Herpes zoster: vaccine is now available in private clinics in Brazil

Launched in Brazil this month, the herpes zoster vaccine is now available in private clinics across the country. The disease is a late manifestation of those who have had chickenpox, which tends to affect more often people over 50 years of age or immunocompromised patients. It should be administered in two doses, with an interval of two months between applications.

Shingrix received regulatory approval from the National Health Surveillance Agency (Anvisa) in August 2021 for the prevention of herpes zoster in adults aged 50 and over and in adults aged 18 and over and at increased risk of contracting the disease, such as the immunocompromised – patients undergoing cancer treatment, people living with HIV, individuals who will undergo bone marrow or organ transplants, lupus, multiple sclerosis, among others.

Each application costs around R$843 on the private network. With a two-dose regimen, with an interval of two months, the total cost is around R$ 1,686. In addition to technology, the exchange rate variation also reflects on the final price of the immunizer. According to the pharmaceutical company GSK, the value may vary according to the ICMS of each region of the country and the price practice of private clinics. The distribution of the vaccine has started, with a considerable supply forecast throughout Brazil until July.

“It is undeniable that the impacts of new technologies on vaccine production have brought significant advances to the health of the population. But technologies are expensive, so vaccines today have prices that make accessibility difficult, especially in Brazil, which has an exchange rate difference quite significant”, explains Geraldo Barbosa, president of the Brazilian Association of Vaccine Clinics (ABCVAC), when reinforcing that the use must be done according to the medical prescription and recommendation that comes in the package insert.

“Cobra”
In addition to discomfort, pain and skin lesions, herpes zoster, also called shingles, can cause serious sequelae. If not treated quickly, the disease can trigger serious complications, affect nerve endings in the eyes, ear, face, causing paralysis, hearing and visual loss. In Brazil, the topic becomes even more relevant, given the 35.4% increase in reported cases of the disease, observed during the covid-19 pandemic.

“The person has had chickenpox or chickenpox, it doesn’t matter when, but in general in childhood, and after the clinical picture passes, the varicella-zoster virus is as if it had fallen asleep in a nerve ending. At some point, in general, in the elderly , the zoster manifests itself. And when that happens, it usually gets a whole nerve ending”, says Juarez Cunha, president of the Brazilian Society of Immunizations (Sbim).

Shingrix is ​​more than 90% effective in people over the age of 50, the age when the virus starts to strike most often. In the age group from 50 to 69 years of age, the efficacy reaches 97% It is the first vaccine against herpes zoster that can be used in immunocompromised individuals, who have a weakened immune system and are more likely to develop the disease. In the case of Zostavax, a vaccine of the previous generation, from the pharmaceutical company MSD, which was less effective, this type of use was also not allowed. “It was an attenuated vaccine with interesting efficacy, but it was decreasing as the person’s age progressed. Licensed from the age of 50 by Anvisa, the duration of protection was also not so prolonged”, explains Juarez.

Shingrix, used in other countries such as the United States, is an inactivated vaccine. “The advantage is that it can be applied to immunocompromised patients and is licensed from the age of 18. And, of course, we recommend it for people between the ages of 18 and 50 who have some predisposition to the disease. In general, immunocompromised people and situations that lead to the risk of zoster, such as diabetes. It is also recommended for people over 50 as a routine vaccine”, adds Juarez. In addition, the new vaccine also protects against a serious complication of shingles, post-herpetic neuralgia, a disease that causes vesicles (bubbles on the skin) that cause a lot of pain.

In addition to Brazil, Shingrix is ​​already licensed for use in the European Union and in several countries such as the USA, Canada, Japan, China, New Zealand, Singapore and Australia. “It is already available in several countries and is highly effective for people over 50 years of age. In addition, it is a vaccine that proves to be safe for immunosuppressed people over 18 years of age, as it is not produced from a live virus”, says Gunnar Riediger, GSK BioTech Business Unit Leader.

For now, none of the vaccines is available in the Unified Health System (SUS).

What is herpes zoster?

Herpes zoster or shingles is a disease caused by the varicella-zoster virus, which also causes chickenpox. The virus remains dormant throughout a person’s life.

Reactivation occurs in adulthood or in people with immunological impairment, such as those with chronic diseases (hypertension, diabetes), cancer, AIDS, transplant recipients, among others.

Exceptionally, there are patients who develop herpes zoster after contact with varicella patients and even with another zoster patient, which indicates the possibility of a reinfection in someone who has already been immunized. It is also possible for a child to acquire chickenpox from contact with a zoster patient.

The disease can lead to complications and other serious clinical forms, including death.

What are the symptoms?

The clinical picture is almost always typical. In most cases, the following symptoms precede skin lesions:

– Neuralgic (nerve) pain

– Paresthesias (tingling, prickling, numbness and pressure)

– Local burning and itching

– Fever

– Headache

– malaise

How is the diagnosis made?

The diagnosis is easily made because the lesions affect the nerve ending. It starts with a tingling sensation, itching and then progresses to lesions. Several skin lesions called vesicles (small blisters on the skin) break open and heal.

Other complications are post-herpetic neuralgia, a condition of a lot of pain that lasts for many years. If it affects the facial nerve, it can also cause vision damage.

How is the treatment done?

The earlier the diagnosis is made, the better the response to treatment. In general, with the use of antivirals. An antipyretic, non-salicylate analgesic and, to alleviate pruritus (pus), systemic antihistamine can be administered.

What are the preventive measures?

– Vaccination (Children are vaccinated against chickenpox at 1 year and 3 months and then at 4 years. Susceptible adolescents and adults who have not had chickenpox should receive the vaccine. Protects against chickenpox – without chickenpox, there is no zoster).

– Wash your hands after touching the lesions.

– Isolation: children with uncomplicated chickenpox should only return to school after all lesions have evolved into scabs. Children who are immunosuppressed or who have a prolonged clinical course should only return to activities after the vesicular eruption ends.

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