Seunga (Jasmine) Han, PharmD Student
Continuing our conversation surrounding vaccinations, let’s talk about the shingles vaccine. Shingrix® is the newest vaccine to be approved in Canada, and it’s now being recommended over Zostavax® to prevent herpes zoster reactivation, also known as “shingles”, and its complications in adults 50 years of age and older.
What is “shingles”?
Before we start talking about the vaccines, let’s first talk about “shingles.” “Shingles,” also known as herpes zoster, is a viral infection caused by varicella zoster, the same virus that causes chickenpox.
When we get chickenpox, the virus stays dormant in the nerve cells after the initial illness subsides. This virus reactivates once our immune system gets weaker, which happens naturally as we age. This reactivation, however, is what leads to “shingles.” This reactivation typically occurs in individuals around 50 years of age and older, since this is when our immune systems start to become weaker.
What are the symptoms of “shingles”?
Usually, the first symptom of shingles is pain, tingling, or itching of the skin which is then followed by the appearance of an itchy, red rash with blisters at the site of the initial pain. This blistering rash usually scabs over after 7-10 days and then heals in about 2-4 weeks.
What’s unique about this rash is that it usually develops in a single stripe on one side of the body (either the left or right side), and it rarely occurs on the face.
Is “shingles” contagious?
Generally speaking, no. “Shingles” can’t spread between people who have already been infected with the varicella virus. However, the virus can spread from one person to another person who has never had chickenpox or the chickenpox vaccine. This happens through direct contact with the fluid from the blistering rash. A person with active shingles can spread the virus this way when the rash is in the blister-phase, but not before the appearance of blisters, or after the crust has developed around the healing rash.
You can avoid spreading the virus to those at risk by covering the rash, avoiding scratching or touching the rash, and washing your hands often.
What are the complications of “shingles”?
The most common complication of “shingles” is a condition called post-herpetic neuralgia (PHN). PHN is a type of nerve pain that may be severe and quite debilitating for some and persists anywhere from weeks to months after the rash heals. In some patients, this pain may last for many, many years, interfering with their day-to-day life.
Other complications of “shingles” may include vision loss, especially when the face is affected, pneumonia, hearing problems, brain inflammation, or even death.
How is “shingles treated”? Can I prevent “shingles”?
“Shingles” is treated through the use of anti-viral medications, which work best when they’re started within 72 hours after the appearance of symptoms.
Currently, there are two vaccines that have an indication for shingles prevention in Canada – Zostavax® (live vaccine) and Shringrix®. It’s recommended that people with a history of chickenpox consider becoming vaccinated with either of these after the age of 50. Why’s that? The chickenpox virus takes about that many years to mutate into shingles, and one in every ten people that get shingles will go on to have lasting nerve pain with the risk and severity increasing with age.
Zostavax® vs Shingrix® – Which one is better?
It’s recommended that individuals over the age of 50 receive 2 doses of Shingrix®, with each dose separated by 2-6 months, if they:
- have previously had shingles – it’s recommended to wait until the “shingles” rash has gone away before getting vaccinated.
- have ever received Zostavax® – it’s recommended to wait at least eight weeks after receiving Zostavax® before getting Shingrix®.
- are not sure if they’ve had chickenpox
Why is this the case? This is because Shingrix® has demonstrated that it provides stronger protection against “shingles” and PHN compared to Zostavax®.
In fact, receiving two doses of Shingrix® is more than 90% effective at preventing “shingles” and PHN, unlike Zostavax® which prevents the risk of “shingles” and PHN by 51% and 67%, respectively. However, Zostavax® may still be used to prevent “shingles” in healthy adults 60 years and older.
Until more data is collected, Shingrix® appears to be the most effective “shingles” vaccine, effectively protecting more than 85% of people 70 years and older throughout the four years following vaccination.
We hope you took away something valuable from this piece. If you have any questions or concerns regarding this article or others, feel free to reach out to us on Instagram, Facebook, or at ask@orbishealth.ca with your feedback. We’d love to hear back from you!
RESOURCES:
- Vaccines and Preventable Diseases. (2018, August 22). Retrieved September 24, 2018, from https://www.cdc.gov/vaccines/vpd/shingles/hcp/index.html
- Vaccines and Preventable Diseases. (2018, August 22). Retrieved September 24, 2018, from https://www.cdc.gov/vaccines/vpd/shingles/hcp/index.html
- RxTx
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