Category Archives: Public Health

What You Should Know about the New Shingles Vaccine, Shingrix.

Last week a new vaccine for prevention of shingles was not only approved by the FDA, but the CDC recommended vaccination of everyone over age 50 with Shingrix, revaccination with Shingrix if you have previously received the older shingles vaccine Zostrix, and expressed preference for Shingrix over Zostavax.  Shingrix has approval and recommendation for use in patients age 50 or older, vs. age 60 for the older Zostavax, presumably because it is expected to last longer and has a higher efficacy.

Here are the key take home details that I can find out about the new vaccine:

  1. Shingrix is non-live vaccine vs. the older Zostavax which is a live attenuated vaccine.  This means that Shingrix should  be able to be  used in people with a suppressed immune system like HIV patients, chemotherapy patients, organ transplant recipients etc.
  2. Shingrix requires two doses, separated by two months to get the desired immunity, unlike the one-dose regimen for Zostavax. This raises concern about patients getting the first dose but forgetting or otherwise not being compliant with getting the second dose.
  3. The immunity from Shingrix seems to be both stronger and longer lasting than immunity from Zostavax.
    1. Zostavax confers about 50% immunity from shingles, but the immunity wanes fairly quickly, so that by years 7-10 the efficacy is only about 20%, and it is likely that by 10-12 years the immune benefit is gone.
    2. Initial data about Shingrix shows about 97% reduction in the risk of shingles initially, with 85% risk reduction persisting at 4 years. Longer term benefits are TBD.
  4. Minor side effects seem pretty common from Shingrix, including:
    1. Most patients had some degree of pain redness and swelling of the injection site, and about 10% had fairly severe pain, and about 2% had at least 10 cm of redness or swelling.
    2. Other common side effects seem slightly more common in patients age 50-69 that in patients age >70. These include:
      1. Myalgia, fatigue, and or headache in about half of patients.
      2. Shivering, fever and or gastrointestinal side effects in about a quarter of patients.

My initial take on Shingrix is that it is a pretty major improvement over Zostavax, and that although it is likely to cost about $280 for the 2-dose regimen, and the chance of moderate side effects it pretty high, it will be well worth it for me to have an effective and long-lasting immunization for shingles which I (and others over age 50) have a 1:3 chance of getting if not immunized.

The remaining questions are when will Shingrix be available at your pharmacy or doctors office and will your insurance cover getting Shingrix.  My guess is Shingrix will be available within the next few months, and that within a few months after that will be covered by Medicare and other insurers since it has the endorsement of the CDC.

A Better Approach to Diet for Type 2 Diabetes

For years I’ve sent my newly diagnosed and poorly controlled patients with type 2 diabetes to diabetes education classes.  There they are taught many helpful skills, including how to test their blood sugars at home, how to watch for complications of diabetes like foot ulcers and infections, and a big focus is on how to… Continue Reading

Overoutrage: The Right Way to Determine Healthcare Policy?

I came across a very interesting article today in The Health Care Blog by Saurabh Jah, MD titled Overoutrage and the Assymetric Skepticism of Healthcare Journalists. This addresses a concept I’d not heard of until now. Here is a quote from the above linked article: “Overoutrage is excessive moral outrage. Outrage is excessive anger. Anger is… Continue Reading

Blood Pressure: How Low is Low Enough

A new clinical trial published in the New England Journal of Medicine called the SPRINT Trial ( Systolic Blood Pressure Intervention Trial ) which compares standard treatment of hypertension to a goal of a systolic BP < 140 compared to more aggressive treatment to a goal of systolic BP <120 was published on Nov. 9,… Continue Reading

Editorial on PSA Screening for Prostate Cancer

If you’ve been following this blog for a while you may have noted a number of posts on the dilemma of overdiagnosis and PSA screening for prostate cancer.  We used to thing that all cancers has a common characteristic that once established they inexorably progressed, eventually becoming symptomatic and often lethal.  We now know that… Continue Reading

WHO: Red Meat, especially Processed Meat Causes Cancer

Although I believe the findings in the WHO report the conclusion of the WHO that eating processed meat, and even eating meat at all, causes cancer this information adds very little to my reasons not to eat meat. Some of you may recall from a prior post that I chose to eat a plant based diet… Continue Reading

The Mammograms or Not in Women 40-49 Controversy

As usual Dr. Kenny Lin, a former USPSTF member and prolific writer of “common sense” articles writes on how emotions rule rather than evidence and data when it comes to how people feel about breast cancer Check out his article: Countering the too neat narrative on screening mammography. Here are a couple of snippets for… Continue Reading