SHINGLES

Nov 9, 2018

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"All Hail Jim Moylan!" Back in 1986 Jim was an interior trim engineer at Ford Motor Company. He was on his way to a meeting. He was driving a company pool car that he was unfamiliar with. He was running low on fuel, so he stopped at a gas station. It was raining. Jim guessed wrong at which side of the vehicle the gas tank door was on. Jim had to stretch the gas hose across his vehicle to fuel up. As an extra bonus, Jim got drenched. But Jim didn't just complain like I might have. Jim changed the automotive world. And the podcast Every Little Thing, tracked him down to find out his story.

The world of shingles vaccines has changed too. 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 the 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. This is why guidelines say people should get a shingles shot starting at age 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 is probably better than its predecessor.

The older vaccine, 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 is made of broken up virus parts. 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 90% of the time, while Zostavax only prevents shingles 51% of the time. Put another way, about 37 people need to get a Shingrix immunization to prevent 1 case of shingles over 3 years. It would take 59 patients immunized with Zostavax to prevent one case of shingles.

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 is probably fine at the same time as pneumococcal and Tdap vaccines, but studies are still ongoing.

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. Shingrix should be fine in immunocompromised patients, but studies are still on going.

Should you get the Shingrix shot if you previously got the Zostavax shot? Guidelines now say yes. You can give Shingrix to someone who previously got Zostavax, but wait at least 8 weeks 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.

Jim Moylan created that little triangle next to your fuel gauge on the dash board. If you hadn't noticed it, that little triangle points to which side of the vehicle the gas tank door is on. You will never have to stretch the gas hose over your car again. Guessing the wrong side of the vehicle will no longer cause you embarrassment and inconvenience. That triangle is fantastically useful. I agree with the Every Little Thing podcast. I should be called the Moylan Triangle from now on.

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

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-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852282/

Every Little Thing Podcast - https://www.gimletmedia.com/every-little-thing/do-you-need-to-warm-up-your-car-plus-a-teeny-glorious-car-hack#episode-player

 


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