Feb 9, 2018

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Minor hockey has really gone high tech. On Friday, Emily, Julien and I went to watch the Yellowhead AAA Midget Female game in Shoal Lake. Emily knows local hockey stars on the team Jaida Flett, Megan Quesnel and Toni Koshowshi. We watched them beat the Eastman Selects 4-1. But I also watched hockey dad Curtis Flett live stream video of the game on Facebook from his phone on a monopod. That kinda blew my mind. Then I thought about the Teamlinkt and TeamSnap apps my kids' teams use. They are all tech improvements over how minor hockey is followed.

There have been recent improvements in the shingles vaccine too. But let's review the basics. What is shingles? Shingles is a condition caused by the same virus that causes chickenpox, varicella-zoster virus (VSV). When you have chickenpox as a child, we say you have varicella. The varicella-zoster virus does not leave your body when the red itchy spots of chickenpox go away. Instead, it becomes inactive in nerve cells called the sensory dorsal root ganglia. The virus goes dormant and just sits there for 30,40, or 50 years. In some people, the virus then reactivates and causes a rash. This time though, instead of being itchy like chickenpox, the rash is usually painful and only on one side of the body. This condition is known as shingles. The medical term for it is herpes zoster.

Doctors talk about two main things when they talk about shingles or herpes zoster. They talk about the reactivation of the virus in the nerve cell and its accompanying rash, and they talk about postherpetic neuralgia. Postherpetic neuralgia is nerve damage pain that remains after the shingles rash is gone. Postherpetic neuralgia can result in severe pain. Common sites of postherpetic neuralgia pain are the torso and the face. Sometimes the pain is so severe patients are unable to wear clothing that comes in contact with the lesions or to be outside in the wind because of the sensitivity of the skin on the torso and face. There have even been cases of loss of vision and facial scarring. The incidence of shingles and postherpetic neuralgia will probably increase as the population ages. The rate of shingles and PHN rises sharply after the age of 50. The number of people with shingles who get postherpetic neuralgia rises from 10% among the general population to as high as 40% among those over 50.

Recently a second brand of shingles vaccine has hit the market. There used to just be Zostavax. The new kid on the block is called Shingrix, and it might be better.

Zostavax is a live attenuated vaccine. That means it has actual virus in it that has been weaken. But if you give it to someone with a very weak immune system, like someone on cancer chemotherapy, they could theoretically get the disease. Shingrix is a non-live recombinant vaccine. It can't give the disease to an immunocompromised patient. Shingrix also has an immune booster ingredient that causes the immune system to react very strongly to the vaccine. That leads to why everyone is excited by Shingrix. Shingrix claims that it prevents shingles 97% of the time, while Zostavax only prevents shingles 51% of the time.

Of course, Shingrix has some downsides. Zostavax is expensive and not covered for most people. Shingrix is even more expensive. Zostavax is just one shot. Shingrix is two shots separated by 2 to 6 months. Shingrix hurts more. This is probably because of the special immune boosting ingredient. You are much more likely to have pain, rash and flu like symptoms with Shingrix than you are with Zostavax.

It is okay to get Shingrix at the same time as the regular flu shot without an immune boosting adjuvant. It hasn't been studied when given with other vaccines yet.

In Zostavax, shingles immunity falls off quickly in year 1 and is just about gone by year 5. We think Shingrix might give immunity out to 7-9 years, but the studies aren't complete. Theoretically, Shingrix should be fine in immunocompromised patients, but again the studies haven't been completed. You can give Shingrix to someone who previously got Zostavax, but wait about 2 months between Zostavax and Shingrix. It is recommended that a patient wait a year after previous shingles episode before getting a shingles vaccine. This is because the body should be relatively immune to shingles for the first year after an episode.

Shingrix is probably better than Zostavax, but more expensive, less convenient and more painful. The new apps for minor hockey are probably better than phone calls, texting and emails. Teamlinkt and TeamSnap are two app's that allow managers to send out schedules and easily change game times and practices. But probably the coolest thing is they allow parents in the stands to instantly update scores for parents who aren't there. While waiting Emily's game to start in Neepawa, I watched the scores as Eric's team in Stonewall beat Beausejour for the gold medal in their tournament. Now as soon as we get self-driving cars that can navigate through blizzards, being a hockey parent might become very pleasant.

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional

As always if you have any questions or concerns about these or other products, ask your pharmacist.

  1. and prevention of herpes zoster: A Canadian perspective-


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