I have known Linda for about seven years now, treating her for Hashimotos’ thyroid disease. Linda has other problems. She takes daily acyclovir for recurrent attacks of oral-facial herpes simplex which can be quite debilitating. Recently, we were chatting and Linda brought up the idea of Shingles vaccination to prevent the oral-facial herpes attacks.
I immediately volunteered my opinion that this is a bad idea. This is a Chickenpox vaccine, not a herpes simplex vaccine. How do we know it would work? The shingles vaccine is a live attenuated chicken pox (varicells) virus cultured on aborted human fetal cells. (MRC5 line), so the vaccine contains human DNA fragments.
Information about the Shingles Vaccine:
“The live virus shingles vaccine is actually a very strong booster dose of the Varicella Zoster (chickenpox) vaccine. Zostavax vaccine for shingles and Varivax vaccine for chickenpox are both manufactured by Merck and are the only licensed vaccines to prevent chickenpox and shingles in the U.S.”
In the Zostavax product information insert, Merck describes the ingredients of shingles vaccine:
“ZOSTAVAX is a lyophilized preparation of the Oka/Merck strain of live, attenuated varicella-zoster virus (VZV). ZOSTAVAX, when reconstituted as directed, is a sterile suspension for subcutaneous administration. Each 0.65-mL dose contains a minimum of 19,400 PFU (plaque-forming units) of Oka/Merck strain of VZV when reconstituted and stored at room temperature for up to 30 minutes. Each dose contains 31.16 mg of sucrose, 15.58 mg of hydrolyzed porcine gelatin, 3.99 mg of sodium chloride, 0.62 mg of monosodium L-glutamate, 0.57 mg of sodium phosphate dibasic, 0.10 mg of potassium phosphate monobasic, 0.10 mg of potassium chloride; residual components of MRC-5 cells including DNA and protein; and trace quantities of neomycin and bovine calf serum. The product contains no preservatives.”
Serious Adverse Events
“By August 2011, the federal Vaccine Adverse Event Reporting System (VAERS) had received 442 serious vaccine adverse reports following Zostavax vaccination, including 36 reported deaths . Serious shingles vaccine reaction symptoms reported to VAERS include rash, joint pain (arthralgia), muscle pain (myalgia), fever, abnormally swollen glands (lymphadenopathy) and hypersensitivity reactions including anaphylaxis (shock).”(reference)
After a few minutes I thought well, maybe somebody else has done a study and tried the Shingles Vaccine for recurrent oral herpes. Maybe it does work, Let’s look it up.
We found a 2012 study France (14): Efficacy of antiVZV antiHSV3 vaccine HSV1 HSV2 recurrent herpes simplex Jacqueline Le Goaster 2012.
In a hospital in Paris a prospective study was done in 2012 using shingles vaccine for 24 patients with recurrent oral-facial herpes, uncontrolled by acyclovir. Another 25 patient serves as controls. Remarkably, the shingles vaccine group had zero recurrence of herpes over 6 years of follow up, while the control group continued to have 4-5 outbreaks per year as before.(14)
I turned to Linda and said I would have to change my opinion, as this actually looks pretty good for preventing attacks of oral herpes. So, if you notice a piece of my hat missing, that’s where I had to take a large bite and “Eat My Hat”.
2017 Update one year later: Linda called in to give me an update. I asked Linda if she decided to go ahead with the shingles vaccine. No she said. She came down with a case of shingles about 6 months ago, and after that, the recurrent Oral-Facial Herpes went away. I thought about it for a minute, and said: Very good, Apparently, your case of Shingles served as a Self-Vaccination, stimulating the immune system. The oral-facial Herpes is now cured.
Update Oct. 2017: FDA Approves New Shingles (Shingrix) Vaccine as More Effective and will Replace Older Zostavax (3-10)
Many people have asked me, should I take the new Shingles Vaccine? Shingrix? My answer is: on paper Shingrix looks more effective and better in some ways than the older vaccine Zostavax which was a live virus. The Shingrix does not contain a live virus, which I consider a safer feature.
