Repeat of a reaction to Shingrix
DEAR DR. ROACH: I received the first dose of Shingrix this week and had pretty severe side effects, though in the range of what can be expected: high fever (101.5), intense shivering, a severe headache and 12 hours of extreme fatigue.
The entire reaction began 11 hours after the shot and ended 18 hours after that. I am 61 and in excellent health, taking only 25 mcg of levothyroxine daily.
I have a few questions that I hope you can answer. I’ve tried looking at the clinical trial results for Shingrix, but I am not qualified to understand the information as presented.
1. Is it likely that I’ll have a similar (or worse?) reaction to the second shot? The package insert says one can react to the first, second, neither or both. 2. Are both injections identical? 3. When I had chickenpox as a child, I was way sicker than the average kid. Related?
4. If I get shingles, do I have a higher risk for a severe case?
ANSWER: Compared with the previous one-time vaccine Zostavax, the new two-dose Shingrix vaccine is much more effective. However, it does have a higher risk of side effects. You have had the most common side effect, though only 10 per cent of people will have symptoms as bad as yours.
These symptoms are caused by your body mounting an inflammatory response to the glycoprotein in the vaccine (the new vaccine does not contain a live virus). You clearly have a robust system to fight off infection.
To answer your questions in order: You are at higher risk for a similar reaction for the second shot. I would plan your day accordingly, and premedicate with Tylenol (even though it may make the vaccine slightly less effective). The second vaccine is identical to the first. I have read recent reports that there are widespread shortages of the vaccine.
Chickenpox and shingles can affect you both by the virus attacking you and by an exuberant inflammatory and immune reaction.
I would guess that you are at lower risk for viral complications (such as infection of the eye, brain or lungs) but at higher risk for symptoms due to your own system, such as high fever. In many cases, the body’s response to infection can be as damaging as the infection itself.
DEAR DR. ROACH: I saw your recent column on enlarged prostate, and I have the same problem. I have no history of cancer, but I do have a high PSA and symptoms of frequent urination. Because of other medications, I cannot take ibuprofen, so I am curious if Tylenol has the same anti-inflammatory effect. I do occasionally use Tylenol for headaches and arthritis pain.
ANSWER: The exact mechanism of how Tylenol reduces pain remains a mystery. However, it is not an anti-inflammatory drug like ibuprofen, so would not be expected to have the benefit in prostate symptoms that some men get from taking an ibuprofen at bedtime.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@ med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803.