One virus, two diseases

You always meet twice. Unfortunately, the saying often applies to varicella zoster viruses. At first, they usually cause chickenpox as early as childhood, i.e. itchy pustules all over the body. They disappear again, but the viruses remain. They can sleep for decades in certain regions of the nerves. If the immune system is weakened, for example due to age or illness, they take the chance. They then appear again as a rash that often appears band-shaped and is accompanied by severe pain: shingles, herpes zoster in technical terms.

New effective vaccine

There are vaccinations to protect against the virus in both variants. Chickenpox is a regular occurrence in small children; the against shingles is intended for the elderly. We have assessed both negatively in recent years. A lot has happened in the meantime.

Changed rating

Therefore, the judgment of our vaccination experts in their reassessment is much better: They classify chickenpox vaccination for children as well as for adults who have not had chickenpox and belong to a risk group. This also applies to vaccinating the elderly against shingles with Shingrix. In contrast to the Zostavax vaccine, which has been available for some time, it is covered by health insurance.

Shingles vaccination useful from the age of 60

High immune response. Shingrix is ​​a dead vaccine. It contains only certain proteins from the varicella zoster virus. According to studies, it generates a high immune response, effectively protects against shingles and thus against chronic pain – a feared consequence.

Right timing. Shingrix is ​​allowed from the age of 50. But at this age, the risk of shingles is still very low. It is also not yet clear how long the vaccination will last. This is why our experts generally only recommend it from the age of 60; as protection at the right time.

Different recommendation. Our assessment differs somewhat from the recommendation of the Standing Vaccination Committee (Stiko). She advises Shingrix for pre-existing conditions such as immune deficiency from the age of 50.

Lieferengpässe bei Shingrix

There remains a practical problem: The demand for Shingrix was high in 2019, the vaccine was often scarce. For example, patients can discuss with the family doctor whether and when vaccination is possible. It requires two doses every two to six months.

Side effects in view

Possible side effects include temporary pain at the injection site. The Paul Ehrlich Institute (PEI) has received reports of suspected cases in which symptoms of shingles such as blister-like skin reactions after a Shingrix vaccination have occurred. One is currently running Observational study on the topic. The PEI asks doctors to participate and to contact the PEI if there are suspicious cases in connection with the vaccination in their practice. The study should clarify the possible side effects. As always, the risks and benefits need to be weighed up: according to approval studies, Shingrix prevents almost all cases of shingles in people aged 60 and over.

Efficient vaccination against chickenpox

There are various live vaccines against chickenpox (Table). They contain weakened viruses – and, according to studies, provide very efficient protection against the untamed. This is borne out by everyday data. Until 2004, when the general vaccination recommendation for children came, there were approximately 750,000 chickenpox cases in Germany. There are currently around 22,600. The vaccination rate for children is now more than 80 percent. This vaccination can also cause side effects, such as temporary discomfort at the injection site or rashes.

What role does the “booster effect” play?

There has been some criticism of chickenpox vaccination since its introduction, starting with the necessity. After all, chickenpox is mostly harmless in children. Regarding shingles, even negative consequences seemed conceivable – for the older generation. The key word is “booster theory”. Accordingly, it is important for adults who have had chickenpox to come into contact with children with chickenpox from time to time. This serves as a reminder kick for the immune system and thus as protection against shingles. And the fall away due to many vaccinated children.

Combined vaccination strategy

According to recent studies that appeared in 2019 and 2020, the booster effect actually plays a role – but a smaller one than previously thought. In addition: To protect against shingles, there is now the new Shingrix vaccine (Table). So it works well to vaccinate children against chickenpox – and the elderly against shingles.

Chickenpox vaccination may also protect against shingles

Maybe at some point Shingrix will become obsolete again. Because there is still positive news: The chickenpox vaccine itself seems to protect the vaccinated against later shingles. However, the studies on this haven’t been going too long. They primarily record the – comparatively rare – shingles in children. It remains to be seen how rates will develop in old age when people are more vulnerable.

Herd immunity pushes infections back

It is already beneficial to society when many children are vaccinated against pathogens such as chickenpox, rubella or measles. Because if they don’t get sick, they don’t infect anyone. This “herd immunity” suppresses infections as a whole and above all helps those who are not allowed to be vaccinated themselves. These include immunocompromised and pregnant women. The weakened viruses of live vaccines can also be dangerous for them – and even more so the natural ones.

User comments posted before July 28, 2020 refer to an earlier release on the same topic.