I did not enjoy getting my recombinant shingles vaccine (Shingrx). I rarely have strong reaction to vaccinations, but the adjuvant in this one really did give me a sore arm, and the second shot (as one might expect) brought on that symptom even more strongly. But I am very happy indeed that I got that series of shots, because the evidence has continued to pile up that this vaccination is associated with a significantly lower risk of dementia later in life. These studies involve large cohorts of patients from several locations around the world, and they all point in that same direction. It very much looks like this is a real effect; I’m unaware of any similar effort to look for it where this signal was not observed.
So if we stipulate that, the next question is How Come That Happens? It’s quite possible that persistent herpes zoster virus imposes some sort of immune/inflammatory burden that contributes to neurodegeneration over time, but that idea needs more data to back it up. There may be other cross-contributions of the immune response to the vaccination at work as well, but we don’t have much to point at there yet, either.
But this new paper makes finding such links a matter of even greater importance. The authors show that this same vaccine is associated with a 9% decrease in cardiovascular disease endpoints over the next seven years. Specifically, disease burden was lower for ischemic heart disease, for heart failure, and for atrial fibrillation, and in male patients it showed a lower burder for ischemic stroke. This study involved over 36,000 patients who received the recombinant vaccine in 2018 and a similar 36,000 who received the older live-attenuated vaccine in 2017. That’s a pretty solid natural-experiment control. The comparison between the two types of shingles vaccine is even more impressive when you consider that the earlier vaccine itself had been linked in similar analyses to cardioprotective effects all its own.
This latest work also looked through these two sets of patients for people who got a TDaP vaccine in 2018 versus 2017 and found no cardiovascular effects at all. So it’s not just “any vaccination”, but it has to be said that both influenza vaccination and pneumococcal vaccination have also been linked to cardioprotective effects. And why stop there? I just wrote back in June about lower cardiovascular events in a study of one million veterans who received the coronavirus vaccine. Not all of these appear (so far) to be necessarily driven by just prevention of myocarditis (direct infection of cardiac tissue), so that simple explanation doesn’t seem to be enough. There are various hypotheses about antibody effects on various types of oxidized LDL particles or on the inflammatory cascades that are found in atherosclerosis, but these too need to be shored up.
Taken together, though, all of this work strongly suggests that more people - especially more older people! - need to get the current vaccines against infectious diseases. They are not only good at preventing the diseases they are targeted for, but they show health benefits above and beyond what you would have anticipated. As for me, as mentioned I have had the recombinant shingles vaccine, and I have had the pneunococcal shot as well. I have had coronavirus vaccines every year since they became available, and I look forward to getting the latest one soon. I will also cheerfully be getting this year’s influenza shot. I have no desire to get any of those diseases, and since I also have strong desires to avoid cardiovascular events and dementia I am just thrilled that it appears that I'm doing something about those at the same time.
Anti-vaccine activists are wrong about the benefits of these shots, and the ones who are currently in high positions in our public health system are worse than wrong: they are culpable. Downplaying the need for these vaccines has caused and is causing significant mortality and morbidity just by the targeted infectious agents themselves, and that alone seems to me to be a total abdication of responsibility. But more and more it appears that discouraging these shots is also exposing people to higher rates of heart attacks and dementia as they age, and what the hell do we have public health officials for if it is not to help lower the rates of all these things? Well?