Shingles Vaccine

I am thinking of getting a shingles vaccine.   My primary things I should get one, but he wants me to check with my neuro before I do, since I have recently switched from Avonex to Copaxone.    Does anyone have any experience with not being able to get a shingles vaccine, either due to the m.s. or being on Copaxone.   I have gotten the flu vaccine every year with no problems.

[SarahL2491]

I am cut/pasting a doctors reply to this question two years ago on this forum in a different area.  I am definitely going to talk to my neuro about it, I have RRMS and I have had shingles twice so don't know if I am eligible because of that.  Hope this helps you


2 years ago
Jeffrey A Rumbaugh, MD, PhD replied to threelabs's response:
There are many anecdotal reports from patients of either a vaccine or an illness causing an MS exacerbation, but no real good scientific evidence to support these claims. As with everything in medicine, the pros and cons have to be weighed. If you are at high risk for complications from the flu, you should definitely get the flu vaccine. If you are young and otherwise healthy, I personally would probably still get the flu vaccine, but some people with MS would choose not to. As for the shingles vaccine, there is certainly no evidence that it would cause an MS exacerbation, and shingles can be very painful, so I would probably get it. The shingles vaccine (called Zostavax) has been recommended since 2005 for all persons over age 60 to prevent shingles and postherpetic neuralgia.

[kwarendorf]

I would check with your MS doc. I'm not sure how Copaxone effects your immune system. I'm on Tysabri and was advised by my MS doc not to get a flu shot last winter.

Kyle

[SarahL2491]

Kyle this has been debated and one of the reports I read said that it was ok to get it.  Cant remember which (the flu vaccine, but I don't take those)

[twopack]

There's always some debate about the wisdom of PwMS being immunized against shingles because it is a live vaccine.  Any live vaccine has the potential to produce the disease instead of just immunity - and MS doesn't appreciate it when that happens.  Shingles is kind of a special case though.  You can't have shingles unless you've previously had chicken pox.... and once you've had chicken pox you already have the live virus hiding out in your body (it lies dormant in nerves).

I have MS.  I'm on Copaxone.  I decided to get a shingles (Zostavax) vaccine after I turned 60.  I had to wait until I had been off all steroids for at least six weeks (so my body would produce antibodies) but I had no problem from the vaccine.

I have greatly lessened my chance of developing shingles but (most important to me) even if shingles do erupt, there is little possibility they will cause prolonged pain along the nerves.

Tysabri is a immunosupressant.  Copaxone is an immunomodulator.

Mary

[SarahL2491]

well that may let me not take it Mary.  I had both of my episodes with shingles after age 60 and since I take a steroid every 28 days, may have a problem....darn it......will have to talk with my neuro about it I guess, in October.  Don't want to go there again.

[twopack]

Talk to him Sarah.  I have no idea if your past double dip into the shingles party makes you LESS likely to repeat now or MORE vulnerable than most.  Be sure to mention the steroids though.  It seems to be an oft forgotten issue when docs are considering vaccines.  I don't even remember seeing it on those CYA info sheets they give out pre-flu shot.

I don’t have to tell you, steroids help clear inflammation and (in some situations) even allow healing to begin BUT they also leave us vulnerable to run-a-way infection.  

                               The problem with
                              receiving vaccines
                            while taking steroids
                                          is
                steroids suppress the immune system
                                and therefore,
                  prevent natural antibody formation.
  
There really isn't much point in risking live vaccine injection when a person's immune system can't manufacture and store the specific Good Stuff (natural antibodies) weapons required to defend against Bad Stuff (organisms).

I wouldn't think there's any hurry in your case Sarah.  In fact, after a little more investigation, I'd probably pass on Zostavax completely if I were in your situation.  Tysabri (as an immunosuppressant) already leaves you more vulnerable than average to infection.  I don't know how much steroid you receive with each Tysabri infusion but I was told it wouldn't take much steroid to suppress my body's ability to make antibodies.

I'm one of those people who had the MMR vaccine three or four times (in addition to having 2-3 of the actual diseases!) without ever developing serum detectible immunity (elevated titers).  With that history I decided to go extreme steroid-avoid before the Zostavax vaccine and banned all nasal sprays and inhalers that contain steroids - for a minimum of eight weeks before the vaccine and three weeks after.  I wanted to be reasonably sure antibody manufacture was a done deal.

As a side, I also delayed this particular vaccine when my sister was receiving chemotherapy for cancer.  I wanted to feel free to visit her whenever an opportunity arose.  Risk to her from my vaccine may have been remote but nothing was higher priority at the time than protecting her severely depressed immune and vascular systems.  

Killed organism vaccines, like flu shots?  Any other contradictions aside, I’d go for it.  What’s to lose but money?  We hope for immunity without any risk of inducing disease.  **Remember, anyone feeling flu-ish the day or two after getting a flu shot is likely experiencing the (ugly) side effects of increased interferon production.  Its part of the immune system process of building immunity.  To me, those symptoms seem to be an indicator that my immune system is working and the vaccine ‘took’.  

Of course there are times we merely end up feeling more protected than we really are.  Titer checks are a good thing any time being sure protective immunity exists is high priority.

Mary

[twopack]

Gmtech, do you know if there is a specific reason this vaccine is being recommended for you now?  As was mentioned in the quote Sarah posted by Dr. Rumbaugh, the Zostavax vaccine is usually recommended for people sixty years of age or older (because the incidence begins to rise at that time).

Maybe your primary thinks you should take it early - while your immune system is in a responsive status rather than potentially miss a window of opportunity?  Or perhaps he sees you as more vulnerable to shingles outbreaks because you need frequent high dose steroid treatment?  Just stabbing at possibilities….

I have no idea how long the immunity boost of Zostavax is expected to remain effective.  I assumed the rest of my life since there is no renewal instruction.  I do wonder if factors other than age related frequency of occurrence were considered when the age recommendation was set.

You should be fine on the Copaxone end.  I think even the interferons (like your Avonex) would be OK because they are immunomodulators rather than immunosuppressants BUT I don't have experience taking any of those myself.

Please let us know what you find out - and decide to do, if you're comfortable with that.  This subject has come up around here many times and it seems to be one of those topics we have a hard time finding many concrete answers for.  My own MSologist wouldn't even venture an opinion when I was investigating!  He told me "it doesn't come up at conferences."  ???  (I'm still hoping that was just a really off day for him... but I never brought it up again.)

Mary

[gmteach]

My neuro seems to think it would not be a problem, and my primary is looking at the vaccine as being preventative.   I am 55 so not quite the 60 people recommend, but I have a chance to think about it because my primary has to order it once he gets a list of 10 people that want it.  

Thanks for all the input, it was greatly appreciated.

[nobleday13]

I was thinking the same, about the shingles vaccine. I need to discuss it with my MS doc because I'm also on Copaxone. I read in the accompanying paperwork (with the Copaxone) enough to realize the vaccine may not work for me.

He and I had discussed the flu shot last visit and I decided not to do it.

[gmteach]

I usually get a flu shot, but it was always when I was on Avonex.   this will be my first "flu" season on Copaxone, so I hope there will be no reaction  for the flu shot.  I have not yet gotten the shingles shot, but I am pretty sure that I will do it.

[joano118]

my husband and i went to a costco today with a dr.'s prescription for the shingles shot (we are 68).  the pharmacy refused to give it to him because he is on copaxone.  it seemed like the pharm. didn't know the difference between copaxone and interferon and that they work differently.  they said it was "too much responsibility."