Tag: shingles vaccine

How Do You Get Caught up If You Have Never Been Vaccinated?

Why would someone have never gotten any vaccines and need to catch up?

Getting caught up on your vaccines is easy.
Getting caught up on your vaccines is easy.

The usual story is that a child’s vaccines were delayed or skipped for some reason, typically over fears of anti-vaccine propaganda.

You can always get caught up though, right?

Well, not always…

Tragically, kids can get sick and catch these vaccine-preventable diseases before they have time to get vaccinated and protected. You can wait too long to get vaccinated!

How Do You Get Caught up If You Have Never Been Vaccinated?

That’s why it is important to get caught up as soon as possible.

How does that work?

The first step is figuring out which vaccines you need, considering that:

  • rotavirus vaccines are only given up to age 9-months
  • Hib and Prevnar are typically only given up to age 5-years, unless someone has specific conditions that put them at high risk for disease, although Prevnar becomes routine again at age 65-years
  • the polio vaccine is typically only given up to age 18-years
  • the meningococcal vaccines (MenACWY and MenB) are routinely given to teens and young adults through age 16 to 23-years, but older high-risk adults can also be vaccinated if necessary
  • the HPV vaccines are routinely given up to age 26-years, although they are FDA approved to be given through age 45 years
  • hepatitis A vaccines are routinely given to children and teens, but are recommended for high-risk adults, including those who travel out of the country or just want to be protected
  • hepatitis B vaccines are routinely given to children and teens, but are recommended for high-risk adults, including those who travel out of the country or just want to be protected
  • the Pneumovax (PPSV23) and shingles vaccines are given to seniors
  • if you already had a natural case of chicken pox, while you won’t need to be vaccinated, some folks might need a varicella titer to confirm that they are immune

So, depending on your age when you are starting your catch-up, there may be some vaccines that you don’t need anymore.

Still, unless you have a contraindication, you will likely at least need:

  • a yearly flu vaccine
  • 1 to 2 doses (high risk groups) of MMR
  • 2 doses of the chicken pox vaccine (Varivax)
  • 1 dose of Tdap, followed by 2 doses of Td

What’s next?

Once you have an idea of which vaccines you need, you should schedule an appointment with your health care provider and get vaccinated and protected.

A local pharmacy or health department are other places that might offer vaccines to older teens and adults.

More on Getting Caught up on Vaccines

Can You Still Get Shingles After Having the Chicken Pox Vaccine?

It is very easy to get confused when thinking or talking about chicken pox and shingles.

Remembering a few things should help though:

  • shingles (herpes zoster) is a reactivation of chicken pox (varicella zoster) – since they are caused by the same virus, you had to have been exposed to the chicken pox virus (varicella zoster virus) to later get shingles
  • exposure to the chicken pox virus can come from a natural chicken pox infection or from getting vaccinated against chicken pox, as it is a live, attenuated vaccine (Varivax)

So no, getting the chicken pox vaccine will not prevent you from later getting shingles. The shingles vaccine is a different vaccine that is given to seniors to help prevent them from getting shingles.

Can You Still Get Shingles After Having the Chicken Pox Vaccine?

Have you ever heard of a child vaccinated against chicken pox getting shingles? It can happen. It’s not a vaccine injury.

Remember that you can get shingles at any age – it is not just a disease of senior citizens. Even preschools or teens can get shingles, with the risk increasing with age.

Although rare, even infants can develop shingles, most commonly if their mothers had a chicken pox infection while pregnant.
Although rare, even infants can develop shingles, most commonly if their mothers had a chicken pox infection while pregnant. Photo by Kaoutar Zinelabidine et al.

Although the chicken pox vaccine won’t prevent you from getting shingles, it does work well to prevent you from getting chicken pox.

And it is thought that getting vaccinated and protected against chicken pox will decrease your risk of later getting shingles, even before you ever get the shingles vaccine.