The problem with a live virus vaccine:
Live Virus Can itself Cause Disease
The Zostavax manufacturer product insert states that “transmission of vaccine virus may occur between vaccines and susceptible contacts.” Zostavax Manufacturer Merck is now involved in class action suit related to the ability of the live virus in the vaccine itself to cause disease .(10)
Unlike the Zostavax which is a live virus, the Shingrix combines an antigen, glycoprotein E, and an adjuvant system, AS01B.(11) These two items are new. Like any new drug, it may take a few years of use before we really know about the adverse side effects. So ask me again 5 years from now. In the mean time, consider the new vaccine a population wide experiment with you and me as the guinea pigs.
Burning Mouth Syndrome
The syndrome of “burning mouth” can be a diagnostic dilemma. However, this is probably just another presentation for oral facial herpes. Elevated blood and saliva Herpes antiviral antibody titers may be found. Resolution of symptoms with anti-viral drug acyclovir was reported.(12,13) One might expect benefit from Shingles vaccination, similar to efficacy in oro-facial herpes.
Jeffrey Dach MD
This article is part two of a series, for part one, click here.
Article with related interest:
Links and References
3) Oxman, Michael N., Ruth Harbecke, and David M. Koelle. “Clinical Usage of the Candidate Adjuvanted HZ/su Zoster Vaccine: re-vaccination of recipients of live attenuated zoster vaccine and co-administration with a seasonal influenza vaccine.” The Journal of Infectious Diseases (2017). Clinical Usage Adjuvanted HZ su Zoster Vaccine Oxman J Infectious Dis 2017
4) Retamal-Díaz, Angello R., et al. “A Herpes Simplex Virus Type 2 Deleted for Glycoprotein D Enables Dendritic Cells to Activate CD4+ and CD8+ T Cells.” Frontiers in Immunology 8 (2017): 904.
5) Cunningham, Anthony L. “The herpes zoster subunit vaccine.” Expert opinion on biological therapy 16.2 (2016): 265-271.
Introduction: Herpes zoster (HZ) causes severe pain and rash in older people and may be complicated by prolonged pain (postherpetic neuralgia; PHN).
Areas covered: HZ results from reactivation of latent varicella-zoster virus (VZV) infection, often associated with age related or other causes of decreased T cell immunity. A concentrated live attenuated vaccine boosts this immunity and provides partial protection against HZ, but this decreases with age and declines over 5-8 years. The new HZ subunit (HZ/su or Shingrix) vaccine combines a key surface VZV glycoprotein (E) with T cell boosting adjuvant (AS01B). It is highly efficacious in protection (97%) against HZ in immunocompetent subjects, with no decline in advancing age and protection maintained for >3 years. Phase I-II trials showed safety and similar immunogenicity in severely immunocompromised patients. Local injection site pain and swelling can be severe in a minority (9.5%) but is transient (2 days).
Expert Opinion: The HZ/su vaccine appears very promising in immunocompetent patients in the ZoE-50 controlled trial. The unblinding of the current ZoE-50 trial and publication of results from the accompanying ZoE-70 trial will reveal more about its mechanism of action and its efficacy against PHN, particularly in subjects >70 years. Phase III trial results in immunocompromised patients are eagerly awaited.
6) CDC recommends new shingles vaccine to replace older one By Susan Scutti, CNN October 26, 2017
7) Shingrix Vs. Zostavax: What Is The Difference Between Shingles Vaccines? By Dr. Brian Staiger
Six people out of 7,344 who received the two doses of Shingrix developed shingles—that is 0.08%. 210 out of 7,415 people who received the placebo became ill with shingles—that is 3%.
8) This New Vaccine Has a Secret Benefit
For older adults, who are often the most vulnerable to severe and occasionally fatal infections, this kind of immune-boosting strategy will be a godsend.Paul Offit 11.07.17 12:00 AM ET
9) Zostavax Just Say No to the Shingles Vaccination! Dr. Julian Whitaker Shingles Vaccination Trial Results Unimpressive
The primary clinical trial prior to Zostavax’s approval showed that it reduced risk of developing shingles by about 50 percent, but this isn’t as impressive as it sounds. In the placebo group, 3.3 percent of the study participants developed shingles, compared to 1.6 percent in the vaccine group. Yes, that’s a 50 percent difference, but the real, absolute risk reduction is just 1.7 percentage points.
