Ask Your Pharmacist

October 26, 2018
Q:

My husband has shingles, and it seems awful. How can I protect myself from getting shingles?

A:

I am receiving so many questions about patients who have shingles (herpes zoster) or know someone who has shingles and would like to know if it’s preventable. I am happy to say that a new vaccine called Shingrix® is helping reduce the risk of shingles by roughly 90 per cent, but before discussing who should get the vaccine, let’s discuss what shingles is, who is at risk, and why it is such a concerning medical condition.

At a basic level shingles is a tingling, painful rash, usually on one side of the body, caused by the chicken pox virus (varicella). After someone has the chicken pox or has been exposed to it, the virus lives inside the nerve cells of your body and is kept dormant by your immune system. At times when the immune system is compromised by stress, illness or medication, etc., the virus can resurge and travel along a nerve to where the nerve ends on the skin where it can erupt in a rash capable of spreading chicken pox (by direct contact) to anyone who has not had chicken pox. Shingles can occur in many places on the body, the most concerning of which is on the face and around the eye. Loss of vision or facial paralysis can occur in this situation.

Rates of shingles are increasing, and now we expect one in three people will have shingles in his/her lifetime. These numbers are so high because over 90 per cent of us have had chicken pox (so the virus is dormant in our body), and shingles can occur at any age. I was lucky enough to have shingles at age 23. The age where risk significantly increases is somewhere between age 50-60, and it continues to increase as you get older with half of those over 85 having been affected. These are the age groups of most concern as complication rates are higher with older people.

The most common complication of shingles is lasting pain (mild to severe) for one to two months after the outbreak. This is called Post-Herpetic Neuralgia (PHN) and is caused by damage to nerve cells as shingles erupts. PHN can range from mild to tingling burning sensation to a severe pain described as similar to thorns or barbed wire burning and scratching the skin. To make matters worse, many patients, especially older patients with weakened immunity, can have pain that lasts into the year range. At 85, my grandfather seemed like he would never slow down, but he got shingles and with it, came severe pain. His pain was so bad that bending or twisting his torso was excruciating (the trunk of his body was affected). The way he walked changed, the normal day-to-day exercise he received from being active all day on his farm was put on hold until the pain subsided. Unfortunately, the pain took almost 18 months to subside, and 18 months with little exercise causes frailty to kick in quickly as muscles deteriorate. I’m commonly asked if I will get the vaccine when I am older and I don’t hesitate when I say yes because I remember my grandfather’s experience.

As of June 2018, the National Advisory Committee on Immunization (NACI) recommends all adults over 50 (without contraindication) receive the Shingrix® vaccine. Why? Because studies show it may reduce your lifetime risk of having shingles by over 90 per cent. And given the potential complications of long-term pain, loss of vision, infection of the rash (although rare, it can be fatal), prevention is by far the best treatment. New Brunswick pharmacists can prescribe vaccines like Shingrix® as well as administer the vaccine. Shingrix® is a two-dose vaccine with a second dose being administered two to six months later. As I mentioned above, shingles often occurs when ill so reducing your chances of having influenza is recommended as well. That can also be done by receiving your flu shot. If you have any questions on Shingrix®, the flu shot, or many other vaccines, ask your pharmacist for help.

Jared Mactavish (BSc., Pharm) is a pharmacist 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.