Ask Your Pharmacist

February 11, 2021
Q:

Should I receive shingles immunization during the COVID-19 pandemic?

A:

Shingles (Herpes zoster) is a painful outbreak of skin lesions that follows a pattern or a track supplied by an affected nerve ending (i.e., a dermatome). Shingles usually starts as a rash on one side of the face or body. The rash starts as blisters that scab after seven to ten days. The rash usually clears within two to four weeks. Before the rash develops, there is often pain, itching, or tingling in the area where the rash will develop. Other symptoms of shingles can include fever and chills, headache, muscle aches and nausea.

Shingles is caused by the same virus that causes chicken pox. After recovering from an episode of chicken pox, the virus remains in our body in a sleeping state at our nerve endings. At some point later in life, the virus gets reactivated, and this is generally known as a shingles outbreak.

The risk of a shingles outbreak increases as we age. This “reactivation” most commonly occurs in people 50 years of age or older but can occur at any age. People who have medical conditions that keep the immune system from working properly (i.e., cancer) or people who receive drugs that weaken the immune system (i.e., corticosteroids, medications given after organ transplantation) are at greater risk to get shingles.

While shingles is usually mild with pain around the blisters and sickness that can last several weeks, some suffer severe pain for years after their rash has healed. This is known as post herpetic neuralgia. The lifetime risk of shingles has been estimated to be as high as 30 per cent in the general population. In Canada, it is estimated that each year there are 130,000 new cases of HZ, 17,000 cases of post herpetic neuralgia and twenty deaths.

Two vaccines are approved by Health Canada to immunize against shingles. Zostavax®II is a live attenuated vaccine (i.e., it is a weakened form of shingles virus) approved in 2008. In 2017, an inactivated vaccine, Shingrix® was approved. Shingrix is recommended for adults 50 years of age and older who do not have a medical reason to exclude them from receiving the immunization. People who have previously had shingles still should receive Shingrix to minimize the frequency and severity of any future shingles outbreaks. Shingrix is also recommended for people who were previously vaccinated with Zostavax II.

Shingrix is preferred over Zostavax II for several reasons. Shingrix provides about 90 per cent protection against shingles in comparison with approximately 75 per cent protection with Zostavax II. Zostavax II is not as effective in the people over age 70, and its ability to protect against shingles generally weakens sooner than Shingrix. In scientific studies, people who received two doses of Shingrix had protection from shingles virus for four to 10 years after immunization, and possibly for up to 15 years. Because Zostavax contains a weakened live shingles virus, it should not be given to anyone with a weakened immune system, such as those receiving chemotherapy.

Shingrix is not covered by the New Brunswick Prescription Drug plan. Coverage for the vaccine has recently been approved government for retired Canadian Armed Forces personnel, RCMP officers, and by Non-Insured Health Benefits (NIHB). The cost of immunization with Shingrix is approximately $160 per dose (i.e., approximately $320 the two-dose series immunization). Some private insurers cover some, or all, of the cost of the vaccine.  

Your pharmacist has the ability to assess, prescribe, and where appropriate, administer the shingles vaccine for you.   A decision about when is safest to receive your shingles immunization during the COVID-19 pandemic is best made in discussion with your doctor or nurse practitioner and pharmacist.  Basic precautions of routine hand hygiene, physical distancing, and wearing a non-surgical medical mask may lessen the risk of COVID-19 exposure during an appointment to be immunized against shingles, but some risk still exists. Older aged New Brunswickers are at higher risk of complications from COVID-19 as well as the bad effects of shingles, compared to younger citizens without weakened immune systems. Ideally, their immunization against shingles should be combined with other medical visits to reduce unnecessary exposure to COVID-19. Consider New Brunswick’s COVID-19 level of recovery phase when planning shingles immunization appointments. New Brunswickers who are immune compromised such as solid organ transplant recipients, stem cell transplant recipients, and those with health conditions that significantly compromise their immune system, should make specific arrangements with their health care provider to receive shingles immunization so as to minimize unnecessary exposure.     

Dr Kevin Duplisea (PharmD BSc. Pharm, BSc. ACPR) is a pharmacist at Sharp’s Corner Drugstore in Sussex, New Brunswick. 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.