Ask Your Pharmacist

December 7, 2017
Q:

I would like to get vaccinated against the shingles virus but heard that there is a new vaccine coming on the market. When will it be available and is there any difference between it and the vaccine available now?

A:

Shingles infections are common, particularly in the elderly, and can cause a lot of pain and potentially other complications. There tends to be a lot of confusion around what the virus is, how it spreads and how it can be prevented. 

Shingles is caused by the varicella zoster virus, a member of the group of herpes viruses, and the same virus that causes chickenpox. After a patient recovers from chickenpox, the virus will lay dormant in nerve tissue near your spinal cord and brain. Years later, the virus can become active again and cause a shingles infection. It isn’t known exactly what causes this reactivation, but it is believed to occur when an individual’s immune system is lowered such as during times of stress or other illness. It occurs most frequently in the elderly.

Shingles can occur anywhere on the body but most often appears as a single stripe of blisters that wraps around either side of a patient’s torso. It is not life threatening but can be very painful. A course will usually last anywhere from two to six weeks. Typically, a patient will experience a burning or tingling sensation at the site which will develop within a few days into a red rash comprised of fluid filled blisters. These blisters will break open and crust over. Patients will often feel lousy as well with symptoms such as fever, headache and fatigue. 

The most concerning complication of the infection is the potential development of a post-herpatic neuralgia. This occurs if the virus damages nerve fibers near the site of the infection and causes them to send confused and exaggerated pain signals to the brain. In severe cases, these can be very painful and last for years.

Patients often ask if they are contagious. It is possible they can pass the infection to anyone who isn’t immune to chickenpox, most often through direct contact with open sores from the rash. For this reason, patients should be careful who they are around and avoid newborns, pregnant women or anyone with a weak immune system. It is a good idea for those infected to see a physician as it is possible to be prescribed antivirals that may reduce the duration and severity of the outbreak.

Vaccination is the best tool available to reduce your chances of a shingles infection.  Vaccination against chickenpox in children as well as adults who weren’t previously vaccinated is the most effective means of preventing a varicella zoster infection and its subsequent dormancy in your body. There is also a shingles vaccine called Zostavax which is designed to build your immunity to the virus in hopes of preventing a future shingles outbreak. Zostavax has been on the market for approximately 10 years. There is a new vaccine called Shingrix that is expected to become available in early 2018.

Based upon data available, it appears that Shingrix will become the preferred vaccine over Zostavax. It has so far proven to be more effective to prevent shingles and it is believed that it will provide a longer lasting immunity. It has been formulated with an adjuvant to boost the immune response which is not a component of Zostavax. As well, unlike Zostavax, Shingrix is not a live vaccine. As such it presently being studied to see if it can be used in patients with a compromised immune system which is not an option with Zostavax.

Vaccination with Shingrix will require two shots, and the booster will be provided two to six months after the initial shot. It is possible for those who have already been vaccinated with Zostavax to get Shingrix to boost their immunity; however, they should wait at least eight weeks after receiving Zostavax to receive this shot. As for the price, it is not yet known how much the vaccination will cost in Canada and whether or not insurance plans will pay for it. In the USA, Shingrix is about 25 per cent more expensive than Zostavax.

If you are considering getting vaccinated for the Shingles vaccine, ask your doctor or pharmacist which vaccine is right for you and if it is worth the wait for Shingrix to hit the market. If you’ve received Zostavax recently and are disappointed to learn that an alternative is soon coming, try not to be upset with your pharmacist. The information being released on Shingrix is very new!

Ryan Kennedy (BSc., Doctorate of Pharmacy, MBA) is a pharmacist/owner at Jean Coutu in Saint John. His opinions expressed in this newspaper are published for educational and informational purposes only and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. Send your questions to AskYourNBPharmacist@gmail.com.