Regio: Being fit and healthy: that brings vaccination against Shingles & Co.? – Follow-up report to the telephone reader of June 6, 2019

"Even those who have shingles need to be vaccinated."
Expert Advice on Immunization Protection for Generation 50plus

With age, our immune system loses its resistance to viruses and bacteria, despite a balanced diet, exercise and a healthy lifestyle. People over 50 are therefore at a higher risk of developing pneumonia, influenza, whooping cough or shingles. Vaccination is the only effective protection against these diseases. The Standing Immunization Committee (STIKO) of the Robert Koch Institute updates its vaccination recommendations each year. The shingles vaccine is a new item on the list of standard vaccinations recommended for people over 60 years old. At the time of the new vaccination, most of the calls on the reader's phone turned to vaccination in the elderly. Here are the most important questions and answers to read:

Which STIKO vaccines does it recommend to people over 60?
Johannes Horlemann: The STIKO recommends that all people over 60 years of age be vaccinated against pneumococcus and, every year, against influenza. In December 2018, vaccination against shingles was added as a recommendation for supplementary vaccination. Some vaccinations must also be renewed or updated regularly. Thus, the tetanus and diphtheria vaccine should be updated every ten years – and since 2009, when combined with whooping cough. It is therefore important to have your vaccine regularly checked, particularly at age 50, as the immune system weakens. Therefore, consult your doctor regularly to check the protection of your vaccine!

I thought you were immune to whooping cough for a lifetime?
Michael Küster: A common mistake! In fact, immunity after illness or vaccination only persists for six to ten years. So you can get sick several times in your life. STIKO recommends refreshing vaccine protection once in adulthood – as a combination vaccine, which works simultaneously against tetanus and diphtheria.

For whom exactly does the Permanent Vaccination Commission recommend vaccination against shingles?
Norbert Schürmann: Firstly, STIKO recommends vaccination as a standard vaccine for all people over 60 years old. Anyone with immunodeficiency or certain underlying diseases should be vaccinated at the age of 50 years. These groups include, for example, people with asthma, COPD, diabetes, or rheumatoid arthritis.

How does the shingles vaccine work?
Thomas Cegla: With a vaccine, the body's immune system is activated so that the pathogen can be fought. It also works with the shingles vaccine, as follows: The vaccine consists of a component of the superficial structure of the "causative" pathogen, the varicella zoster virus, and causes a specific immune response against these viruses. However, this immune response is often not strong enough in the elderly. Therefore, the vaccine contains an activator that supports and supports the immune response. For complete protection against shingles, two vaccinations are needed. The second vaccination should be given two to six months after the first vaccination.

What side effects can occur with vaccination against shingles?
Johannes Horlemann: The most common side effects of the shingles vaccine can be pain, redness and swelling at the injection site, as well as muscle aches, fatigue and headaches. Most of these reactions disappear after two or three days. The vaccine is available in the United States, Canada and Germany. It has been administered millions of times around the world and is very safe.

I already had shingles a few years ago. Am I immune or should I be vaccinated?
Michael Küster: Unfortunately, you do not acquire immunity with the "pass" of shingles. This can happen again. One to three percent of sufferers develop a second shingles, the risk increasing with age and diminished immune capacity. People who have had shingles can also benefit from the vaccine, as can people without the disease.

How well does the vaccine protect me and how long?
Norbert Schürmann: The effectiveness of the shingles vaccine is greater than 90% in people over 50 – proven experience over a period of four years. The effectiveness and duration of the effect will continue to be recorded in clinical trials. Other data from studies show that the immune response remains high for at least nine years. The second dose is important for long-term protection.

I do not know if I had chicken pox in my childhood. Should I be vaccinated against shingles as a precaution?
Thomas Cegla: More than 99% of adults over 50 have had chicken pox in their childhood, and the varicella zoster virus (chicken pox virus) remains in the nerve roots all life after the disease and can therefore be reactivated later – in the form of shingles. With age, the defenses of the immune system, which until now kept the virus at bay, weaken, which promotes this reactivation. This means that almost all adults can develop shingles and protect against vaccination.

