Shingles

Dec 15, 2020

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Over the past couple weeks, tall, skinny, metal, prism-shaped structures have been popping all over the world. People have been calling them Monoliths, after the movie 2001: A Space Odyssey. The first one mysteriously appeared in Utah's remote Red Rock Country on Nov 18/20. Then it disappeared a few days later. Since then, Monoliths have been appearing and disappearing all over the world. Canada finally got one on Sunday Dec 6/20. The Manitoba Monolith mysteriously appeared near my home town.

Some infectious diseases are mysterious like Monoliths. Shingles is kind of mysterious. You don't just get infected with the virus and then immediately get the disease. There can be a lag period of decades. 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 and goes into 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 cells 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.

The Old Pinawa Dam was the first hydroelectric dam in Manitoba. It was built in 1903 and ran until 1951. After decommissioning, it was used as a demolition training ground for the Canadian Military in the 1950's. The current town of Pinawa was established in 1960 for the employees of Atomic Energy of Canada Limited's Whiteshell Laboratories about12 kilometers away from the town site for Old Pinawa Dam. In the 1970's, Old Pinawa was renowned for Biker Gang parties. In the 1980's, as teenagers, we'd drive to Old Pinawa and swim in the rapids. It was a natural waterslide. A waterside where someone got hurt/needed stitches after every trip. Now, Old Pinawa Dam is a provincial park. It has nicely maintained walking trails and picnic areas. On Sunday, Dec 6/20, I got a Facebook Message from an Eagle-Eyed News Scout at CKDM. He shared pictures of what looked like a Monolith at Old Pinawa. I sent out a few messages of my own, and none of my friends in the Pinawa area knew anything about it. My parents went for a walk around Old Pinawa on Monday, Dec 7 just after lunch. They said the Monolith was already gone. Global News had a piece about the Manitoba Monolith in which they quoted "Winnipeg Resident" Colin Fast and posted some of his photos. Colin might live in Winnipeg now, but I remember Colin as a kid a year younger than me who I played hockey with in Pinawa many moons ago. CBC has since reported they have found the artist responsible for the Manitoba Monolith, but they are honoring the artist's request to remain anonymous. That is fair. Neither wonder nor mystery are bad or unwelcome things in 2020. Unless the CBC reporter was named, "Dave". And he is currently held captive in some kind of pod by a Heuristically Programmed ALgorithmic Computer. "Open the pod bay doors please, HAL." "I'm sorry Dave. I'm afraid I can't do that"

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

Monolith Timeline Monolith Timeline - https://www.usatoday.com/story/travel/news/2020/12/08/monolith-timeline-appearances-disappearances-around-world/6491015002

Monolith at Old Pinawa Dam - https://globalnews.ca/news/7506677/canada-gets-its-own-shiny-viral-monolith-in-manitoba

History of Old Pinawa Dam - www.granite.mb.ca/oldpinawa/opbh1beg.html

 


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