Another way of looking at it is 175 people would have to be vaccinated to prevent one case of shingles, and 1,087 would need to be treated to prevent one case of postherpetic neuralgia (lingering nerve pain after an initial attack)—at a cost of $150–$300 per shingles vaccination.
10) Merck’s Zostavax Drug Hit With Lawsuits (MRK, GSK) By Shobhit Seth | March 15, 2017 — 3:05 PM EDT
11) Chlibek, Roman, et al. “Safety and immunogenicity of an AS01-adjuvanted varicella-zoster virus subunit candidate vaccine against herpes zoster in adults≥ 50 years of age.” The Journal of infectious diseases 208.12 (2013): 1953-1961.
Background. An adjuvanted varicella-zoster virus glycoprotein E (gE) subunit vaccine candidate for herpes zoster is in development. In this trial we compared the safety, reactogenicity, and immunogenicity of the vaccine antigen combined with different adjuvant doses.
Methods. This was a phase II, observer-blind, randomized, multinational study. Adults ≥50 years old were randomized 4:4:2:1 to be vaccinated at months 0 and 2 with gE combined with a higher (AS01B) or lower (AS01E) dose adjuvant, unadjuvanted gE, or saline. Following each dose, solicited events were recorded for 7 days and unsolicited adverse events for 30 days. Serious adverse events were collected for 1 year. Cell-mediated and humoral immune responses were assessed at baseline and following each dose.
Results. No vaccine-related severe adverse events were reported. Solicited adverse events were generally mild to moderate and transient. For all gE-based vaccines, pain was the most common local symptom and fatigue the most common general symptom. Immune responses were significantly enhanced by AS01B and AS01E compared to unadjuvanted gE and were significantly stronger for gE/AS01B than for gE/AS01E.
Conclusions. AS01 improved the immunogenicity of gE while retaining acceptable safety and reactogenicity profiles. The enhancement of gE-specific cellular and humoral responses was adjuvant dose dependent.
Burning Mouth Syndrome
12) Nagel, Maria A., et al. “Burning mouth syndrome due to herpes simplex virus type 1.” BMJ case reports 2015 (2015): bcr2015209488.
Burning mouth syndrome is characterised by chronic orofacial burning pain. No dental or medical cause has been found. We present a case of burning mouth syndrome of 6 months duration in a healthy 65-year-old woman, which was associated with high copy numbers of herpes simplex virus type 1 (HSV-1) DNA in the saliva. Her pain resolved completely after antiviral treatment with a corresponding absence of salivary HSV-1 DNA 4 weeks and 6 months later. The patient was treated with oral valacyclovir, 1 g three times a day for 10 days, followed by valacyclovir, 1 g daily for 1 year.
13) Nagel, Maria A., and Don Gilden. “Burning mouth syndrome associated with varicella zoster virus.” BMJ case reports 2016 (2016): bcr2016215953.
We present two cases of burning mouth syndrome (BMS) —of 8-month duration in a 61-year-old woman and of 2-year duration in a 63-year-old woman—both associated with increased levels of antivaricella zoster virus (VZV) IgM antibodies in serum and with pain that improved with antiviral treatment. Combined with our previous finding of BMS due to herpes simplex virus type 1 (HSV-1) infection, we recommend evaluation of patients with BMS not only for VZV or HSV-1 DNA in the saliva, but also for serum anti-VZV and anti-HSV-1 IgM antibodies. Both infections are treatable with oral antiviral agents.
14) Le Goaster, Jacqueline, et al. “Efficacy of the anti-VZV (anti-HSV3) vaccine in HSV1 and HSV2 recurrent herpes simplex disease: a prospective study.” J Clin Trials 4 (2012): 51-58. Efficacy of antiVZV antiHSV3 vaccine HSV1 HSV2 recurrent herpes simplex Jacqueline Le Goaster 2012
Jeffrey Dach MD
7450 Griffin Road Suite 190
Davie, Fl 33314
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