Concerns about hearing loss and vision loss with shingles… Mandatory vaccination for herpes zoster in major developed countries
The risk of infectious diseases has been significantly reduced due to the development of new drugs and vaccines and improved hygiene, but in the 21st century, new and unpredictable infectious diseases are emerging again as a threat to public health.
According to the Korea Centers for Disease Control and Prevention’s report on legal infectious diseases, the number of cases in 2018 was 17,498, an increase of about 11.5% from the previous year. Medical experts believe that negative views on vaccinations, such as anti-vaccine campaigns, or lack of understanding of herd immunity, mainly seen in young people, are related to the increasing number of infectious diseases. Regarding the vaccine, especially the shingles vaccine, which is essential for the elderly, we heard about the vaccine from Professor Yoo Byung-wook, Department of Family Medicine, Soonchunhyang University Seoul Hospital.
Q. It’s easy to become indifferent after getting vaccinated as a newborn. Please explain the vaccines that must be given for each age group.
T-dap vaccination is required between 11 and 12 years of age. As of December 2019, it was included in the national vaccination program, and pregnant women were also included in the vaccination list. Another vaccine included in the national vaccination program is the cervical cancer vaccine. Girls aged 9 to 14 can receive up to two doses free of charge.
And I have hepatitis A. Those born after 2013 are included in the national vaccination program, so most teenagers have antibodies. However, if you are in your 30s or 40s, some people do not have antibodies, so they are vaccinated after testing.
In the case of the elderly, the pneumococcal vaccine cannot be omitted, and although once is sufficient, it is recommended to vaccinate at least 50 years of age. According to the latest knowledge, it is recommended to receive a single dose of 13-valent vaccine (PPSV13) at the age of 50 and an additional dose of 23-valent vaccine (PPSV23) provided by the government at the age of 65.
In particular, chronic cardiovascular disease, chronic lung disease, diabetes, chronic liver disease, chronic kidney disease, nephrotic syndrome, malignant tumors (blood cancer, solid tumors), immunocompromised (HIV, hematopoietic stem cell transplant recipients, immunosuppressants including steroids) Administrative), if it is the case for patients with functional and anatomical asphyxia, it must be true.
The herpes zoster vaccine is recommended for chronic disease patients over the age of 50 in Korea. It should fit the elderly, but awareness is low. And the price is also on the expensive side, ranging from 12 to 13 thousand won.
In conclusion, all vaccinations for children are free under the NIP National Immunization Program.
Q. The incidence of shingles is increasing not only in the elderly, but also in the younger generation. What could be the cause?
There are several theories as to why shingles is commonly found among young people, but the prevailing knowledge is that the dormant chickenpox virus emerges and appears as shingles. In Korea, the chickenpox vaccine is only administered once. So, the antibody titer of the chickenpox vaccination once given as a child ends around the late teens to early 20s, and the varicella virus is activated again after that.
Another theory is that people with the chickenpox virus are reactivated as they gather in groups. To compensate for this, the chickenpox vaccine is given again around the age of 4-6 years. In the United States, booster varicella vaccination has been in place since 2014.
So, there is no way to control shingles in your 20s or 30s right now. The chickenpox vaccine is effective 10 to 20 years later.
Q. Recently, Shingrix was approved in Korea. Can you explain it compared to the existing live vaccine?
Existing ‘Zostavax’ and ‘Skyzoster’ are live attenuated vaccines, that is, bacteria that have only removed pathogenicity as vaccines. means. According to the clinical trials published so far, the primary preventive effect of Syngrix is over 90%. On the other hand, the existing live vaccine has a primary prevention effect of 60%.
Although Singrix is superior in the preventive effect, the secondary effect of preventing complications from herpes zoster showed similar results between the two. So, in terms of its ability to suppress outbreaks, it can be said that Syngrix is good, but if you look at the secondary prevention effect, it can be said that it is similar.
Q. Shingles (or chickenpox) and herpes are two different viruses, but their symptoms and immune-related mechanisms are similar. What’s different?
The varicella-zoster virus remains dormant in the ganglia and causes inflammation. Herpes is also a virus dormant in the ganglia, but it is not as severe as herpes zoster. In severe cases of shingles, complications can include pneumonia, loss of hearing or vision, scarring, encephalitis, and even death.
Q. There is no cure for shingles or herpes, and I am wondering if there is only vaccine prevention. I wonder if a treatment can be developed in the future.
If there is money, I think it will be developed (laughs). Because it is impossible to get rid of the virus itself, the treatment of shingles uses a mechanism that inhibits viral DNA from replicating, like any antiviral drug. The treatment for herpes zoster is acyclovir (ACV).
But I think we need to move towards encouraging more shingles vaccination. In Korea, herpes zoster vaccine is not included in the national mandatory vaccination due to the low fatality rate and high vaccine price.
For example, the UK introduced the national mandatory vaccination in 2013 and observed 5.5 million people for 3 years, confirming that there is a 35% reduction in the incidence of shingles in people in their 70s and 70-88% effectiveness in postherpetic neuralgia. I did.
Q. It is said that after receiving the COVID-19 vaccine, you may have rare shingles symptoms. According to the Herpes Patients Association, herpes came up after being vaccinated against COVID-19. What’s the connection to them?
It does not mean that you have been vaccinated against COVID-19 and contracted another disease. The same goes for shingles and herpes. However, in the case of live herpes zoster vaccine, caution should be taken when inoculating: ▲ Those who have had a life-threatening reaction to vaccine components such as gelatin or neomycin in the past ▲ Those whose immune system has been weakened by disease or medical treatment ▲ People with untreated active tuberculosis ▲ Women who are pregnant or plan to become pregnant.