Vaccines against shingles, “shingles”, are out of SUS; the new vaccine costs R$1,686

Vaccines against shingles, "shingles", are out of SUS;  the new vaccine costs R$1,686

the vaccine Shingrix for the prevention of shinglesfrom British pharmaceutical company GSK, arrives in Brazil almost a year after regulatory approval from the National Health Surveillance Agency (Anvisa) in August 2021.

Administered in two doses, with an interval of two months between applications, the manufacturer promises more than 90% efficacy in people over 50, one of the target populations of the vaccine.

However, the vaccine is also recommended for any adult over the age of 18 who is at higher risk of contracting the disease, such as patients immunocompromised. This is the first time that such an indication will be available in the country. Prior to that, only MSD’s vaccine, Zostavax, was licensed in Brazil, but not for this audience.

None of the vaccines are available from the National Vaccination Program, the PNI. How does a full immunization cost 1,686 reais on the private market, see below what are the indications for vaccination and what are the prospects for integration into the public health system.

1) What are the vaccination recommendations?

According to Anvisa, the vaccine GSK (Shingrix) with inactive virus is indicated for adults aged 50 and over and adults 18 and over at increased risk of shingles, usually people undergoing treatment for cancer, people living with HIV, who are going to have a bone marrow or organ transplant, lupus, multiple sclerosis, etc.

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Already the vaccine TMS (Zostavax)produced with live attenuated virus and approved by the regulatory body since early 2014, It is not indicated for immunocompromised people.

According to the Brazilian Society of Vaccinations (SBIm), it is equivalent in potency to 14 times the varicella vaccine and has been approved for use in a single dose in adults called immunocompetent (which can induce a normal immune response) over 50 years. The vaccine also showed protective efficacy against shingles of approximately 69.8%.

Isabella Ballalai, vice-president of the SBIm, explains that since shingles affects people who have had chickenpox, vaccination is recommended for groups at risk: people over 50, in particular people over 60, and immunocompromised people, whatever their age.

“Vaccines are used to prevent shingles, postherpetic neuralgia (a persistent pain that can last more than three months) and among other complications, such as facial paralysis,” explains the specialist. “And the older the age, the greater the risk [de ter a doença]”.

As for young people, Ballalai points out that it is rare for non-immunocompromised patients to become infected.

Zostavax, MSD/MERCK shingles vaccine. The vaccine is not indicated in immunocompromised patients. — Photo: UK Health Security Agency/Disclosure

What is the disease and what are the symptoms?

Popularly known as copper, shingles has serious consequences if not diagnosed and treated earlywhich can affect nerve endings in the eyes, ears and face causing paralysis, hearing and vision loss.

A recent example is the case of singer Justin Bieber, diagnosed with Ramsey-Hunt syndrome, which is shingles of the ear.

The disease is caused by the same virus that causes chicken pox (varicella), the so-called varicella zoster, and is different from cold sores. The most common condition is to affect immunocompromised people or people who have had a decrease in their immunity, such as an infection or other health problem.

According to the Ministry of Health, the main symptoms that precede the skin lesions typical of the disease (and usually painful) are as follows.

  • neuralgic (nerve) pain;
  • paresthesias (tingling, tingling, numbness, pressure, etc.);
  • local burning and itching;
  • fever;
  • headache;
  • faintness.

Ballalai adds that the shingles is NOT transmissible to someone who is immune to chickenpox (like everyone who has had chickenpox)but that skin lesions that affect those who have the disease virus can cause the transmission of chickenpox.

“You won’t get shingles, now a child who hasn’t had chickenpox and hasn’t been vaccinated can get chickenpox from that adult [que está com o vírus da varicella-zóster]“, says Ballalai.

How much do vaccines cost? How should they be managed?

The Shingrix (GSK) dosage regimen consists of two vaccinations two months apart. The cost per request is R$ 843 (1,686 reais in total).

Zostavax (MSD) is given in a single dose, which costs an average of R$570.

“For those who have already taken the attenuated vaccine (MSD), we recommend that they take the inactivated vaccine (GSK), because the attenuated vaccine generally protects for four years. More effective”, details Ballalai. “And those who have had shingles and are at risk should also be vaccinated, because the risk continues: the disease can occur more than once.”

Vaccines are not in the PNI

The GSK and MSD vaccines are not part of the national immunization program, the PNI, making access difficult for those who need the vaccine and are unable to pay the market price.

For the vice-president of the SBIm, the inclusion of these vaccines in the public system is “always desired”, especially for people over 60.

Despite this, she stresses that this availability depending on several factors, such as cost-effectiveness studies, the best and “quickest” way could be to make these vaccines available in Special Immunobiological Reference Centers (CRIE), training public and free sanitary facilities that provide vaccines not available in the PNI for immunodeficiency carriers.

O g1 asked the Ministry of Health about the possibility of including these vaccines in the public system, but received no response from the Ministry until the last update of this report.

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