“The Herpes Zoster Vaccine: Safety and Effectiveness for Middle-Aged Adults”

During the high virus outbreak period in spring, in addition to chickenpox and hand, foot and mouth disease in infants and young children, herpes zoster in middle-aged people is also the focus of attention of dermatologists. Do adults need to be vaccinated? Should you get the shingles vaccine or the chickenpox vaccine? Physician Song Fengyi, Director of Extreme Skin Specialist Clinic (Executive Director of the Republic of China Association of Aesthetic Medicine), uses the profession of a dermatologist to analyze the safety and effectiveness of the herpes zoster vaccine in detail, helping the public to make wise choices!

Both chickenpox and shingles are caused by the varicella-zoster virus (VZV). Chickenpox patients are highly contagious from the initial stage of onset to herpes scabs, and must be isolated to prevent infecting others.Especially for pregnant women, the risk of teratogenicity and miscarriage after infection is doubled。

Herpes zoster is a disease in which the varicella virus lurks in the dorsal root ganglia and recurs due to low immunity. Generally speaking, unless the infected area is the head and face, the patient’s life risk is low; therefore, the focus of treatment is often to prevent postherpetic neuralgia; to avoid long-term severe nerve pain, dull pain, itching or burning caused by herpes zoster in middle-aged and elderly patients Symptoms that ultimately interfere with quality of life.

Physicians must identify health effects and risks when considering the effects and costs of medical treatments. When considering “Do I need to be vaccinated? What kind of vaccine?” In addition to the indications and effects, the risks of the vaccine should also be considered, such as “Chickenpox can be deadly in adults, shingles mostly hurts“. Rational analysis can make an appropriate decision.

Both the United States and Taiwan provide publicly-funded chickenpox vaccines for infants and young children, because “chickenpox can be fatal”. According to the US CDC data, the varicella vaccine has prevented more than 91 million cases, 240,000 hospitalizations and 2,000 deaths during its 25 years of marketing. A study in Taiwan also showed that the incidence of chickenpox dropped by 87% in 2012 after the policy of public-funded chickenpox vaccine. Physicians also recommend that users of chemotherapy, AIDS, immune diseases and steroids be vaccinated against chickenpox at their own expense to avoid the threat of chickenpox to health.

While both Taiwan and the United States believe that the chickenpox vaccine is necessary, the attitude towards the shingles vaccine is not necessarily the same. Readers can think about it, even though the new crown pneumonia is extremely lethal, the benefits and risks of the COVID vaccine are still debated by the public;Faced with herpes zoster, which harms the quality of life but may not be life-threatening, the attitude of the medical profession and the government is certainly not as mandatory as the chickenpox vaccine.

As for whether chickenpox and shingles vaccines can “support each other”; chickenpox vaccine is an active attenuated vaccine, which is mainly designed for infants and young children, and has less virus content; Have had or been vaccinated against chickenpox.Active virus vaccines are not recommended for middle-aged and elderly people, and it is unlikely that lower doses of varicella vaccine can prevent herpes zoster, which requires high antibody levels, so“Varicella live vaccine to prevent shingles” is not feasible。

Currently, there are two types of herpes zoster vaccines in Taiwan. Among them, the virus-free glycoprotein recombinant vaccine Shingrix, referred to as the inactive vaccine, has high safety but low efficacy. Active attenuated vaccine Zostavax zoster, referred to as active vaccine, has not been proven to prevent chickenpox although the virus load is high.considerThe United States will stop using this active vaccine from November 18, 2020, and the Taiwan Dermatology Association recommends giving priority to inactive vaccines in 2022.Inactive herpes zoster vaccine cannot prevent chickenpox, and it is unreasonable for middle-aged and elderly people to use active herpes zoster vaccine to prevent chickenpox. Therefore, “using the shingles vaccine to prevent chickenpox” is also not feasible.

Capricorn dermatologist Song Fengyi finally added an anecdote.The National Health Service (NHS) does not provide public varicella vaccines for infants and young children, which has also aroused discussion in the medical community. The NHS believes that the clinical symptoms of chickenpox in childhood are relatively mild, and the immune memory produced is much longer than vaccination. “Letting natural infection to generate herd immunity will reduce the incidence of chickenpox and shingles in adults.” After understanding the views of the NHS on the chickenpox vaccine, you will know why Prime Minister Johnson & Johnson proposed the “COVID Natural Immunity Theory” in 2020…

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