Your Burning Questions About Shingles

Many of you will have known someone who has had shingles (or have had it yourself). You probably already know about the pain which can severely affect someones life. Hopefully this will give you some insight into the vaccines available on the market, and help you make a decision on what is best for you. Currently the only vaccine to have public coverage is Zostavax II which is covered for seniors between the ages of 65 and 70.  

What is shingles?

Shingles is a reactivation of the chickenpox virus generally occurring later in life (most often in those over the age of 50). Generally shingles will start as a rash which is associated with burning or tingling pain sensation. In some cases patients will experience nerve pain which can last years in some cases after shingles. This risk is increased in the elderly (over 65 years of age).  

Can shingles be treated?

Different types of medications can be used for shingles. There are medications called antivirals that target the specific virus causing shingles. There are also medications that are used to help with the nerve pain associated with shingles. Unfortunately the antivirals are not that effective and may be mildly effective only if started within 2-3 days of noticing symptoms. The best treatment for shingles is preventing it from happening in the first place.  

What can be done to prevent shingles?

There are 2 vaccines on the market to prevent shingles, one is Zostavax II and the other is Shingrix. Both are safe vaccines which can decrease the number of people who experience shingles and the long term shingles pain. Zostavax is a live vaccine, and Shingrix is a recombinant vaccine. Because of this difference Zostavax has some limitations on who can use it (for example if you are on certain medications you may not be able to receive the Zostavax vaccine).  

What are the main differences between the 2 vaccines?

	Zostavax II (Live Vaccine)	Shingrix (Recombinant Inactivated Vaccine)
How well does it protect for ages 50-80?	Efficacy ranges from 70%  down to less than 40% for those in the older age bracket.	Efficacy ranges from 96% to 91%
Bottom line: This means that for Zostavax anywhere from 3-6 people out of 10 will still get shingles despite receiving the vaccine This means that for Shingrix only 1 out of 10 people who get the vaccine will still get shingles
How well does it help with long term pain?	Efficacy ranges from 65%-66%	Efficacy ranges from 91%-88%
Bottom line: This means that for Zostavax roughly 4 out of 10 who get the vaccine will still get pain This means that for Shingrix only 1 out of 10 who get the vaccine will still get pain
Are there people who shouldn’t get the vaccine?	People taking drugs that can decrease the immune system should not get the vaccine (examples include someone receiving chemotherapy or high dose prednisone) Also, people who have recently had shingles may not need to get the vaccine until 1 year has passed since the infection.	This vaccine can be given to those taking drugs that decrease the immune system, but there isn’t good information to show that the vaccine will be beneficial Also, people who have recently had shingles may not need to get the vaccine until 1 year has passed since the infection.
Side Effects	6/10 people – Injection site reactions which can include pain and redness and swelling where the needle was inserted. 1/10   people- headaches 2/100 people- bruising, 1/100 people- arm pain 1/100 people- weakeness	8/10 people -injection site pain 4/10 people -tiredness 4/10 people -headache 4/10 people  -muscle pain 3/10 people  -shivering 3/10 people -redness at injection site 2/10 people  -people had nausea/stomach upset

 

What does this all mean? Should I get vaccinated?

Nearly 1 in 3 Canadians will develop shingles in their lifetime. The vaccines that prevent shingles are safe, and effective at preventing shingles as well as the potential long term pain. An interesting number which may help you make your decision is that 31 people will actually need to receive the vaccine to prevent 1 case of shingles over 3.5 years. It is important to weigh your feelings, along with the cost of the vaccine, and the evidence to make a decision. Our pharmacists are trained to administer the shingles vaccines, let us know if you are interested and we can help you.  

What if I already received Zostavax?

If you already received Zostavax but want additional protection with Shingrix, as long as it has been one year from your Zostavax immunization, then we can certainly help you update your shingles immunization.  

References https://www.cdc.gov/shingles/surveillance.html (Accessed Oct. 24, 2018) National Advisory Committee on Immunization (NACI). Updated Recommendations on the Use of Herpes Zoster Vaccines. Public Health Agency of Canada, June 2018. Lexicomp Zoster vaccine (Live/Attenuated) Lexi-Drugs (Accessed Oct. 24, 2018) Lexicomp zoster vaccine ( Recombinant) Lexi-Drugs (Accessed Oct. 24, 2018) https://www.ti.ubc.ca/2018/10/10/114-shingrix-a-new-vaccine-for-shingles/ (Accessed Nov. 14, 2018)