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At a physician visit last year my physician offered me vaccination to prevent shingles, more formally known as herpes zoster. It’s a mostly preventable condition with vaccination. Shingles itself is a very painful infection that can lead to lasting consequences in the form of postherpetic neuralgia (PHN). Here are a couple of references on shingles and PHN.

The Province of Ontario provides the shingles vaccine, Zostavax from Merck, at no charge to residents between the ages of 60 and 69. For those older and younger the cost is on the order of $250. It involves a single injection and is said to be 74% effective, what this means in practical terms is discussed below.

When given the option of the shingles at no cost last year I declined, I had read about a GlaxoSmithKline vaccine for shingles, Shingrix, that was in the registration phase and was reputed to be more effective than Zostavax. Waiting a year for Shingrix to be available seemed a reasonable choice.

Well, Shingrix is available but it is not covered by the Province of Ontario. Zostavax is covered at no cost. Shingrix costs about $300 for the two-injection protocol (Zostavax requires a single injection). So what is the best option? In the next few paragraphs I lay out some numbers and my decision process regarding which vaccine makes more sense for me. Some of you facing a similar decision may find it helpful.

How Common is Shingles?
The clinical trials for Zostavax and Shingrix involved immunizing patients with either drug or a placebo (sham injection). What they found was that patients 60 and older contracted shingles at the rate of about 10 infections per 1,000-person years. What this means is that if you took 100 people and followed them for a single year about one person in that group would contract shingles. Look at that same population of 100 people over 10 years and 10 of them would contract shingles, about 1 in 10. Take that same population and look at them over a 20-year period and about 20 people would contract shingles in that 20-year period, or 1 in 5.

This suggests that if you are in your 60s and you live for an additional 20 years your chance of developing shingles is about 20%, or 1 in 5. If you are a little younger, or are an optimistic person with plans for 30 more years, your chance of contracting shingles rises to about 1 in 3. The older you get the more serious a shingles infection can be, especially if you are immunocompromised.

Zostavax
Zostavax is reported to reduce the number of cases of shingles by 74%. An individual receiving Zostavax immunization would have a 4% chance of contracting shingles over the next 20 years, about 1 in 25. This is versus a 20%, or 1 in 5 chance, of contracting shingles without vaccination.

Shingrix
Shingrix is reported to reduce the number of cases of shingles by 97%. An individual receiving Shingrix would have a less than 1% chance of contracting shingles over the next 20 years, or about 1 in 100. This is a 95% reduction over no vaccination, and a 75% reduction over Zostavax. The chance of contracting shingles after vaccination with Zostavax is rather small and the question is how much you want to further reduce the risk.

My Choice
I’ll pay the $300 for Shingrix. If I can reduce the chance of a shingles infection by 95% over the next 20 years, and improve outcomes versus Zostavax, it will have cost me $15 per year. I’m not sure there are many things that can offer this type of value.

But – nothing is guaranteed. Not only is it possible to develop shingles after being vaccinated, there is also the possibility that the vaccine will wear off before I reach my 20-year expiration date. The studies to date with Shingrix only cover 3 years. It’s possible that the efficacy drops off in 5 or 10 years. But by then it is likely that there will be information about this and as necessary I’ll pay a bit more and get a booster. It’s still a bargain in my opinion. I have a cousin, aunt and brother-in-law who all developed shingles before Zostavax was available. They ranged in age from mid-50s to 90. They did not have a very pleasant experience and one of them developed a mild but nasty case of post herpetic neuralgia.

Bottom Line
Get your shingles vaccine when you reach the age of eligibility to receive it for free. And if you are younger or older, consider paying to be vaccinated. If you are paying, Shingrix seems to be the better choice. It may be a little bit more, but it seems to provide better value especially if you have to pay for either Zostavax or Shingrix. As discussed above, if you are eligible for Zostavax at no cost the choice is a little more difficult.

As always, talk to your physician and pharmacist about the pros and cos of vaccination and the benefits of Zostavax and Shingrix. The numbers above were rounded to make the overall figures a little easier to understand, but they fairly summarize the three options, Zostavax, Shingrix and no vaccination