Are people vaccinated against chicken pox protected against shingles?
Michael Küster: A no, that's because the vaccine was used because, for the chickenpox vaccine, a live attenuated vaccine is used. In principle, these vaccine viruses also have the property of nested in the nervous nodes and can also be reactivated later. There is therefore a risk of contracting shingles despite the varicella vaccine, although the disease is usually much lower.

Is shingling contagious?
Norbert Schürmann: The liquid in blisters that occurs in shingles contains varicella-zoster virus. Contact with this liquid may be contagious to people who have not been vaccinated against chickenpox and who have not yet contracted the disease. You can then catch chicken pox. People who have already had chickenpox can not be infected by a sick person.

Does my health insurance cover vaccination costs?
Günter Rambach: The shingles vaccine has been added to the STIKO recommendation in the catalog of health insurance benefits and is therefore fully reimbursed. Due to the very high demand for the vaccine, the manufacturer can not fully cover the high demand for the moment. It can therefore happen at times of waiting.

My vaccination certificate was not found. How do I know which vaccine protection I have?
Johannes Horlemann: You can try to get vaccinated with a new vaccination certificate. But only the doctor who did the vaccination should do it. What is not documented is considered not done. Vaccination must then be repeated so that vaccination is safe and complete. If it's a repeat of a previous vaccination, it simply means an extra reminder.

My mother had shingles four months ago. The pain continues unabated, even though the rash has disappeared. What can you do against pain?
Günter Rambach: In the normal course of the disease, rashes and pain disappear after a few weeks. In a third of cases, we speak of post-zoster neuralgia (PZN). These are serious nerve pains due to nerve damage and can last for months or even years. In this case, a special treatment for pain is necessary, which accompanies the medical treatment of the pain and stress management procedures. Such treatment is essential in the hands of an experienced pain specialist. The quality of life is greatly reduced by a PZN – one more reason to protect yourself in time with a vaccine. Once a PZN is passed, subsequent vaccination will no longer be effective against pain.

Information box for the follow-up report

Shingles – pain treatment, self-help, vaccination

Medical information on chronic pain
The German Society for the Treatment of Pain e.V. undertakes to better understand and better diagnose and treat chronic pain – including with its own regional centers for the treatment of pain.
 www.dgschmerzmedizin.de

Help for self help
The German Pain League e.V Patient Association (DSL) provides information from, with and for patients suffering from pain, including individual counseling and a separate pain-relieving phone.
 www.schmerzliga.de

Vaccination Shingles & Co.
The pharmaceutical company GlaxoSmithKline is now on the net about shingles, other infectious diseases and vaccinations.
Imp www.impfen.de

help with the decision
The Federal Health Education Center (BZgA) has compiled understandable information and decision support on the topic of immunization.
Imp www.impfen-info.de

The experts on the reader's phone were:

Dr. med. Dipl. Oek. Thomas Cegla; Specialist in Anesthesiology, Special Pain Medicine, Acupuncture, Palliative Medicine, Chief Medical Officer of the Wuppertal Pain Clinic, Helios University Hospital in Wuppertal, University of Witten / Herdecke, Head of the Regional Center for Pain DGS Wuppertal, Honorary Prize Winner of the German German Award 2004, Vice President of the German Pain Society
Dr. med. Degree in Psychology Johannes Horlemann; Specialist in Internal and General Medicine, Special Medicine for Pain, President of the German Society for Pain Medicine, Director of the Regional Center for Pain, DGS Geldern, Kevelaer
Dr. med. Michael Küster; Specialist in internal medicine, general medicine, anesthesia, special pain medicine, manual medicine and sleep medicine, head of the regional pain center DGS Bonn – Bad Godesberg
Günter Rambach; Vice President of the German Pain League e.V., Frankfurt / M.
Norbert Schürmann; Specialist in Anesthesiology and General Medicine, Algesiologist, DGS, Head of the Department of Pain and Palliative Medicine, St. Josef Hospital in Moers, Director of the Regional Center for Pain, DGS Duisburg / Moers, Vice President of the German Society for the treatment of pain eV