A Herpes Zoster infection – in English “shingles” – is an unpleasant thing. Not only do you feel quite ill during the acute phase, but there is also the risk of a so-called post-Zoster neuralgia remaining – these are very unpleasant burning pains in the affected segment.
Herpes Zoster is the endogenous reactivation of a chickenpox infection (chickenpox = varicella), which many of the children born before 2004 have undergone as a classic childhood disease. After the signs of the disease subside, the varicella remains in the nerve cells (more precisely in the spinal or cranial nerve ganglia) and can be reactivated from here in the form of shingles (Herpes Zoster) – when the immune system is distracted for some reason (sometimes a simple cold is enough). Since chickenpox is highly contagious, most adults, even if they were never manifestly ill, have been infected during their lifetime. They are thus carriers of the Varicella zoster virus (VZV) and therefore also have a basic risk of developing shingles under unfavorable conditions.
Since 2004, the Permanent Vaccination Commission (STIKO) recommends vaccinating children against varicella with a weakened (attenuated) live vaccine, which is ultimately not only a good thing because of the high risk of infection, but also because chickenpox is sometimes not as harmless as it sounds – it can certainly cause serious complications. In addition, there is hope that the consistent vaccination will also push back the shingles, or at least make it less harmful.
In Germany, an estimated more than 300,000 people fall ill with shingles each year – with a rising trend. The risk is age-dependent and steadily increases from the age of 50. Since December 2018, the Permanent Vaccination Commission (STIKO) therefore recommends vaccination with a new Herpes Zoster subunit vaccine (Shingrix®). This is an adjuvanted inactivated vaccine, which has been found to have better effectiveness across all age groups from 50 years and longer lasting vaccine protection compared to the live vaccine. Furthermore, the use of this inactivated vaccine is not excluded in people with chronic diseases and disorders of the immune system, whereas the live vaccine is contraindicated in immune deficiency or under immunosuppressive therapy. Therefore, vaccination with Shingrix® as an indication vaccination (i.e., the vaccination is at the expense of the health insurance) is also recommended for people over 50 years of age with an increased risk for Herpes Zoster due to a basic disease or because of an immunosuppression.
And here it becomes relevant for MS patients – because the above-mentioned chronic underlying diseases include, among others, rheumatoid arthritis, chronic kidney diseases, chronic obstructive pulmonary diseases or diabetes mellitus (patients with these diseases also participated in the licensing study for the vaccination) as well as multiple sclerosis. Moreover, many MS patients are treated with substances that downregulate the immune system. Accordingly, given the data situation, vaccination of MS patients from the age of 50 can definitely be recommended. The vaccination schedule consists of a 2-time intramuscular vaccination at intervals of at least 2 and a maximum of 6 months, which should ideally be adhered to.
But what about patients under 50 years of age, who also represent a large proportion of MS patients? Since Shingrix® is approved for use from the age of 50, vaccination of younger patients with chronic diseases or immunosuppression can only be considered within the framework of an off-label use – i.e., reimbursement by the health insurance is probably not going to take place.
However, I could imagine that a lot will change in this respect. Shingles is an unpleasant complication and the risk of shingles is increased by certain MS medications. Therefore, it would be sensible if the indication for a very effective and safe prophylaxis would be expanded.