“In the early post-varicella vaccination period, incidence rates of medically attended herpes zoster did not increase for the overall population and decreased moderately for children 9 years and younger, the age group targeted for varicella vaccination.”

Tanuseputro et al on Population-based incidence of herpes zoster after introduction of a publicly funded varicella vaccination program

No chicken pox and a lower risk of shingles?

I’m glad my kids are fully vaccinated!

More on Shingles and the Chicken Pox Vaccine

What Are the Changes in the 2018 Immunization Schedules?

As they do every year, the Advisory Committee on Immunization Practices (ACIP) just released an updated immunization schedule.

The 2018 immunization schedule didn't bring any changes for most kids.
The 2018 immunization schedule doesn’t bring any changes for most kids.

And just like in most other recent years, there were few big changes or announcements.

That means that most kids won’t need any extra shots when they go to their next well check up with their pediatrician or to start school.

What Are the Changes in the 2018 Immunization Schedules?

There are some changes though…

  • A third dose of MMR is now recommended for some people during outbreaks of mumps.
  • MenHibrix was removed from the schedule, which was expected, as this combination meningococcal vaccine for high risk kids was discontinued in 2016 because of low demand. Fortunately, this doesn’t mean that any kids will be left unprotected. They can just get one of the other meningococcal vaccines if they need it, with a separate Hib vaccine, just like other infants.
  • Menomune was removed from the schedule, which was expected, as this older meningococcal vaccine was discontinued in 2017, as it was replaced with the newer meningococcal conjugate vaccines (Menactra and Menveo).
  • Shingrix, the new recombinant shingles vaccine is added to the schedule for adults aged 50 or older. They should get 2 doses 2 to 6 months apart, even if they have had shingles in the past or have had the older Zostavax already. And Shingrix becomes the preferred shingles vaccine for those who are at least 60 years old.

The other changes are to the formatting of the schedule and schedule footnotes.

“The schedule footnotes are presented in a new simplified format. The goal was to remove unnecessary text while preserving all pertinent information and maintaining clarity. This was accomplished by a transition from complete sentences to bullets, removal of unnecessary or redundant language, and formatting changes.”

CDC on Changes to This Year’s Schedule

So, unless your child is in a mumps outbreak, the new immunization schedule shouldn’t mean any extra vaccines.

What to Know About the 2018 Immunization Schedule

The 2018 immunization schedule from the CDC, AAP, ACOG, and AAFP incorporates the latest recommendations from the ACIP, including that folks in a mumps outbreak might need a third dose of MMR.

More on the 2018 Immunization Schedule

What to Do If Your Child Is Exposed to Shingles

Pediatricians often get calls from worried parents because their kids have been exposed to someone with shingles.

Would you know what to do?

Shingles and Chicken Pox

Shingles is definitely contagious.

“A person with active shingles can spread the virus when the rash is in the blister-phase. A person is not infectious before the blisters appear. Once the rash has developed crusts, the person is no longer infectious.”

CDC on Shingles Transmission

Herpes zoster was described as early as 1867, as can be seen in the lithograph from the Atlas der Hautkranheiten, although the connection with chickenpox didn't come until later.
Herpes zoster (HZ) was described as early as 1867, as can be seen in the lithograph from the Atlas der Hautkranheiten, although the connection with chickenpox didn’t come until later.

Not surprisingly, the biggest factor that will determine what needs to be done is whether or not your child is immune to chicken pox (primary varicella). Has your child ever had a natural chicken pox infection or completed a two dose chicken pox vaccine series?

Chicken pox vaccine?

Yes, because while shingles is contagious, you won’t get shingles if you are exposed to someone with shingles, but you can get chicken pox.

Remember, shingles is a reactivation of the varicella zoster virus (VZV), which also causes chicken pox. After a natural chicken pox infection, or less commonly after having the chicken pox vaccine, the chicken pox virus can stay dormant in the dorsal root ganglia of a spinal nerve. And you get shingles if the virus ever reactivates.

