As demand for the shingles vaccine grows, understanding the pros and cons of the two available options — Shingrix and Zostavax —  may help patients decide which to receive.

What is Shingles and What are Its Complications?

Shingles is thought to occur when the dormant chickenpox virus is reactivated in the central nervous system. As indicated by Sciencenews.org, after the anatomy has overcome the effects of the first outbreak of the varicella-zoster virus—commonly known as chickenpox—it can hide within nerve cells for the life of the person. It may or may not ever reactivate, but if it does the results can be both excruciating and devastating.

The virus may be activated by stress, age, illness, or numerous other factors, according to the Mayo Clinic. The condition is usually characterized by a rash and/or blisters on the face or torso. The outbreak can also occur around one or both eyes or in an ear as well and are usually accompanied by a great deal of pain. The blisters may scab over in seven to 10 days, but it could take two to four weeks to clear up entirely.

According to Science Direct, researchers have discovered that there are situations where the shingles “outbreak” occurs internally in the gastrointestinal tract, with no blister trail.

Although shingles can really hurt, the real danger lies in its potential complications. The most common complication is persistent, severe pain known as postherpetic neuralgia (PHN). As indicated by Medical News Today, PHN can affect one out of every five sufferers of shingles, haunting them with what may feel like “intense burning or stabbing” along the path of a nerve or group of nerves after the outbreak has gone into remission. PHN is endemic to the nerve and not a response to outside stimuli or sources. It is believed to be caused by damage to the actual structure of the nerve.

People with shingles may also suffer from vision loss. Scientists are discovering a relationship between the way the virus affects arteries which contribute to problems with eyesight, as well as increasing chances of severe headache, and fatal cardiovascular events such as stroke. There has also been some data generated that is pointing to a link between getting shingles in and around the eye and developing dementia later on. Finally, shingles sufferers may develop inflammation of the brain itself, hearing problems, facial paralysis, balance problems, and ongoing skin infections.

Vaccines to Prevent Shingles

In order to prevent shingles and its complications, the Centers for Disease Control and Prevention recommends adults 50 and older get the vaccine. There are two vaccinations available: Shingrix and Zostavax.

Shingrix is a recombinant zoster vaccine that has been available since 2017 and is currently the “preferred” shingles vaccine. It’s preferred because it seems to provide longer protection against shingles. The Centers for Disease Control and Prevention (CDC) says that the two-part vaccination series provides over 90 percent protection from both shingles and postherpetic neuralgia.

The unexpected high demand for Shingrix has resulted in a nationwide shortage. According to the CDC, Shingrix manufacturer, GlaxoSmithKline is increasing production. However, there may be supply gaps through 2019.

“About a million people a year develop shingles, so people are definitely aware of the new vaccine,” Dr. Gretchen LaSalle, a Washington doctor, told Newsday. “They see the commercials and talk to friends. It’s frustrating that it’s hard to find. I think the manufacturer underestimated how popular the vaccine would be, and it takes six to nine months to make the shingles vaccine.

“Hopefully, we will be catching up in the coming year, but right now we’re only getting it here and there, and not getting a reliable schedule.”

If individuals are unable to secure Shingrix, they may be able to get Zostavax, the other shingles vaccination. Zostavax is the oldest shingles vaccine available and has been around since 2006. It uses a live zoster virus to inoculate the immune system. This vaccine provides 51 percent protection from shingles and 67 percent protection from postherpetic neuralgia, according to the CDC.

Although Zostavax has the age advantage, it may not be as safe as Shingrix. Adverse Zostavax reactions may include rashes, joint pain, gastrointestinal disorders, muscle pain, necrotizing retinitis, blindness, paralysis, brain damage, and death. Complications may develop between up to six months after receiving the vaccine, though others may take longer to develop.

Zostavax manufacturer Merck has faced several consumer lawsuits over severe complications from its shingles vaccine. Legal action against Merck claims the pharmaceutical company failed to warn doctors and patients about Zostavax’s risks.