The shingles vaccine

Friday, October 21, 2016

Shingles, also known as herpes zoster, is caused by the same virus as chicken pox. In Canada, as in all industrialized countries, about a third of individuals will suffer from shingles at one point in their lives. Although the incidence of shingles increases with age, most sufferers (60%) are less than age 65, and are most likely still working.

In Canada, the number of annual cases of shingles is estimated to be on the order of 130,000, the number of cases of post-herpetic neuralgia (a persistent pain along the pathways of the nerves affected) at 17,000 and the number of deaths from shingles complications at 20. That translates into 252,000 physician consultations and 2,000 hospitalizations.1 Each year, the diagnosis and treatment of shingles and its complications cost the Canadian healthcare system $68 million.2

Cost of care in 2005: $68 million

 

 

Shingles-related events in Canada

 

 

 

Reference: Brisson M, Pellissier JM, Camden S et al “The potential cost-effectiveness of vaccination against herpes zoster and post-herpetic neuralgia,” Hum. Vaccin., 2010; 4(3): pp. 238-45.

Description

In a person who has had chicken pox, the virus is never truly killed off and can remain latent for many years. It lies in ambush inside the sensory nerves of the spinal cord without causing any symptoms. At times, however, especially when the immune system is not working at full capacity, the virus can reactivate and cause very painful skin rashes. This is called shingles. There are many reasons thought to weaken the function of the immune system:

  • Aging
  • Chronic diseases such as cancer or AIDS
  • Taking medication that suppresses the immune function, e.g. immunosuppressors or immune system modulator
  • Stress
  • Radiation therapy

Symptoms

The symptoms of shingles are rash, stomach ache, headache, fever and shivering. There are precursors to these symptoms, however. Itching, numbness and sometimes intense pain can arise in the days before the rash. The rash is most often accompanied by a burning, tingling sensation caused by tiny fluid-filled red blisters.

The rash most often occurs on the chest, abdomen, back, buttocks or the nape of the neck, and sometimes the face and scalp. It usually lasts 7 to 10 days and disappears completely after a month. However, if the immune system is down for any reason, the rash can be much more serious, with lesions that take longer to heal and can even leave scars.

Post-herpetic neuralgia is one of the more common complications of shingles, occurring in 8% to 27% of cases. It follows the pathways of the nerves affected by the herpes zoster virus. This neuralgia (nerve pain) can last several weeks, months or years, or even a lifetime if you’re terribly unlucky.

Other possible complications

  • Optic nerve damage: The virus can cause an eye infection or pain triggered by exposure to light. Left untreated, such infections may eventually lead to blindness.
  • Facial nerve damage: If some of the facial nerves are affected, the result could be Ramsay Hunt syndrome. This syndrome features pain in the ears, facial paralysis, and loss of hearing and taste, which is fortunately transient.

Impact on absenteeism and productivity

As demonstrated in the Drolet et al. study,3 which was published in 2012, the pain brought on by shingles can be very incapacitating and reduce work productivity in people with the disorder. This prospective study, carried out in Canada on shingles sufferers 50 years of age or older, found that 64% of the subjects had to take time off work because of it. Plus, 76% of them reported decreased productivity at work, known as “presenteeism,” due to the neuralgia of shingles. On average, each such employee took 27 hours off work and reported 34 hours of presenteeism.

Prevention

According to the Public Health Agency of Canada, the shingles vaccine remains your best protection against this painful affliction. Approved by Health Canada in 2008, Zostavax is the only vaccine available against shingles. It is intended for adults 50 years of age or older, and the way it works is by strengthening the immune system, enabling the body to fight off the virus. A single dose is enough. The shingles protection conferred by the vaccine remains statistically significant for at least 5 years, and the latest indications are that it can be effective for as much as 7 years.1 Despite its effectiveness, some vaccinated people may still develop shingles. In such cases, however, the pain is less severe and lasts a shorter time.

Conclusion

Shingles exerts a major impact on the quality of life and daily routine of Canadians. Although it is best to prevent it as much as possible, few Canadians have opted for the vaccine since it became available in 2008.

Treating shingles and its complications costs our health care system tens of millions of dollars annually. Moreover, the negative effect of this disorder on worker productivity costs employees quite a bit in not only absenteeism, but also presenteeism.

References:

  1. The Public Health Agency of Canada. Canadian Immunization Guide, Part 4.
  2. Brisson M, Pellissier JM, Camden S et al “The potential cost-effectiveness of vaccination against herpes zoster and post-herpetic neuralgia,” Hum. Vaccin., 2010; 4(3): pp. 238-45.
  3. Drolet, M et al “Employment related productivity loss associated with herpes zoster and postherpetic neuralgia: a 6-month prospective study,” Vaccine, 2012.