April 2018: All About Shingles

The Rural Pharmacist: All About Shingles

-Devon Myers, Pharmacist & Owner

You may have seen ads recently in magazines and on TV advertising a new shingles vaccine called Shingrix. Maybe you’ve already had the Zostavax vaccine. Maybe you were thinking about it after seeing a friend or family member go through an episode of shingles. Let me tell you: Shingles can be nasty and I’ve seen patients suffer from the pain for weeks, even months, after the rash resolves.

Shingles is caused by the same virus as the chicken pox. Once you’ve had the chicken pox, your body does not get rid of the virus, but rather the virus stays in your body, specifically in a portion of your spinal nerves. The virus may stay silent and cause no problems or, unfortunately, it can become reactivated to cause shingles if your immune system is compromised, which can happen with increasing age and/or stress. The initial symptoms that present with shingles are headache, fever, chills and nausea which can progress to the itchy, burning and painful rash usually found on, but not limited to, one side of the torso.  This burning, itching pain tends to occur before the rash even appears; in fact, the rash may take two days to develop after the first sign of these symptoms. Is the rash contagious? People with shingles can spread the chickenpox virus to others if the rash transitions into oozing blisters. Keep your distance until the oozing blisters scab over.

Up to 40% of patients experience pain from shingles long after the blisters and rash have healed. This is a phenomena known as postherpetic neuralgia and is more likely to occur as you get older. Talk about kicking someone when they’re already down; the area can be so sensitive that even having the fabric of a soft shirt can cause pain. Due to its nature, this pain can be very difficult to manage, even with prescription medications.

The best thing to manage shingles is to prevent it with a vaccine and minimize stress. However, if you do get shingles you should see your doctor or nurse practitioner immediately – starting antivirals early can ease symptoms.

Currently, there is one shingles vaccine that the Ontario government covers for eligible patients. Zostavax vaccine is covered for individuals between the ages of 65-70 years old, but only if they receive the injection from their doctor or nurse practitioner. Without coverage, the cost of this vaccine is approximately $210 through a pharmacy. Zostavax is a one-time subcutaneous injection that is recommended for people over 60 years old. It is a “live” vaccine, which means it contains the live virus. This is important if you are immunocompromised or on medications that can affect your immune system. It can prevent shingles in up to 51% of patients, and if you do contract shingles it can prevent your episode from progressing to the painful post-herpetic neuralgia 67% of the time. There is, however, a newer vaccine intended to prevent shingles infection that may be more effective.

Shingrix is a new shingles vaccine that was released in January 2018. Studies have demonstrated the Shingrix vaccine to be up to 90% effective in preventing shingles episodes or the painful post-herpetic neuralgia episode. That is a significant improvement from the 51% prevention rate that is associated with Zostavax. Shingrix is also recommended in people 50 years and older and is not a “live” vaccine, which is good news for immunocompromised patients.

The dosing schedule for the Shingrix vaccine consists of 2 intramuscular injections. Injection site reactions may be more severe with Shingrix than Zostavax because it is administered intramuscularly instead of subcutaneously.  Once you receive the first injection, the subsequent injection is given between 2 and 6 months later (preferably 2 months later because the sooner you finish the course the sooner you are protected). At this time there is no provincial coverage for Shingrix, although it may be covered by certain private insurance plans. The cost for each dose is approximately $150 for a total of $300. When receiving injections that require a second dose sometimes people can forget to follow up with their healthcare provider. We don’t want people unintentionally missing doses and thinking they’re protected when they may not be.  Our pharmacy staff will set up a refill reminder for you and we’ll call you to set up an appointment for your second dose.

Our pharmacists at Rosslyn IDA Pharmacy and Kakabeka Falls IDA Pharmacy are trained to administer the shingles vaccines, along with other travel vaccines. If you are considering a vaccine to prevent shingles please stop by our pharmacy to discuss your options. Our staff would be happy to answer any questions that you may have regarding the vaccines, including if your private health plan offers any coverage. We can also assist you in obtaining a prescription. Even if you’ve had the Zostavax vaccine in the past you can receive the Shingrix vaccine permitted enough time has elapsed since the Zostavax injection. Visit our new Rosslyn Pharmacy at 202 Highway 130, across the street from Lulu’s Variety or give us a call at 939-2007! Our Kakabeka Falls Pharmacy is located in the heart of Kakabeka village and has a walk-in clinic Monday-Friday 9am-5pm. COMMITTED TO YOUR COMMUNITY!