The type of exposure also matters.

Shingles is usually thought to be less contagious than chicken pox and requires direct contact with the rash, while it is in the blister phase, to spread disease. You shouldn’t catch the virus by simply being in the same room as someone with shingles. So if their shingles rash was completely covered by clothing, that decreases the chance of any real exposure.

“Not only was the risk of secondary infection with HZ comparable to that of primary varicella, the risk was similar regardless of the anatomic location of HZ. This finding contradicts the assumption that coverage of active skin lesions with dressings or clothing reduces VZV aerosolization and, if substantiated through further investigation, may warrant a change in current recommendations for VZV prevention.”

Bloch et al on Varicella Zoster Virus Transmission in the Vaccine Era: Unmasking the Role of Herpes Zoster

Covering the shingles rash doesn’t eliminate the risk of exposure though.

Another problem is that it isn’t always easy to recognize that someone has shingles, especially when younger children or teens have it.

“Anyone who has recovered from chickenpox may develop shingles; even children can get shingles. However, the risk of shingles increases as you get older.”

CDC on Shingles Clinical Overview

After all, no one expects an infant or toddler to have shingles, but it is important to remember that you can get shingles at any age, it is just more common the older you get.

Although rare, even infants can develop shingles, most commonly if their mothers had a chicken pox infection while pregnant.
Although rare, even infants can develop shingles, most commonly if their mothers had a chicken pox infection while pregnant. Photo by Kaoutar Zinelabidine et al.

And since it is often less severe in children and younger adults, who get a lot of rashes anyway, shingles isn’t usually the first thing a parent or many pediatricians will think of as a diagnosis.

That increases the risk of exposure before a diagnosis of shingles is finally made.

What to Do If Your Unvaccinated Child Is Exposed to Shingles

If your unvaccinated child, or incompletely vaccinated child, who has never had chicken pox is exposed to shingles, you should talk to your pediatrician about getting him vaccinated with the chicken pox vaccine. The vaccine should be given as soon as possible and preferably within 3 days of the exposure, but it can work even if it is given as long as 5 days afterwards.

“Vaccination within 3 days of exposure to rash was >90% effective in preventing varicella whereas vaccination within 5 days of exposure to rash was approximately 70% effective in preventing varicella and 100% effective in modifying severe disease.”

ACIP on Prevention of Varicella

This post-exposure vaccination can greatly reduce your child’s chances of developing chicken pox and even if your child does develop chicken pox, it will reduce the severity of the disease.

Otherwise, you should watch your child carefully over the next 10 to 21 days for the development of the classic symptoms of chicken pox, including a rash and fever, keeping him quarantined until after this incubation period so that you don’t expose others.

Certain high risk children who aren’t immune and who can’t get a chicken pox vaccine should get VariZIG (varicella zoster immune globulin) after being exposed to shingles (or chicken pox). This includes:

  • immunocompromised patients
  • hospitalized premature infants born at or after 28 weeks gestation, if their mother wasn’t immune to chicken pox
  • hospitalized premature infants born before 28 weeks gestation, even if their mother was immune to chicken pox
  • pregnant women who are not immune to chicken pox

VariZIG is given as soon as possible and within 10 days of exposure.

What to Do If Your Vaccinated Child Is Exposed to Shingles

If your child has already had chicken pox or two doses of the chicken pox vaccine, then you can likely safely assume that he is protected if he is ever exposed to shingles.

Still, since no vaccine is 100% effective, you should watch him over the next 10 to 21 days in case he does develop any signs or symptoms of chicken pox.

And keep the shingles rash covered to prevent further exposure.

What to Know About Getting Exposed to Shingles

Shingles is contagious and can cause someone to develop chicken pox if they haven’t already had it or aren’t vaccinated and protected.

More on Getting Exposed to Shingles