Until recently, it was not possible for WM patients to be safely vaccinated against varicella zoster, commonly called shingles, because the vaccine, Zostavax, was a live virus vaccine not recommended for the immunocompromised, including those with blood cancers.
Recently, a new vaccine, Shingrix, has been approved in the US and Canada. Shingrix is a non-live, recombinant vaccine that enhances the body’s immune response with an “adjuvant”. As a result, it is likely to be considered safe to administer to the immunocompromised.
Several noted WM researchers and clinicians are recommending Shingrix for their WM patients on both observation and treatment. However, it is not yet known how effective it will be in immunocompromised individuals. Therefore, patients who are on acyclovir or another shingles prophylaxis during treatment may prefer to remain on that medication rather than be vaccinated. So, if one wishes to stop prophylaxis, then it is strongly recommended to get the vaccine. In either case, as with any vaccination, it is important that you consult your doctor before getting the vaccine.
About 99% of persons aged fifty and older are infected with varicella zoster virus (VZV). This is because nearly all of us had chickenpox as children. One in three will develop shingles in their lifetime. The risk increases to one in two for adults aged 85 years and older. The chickenpox virus, like all herpes-type viral infections, never goes away but does become dormant or latent in our bodies, specifically in the sensory neurons of dorsal root and cranial nerve ganglia. It can “wake up” when our immunity is suppressed, and may then cause a severely painful cluster of small blisters called shingles, usually following a nerve root. If it breaks out on certain areas of the face, it can damage the cornea and lead to vision problems. Some never get the rash, only the pain.
But what is worse is the sequela. Shingles can lead to a chronically painful condition called post-herpetic neuralgia (PHN). That nerve pain is felt in areas where the shingles rash occurred, and can last for years. It also can be quite severe.
According to the CDC, in the US, there are one million cases of shingles each year. About half of all cases occur in people sixty and older. Between 10% and 20% of those with shingles will develop PHN.
It is likely that other countries will follow the US and Canada in approving Shingrix. Applications already have been made in Australia, Japan, and the EU.
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