthcare expenditures.

The availability of the vaccine at a reasonable price in India may be essential for lowering shingles incidence and severity.

Adults 50 years of age and older should take two doses of Shingrix to prevent herpes zoster (the reactivation of the chickenpox virus in the body) and post-herpetic neuralgia. Usually, two to six months should pass between the first and second dosage of Shingrix.

What is herpes zoster (HZ)?

1. Shingles, also known as Herpes Zoster (HZ), often manifest as a painful skin rash with clusters of vesicles. This rash often develops on one side of the face or body, lasts 2 to 4 weeks, and normally does not cross the midline. Its primary symptom, which may be fairly severe, is pain. Fever, headaches, and rashes that burn might be additional symptoms.
2. The most frequent side effect of shingles is chronic, recurring discomfort that persists at the rash's location even after it has healed. Postherpetic neuralgia (PHN) is the term for this condition, which may linger for months or years. PHN may cause crippling and severe pain.
3. The Varicella Zoster Virus (VZV), which also causes chickenpox, reactivates and causes zoster or shingles. Only those who have had chickenpox are susceptible to zoster. The virus stays latent in the body and may manifest as zoster many years later when immunity is compromised by illness or ageing.
4. People 50 years of age and older are far more likely to get zoster. Additionally, those with weakened immunity are more likely to develop it.

Signs & symptoms of shingles

1. Shingles is a nerve disease. Common signs and symptoms include tingling, burning, itching, and shooting pain.
2. Rash with blisters packed with fluid.
3. The rash with blisters often appears on one side of the body, perhaps in a single band around the right or left side of the torso. The face and the area around the eyes might also develop a rash. If an eye condition exists, vision loss may result.
4. Following the rash, many patients have excruciating nerve pain in the region where the rash was, a condition known as postherpetic neuralgia (PHN).
5. PHN lasts for months, usually for at least 90 days and often for a long time.
6. If the rash involves the eyes or ears, shingles may cause vision or hearing issues as well as scarring and bacterial skin infections.
7. In rare instances, shingles may also harm the brain or spinal cord, leading to neurological conditions including encephalitis or meningitis. People who have underlying medical disorders or compromised immune systems are more vulnerable to complications.

Who is most susceptible to developing shingles?

1. As one ages, the chance of contracting shingles rises. The symptoms, however, worsen with time.
2. Due to decreased immunity, those over the age of 50 and those with chronic illnesses including diabetes, heart disease, and renal disease are more likely to acquire shingles. Adults over the age of 50 have a 30% greater chance of having post-herpetic neuralgia, and the pain is more incapacitating in this group of people. Even psychological disorders and a greater reliance on carers may result from this suffering. In elderly folks, shingles may also result in consequences including hearing loss and vision loss. Since Shingrix is a non-live vaccination, it may be given to those over 50 who are immunosuppressed or weakened and may be at an increased risk of developing shingles.

Importance of getting the vaccination for shingles

1. In order to avoid shingles and its associated problems, the Centres for Disease Control and Prevention (CDC) advises getting the shingles vaccination for anybody over the age of 50.
2. The shingles vaccination has a 90% success rate in avoiding shingles and the associated nerve discomfort.
3. According to studies, being vaccinated against shingles offers at least ten years of protection.
4. Anyone may get the vaccination, regardless of whether they have ever had shingles.
5. Although some people may still have shingles following vaccination, the length and intensity of symptoms decrease, and the risk of PHN is also decreased.

Shingles vaccination dosage:

Two doses are required. The second dose is given 2 to 6 months following the first.

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.