Shingles Vaccine Trials and Tribulations

History

I participate in a message board about taking Remicade specifically but biologicals in general.  On that board, many members complain about developing Shingles shortly after starting the biological medication.

In September, my Infectious Disease doctor diagnosed me as suffering from Cryptococcus Neoforman fungal pneumonia.  The prognosis for treatment of this fungal pneumonia remains excellent as long as it does not affect other organs/systems (e.g. the Central Nervous System).  If it does spread, the prognosis declines and, in the event of a CNS infection, most often results in death.

Due to this concern, I had to stop taking all immunosuppressant therapies for my Crohn’s Disease (no Imuran, no Prednisone, no Azulfadine, no Remicade).  Do the cessation of all immunosuppressant therapies, this period of time presents an opportunity unique to me over the last 25 years – a period of time in which I was taking nothing suppressing my immune system.  When I asked my Infectious Disease doctor about getting immunized for Shingles, he encouraged me to do so.

What are Shingles?

Shingles manifest as a rash that can affect only one side of your body.  Common symptoms include
 

• Rash
• Pain, burning, itching, numbness, tingling
• Fluid filled blistering

Shingles is caused by the Herpes Zoster virus.  The Herpes Zoster virus manifests itself upon initial infection as Chicken Pox.  After your body defeats Chicken Pox, small quantities of the virus remain in your nerves.  If something suppresses your body’s immune system, the virus can emerge, multiply, and manifest as Shingles

Insurance

By policy, my insurance covers this vaccination for patients 60 years old or older.  When I called and asked them, they stated that they would refuse to cover the immunization (I'm only 49).  I planned to get the shot anyway and appeal the decision based upon my current immunocompromised status and anticipation of further immune suppression from drugs I'll be starting.

Pharmacy

My pharmacy refused to give me the vaccine for the same reason my insurance refused to cover the medication, namely that I was too young. They stated that the standard is to vaccinate only those age 60 or older.

I called my ID doctor and asked them to provide a script to the pharmacy, which he did.  I went to the pharmacy to get the vaccination and they pharmacy rang the vaccination up, discovered that my insurance covered it at 100%, and drew the vaccine into the syringe.  At that point, the pharmacist realized that I was only age 49.  By law they could only administer the vaccination to people with a script if they were age 50 or older.

The pharmacy declared that injecting this vaccine into someone my age is "off label" use of the drug according to the FDA.  Yet the Mayo Clinic site lists someone like me as "at risk" for contracting Shingles and a good candidate for receiving it.

"Factors that may increase your risk of developing shingles include:

...

Medications. Drugs designed to prevent rejection of transplanted organs can increase your risk of shingles — as can prolonged use of steroids, such as prednisone."

Anyway, the pharmacy asked me to take the syringe to my doctor for administration.  Since my doctor’s office was literally across the street, I agreed and took the syringe to the GP doctor’s office.

The Doctor

Essentially the doctor could not administer the vaccine because they had not drawn it from the vial and could not verify the syringe’s contents, so I volunteered to administer the vaccine to myself.  My doctor’s office staff hemmed & hawed but eventually returned the syringe to me.

DIY

When I got home, I realized it was within a few days of when I needed to administer my B12 injection so I elected to do both today.

I administer my B12 monthly subcutaneously (under the skin).  For a SC injection;

1. gently pinch the skin to pull it away from the muscle
2. insert the needle at ~45 degree angle to the skin
3. gently draw back on the syringe plunger to ensure you haven't entered a blood vessel
4. if no blood pulls into the syringe, then inject the B12 (in 15 years of B12 injections, this happened to me exactly once)
5. withdraw the needle

The Shingles vaccine is normally administered into the muscle (intramuscular) into the muscle on the back of your arm (tricep).  This is a tricky location to self-inject into so I got permission to administer mine into my thigh (quadriceps).  For an IM injection;

1. insert the needle at a 90 degree angle to the skin
2. gently draw back on the syringe
3. if no blood pulls into the syringe, then inject the vaccine (I saw no blood)
4. withdraw the needle

Note that I did NOT combine their contents and I did not use the same injection site.

The Vaccine

The vaccine is a weakened but live Herpes Zoster virus.  It has been manipulated to provide protection against Shingles and cannot be used interchangeably with the Chicken Pox vaccine.  The Mayo clinic claims that there are not documented cases of transmission of Shingles based upon this vaccine, however, I recommend avoiding people with a weakened immune system for a couple of weeks after receiving the injection.

Notes

 Inserting the needle didn’t hurt at all

• Injecting the syringe contents didn’t hurt at all
• The whole process was frustrating, time consuming, and took way more effort than it should have
• Next time, I’ll get the vaccine at the doctor’s office