Last month, my wife complained of an unexplained onset of right-sided chest pain… most severe in the lower rib cage area. I listened to her story and examined her, but I failed to come to any conclusion. Within several hours it had intensified, prompting me to take her to the emergency room for assessment. I had suspected the possibility of a gallstone attack or nerve root pain from her thoracic spine, as she had a history of lumbar disc problems. In the back of my mind, I only briefly considered shingles, as she had never had the vaccine. The blood tests and gallbladder ultrasound were normal and she was discharged without a firm diagnosis. Two days later, still suffering from the pain, she developed the diagnostic rash typically seen with shingles.
Like so many of us, although the very effective vaccine Shingrix has been available and recommended for six years – especially for seniors and persons who are immune compromised – she had not yet been vaccinated. Perhaps the focus on Covid vaccinations and the fact that, in most provinces, the cost is not covered by provincial health plans has deterred both physicians from not reminding their patients about its importance, as well as patients not seeking it.
Shingles is the common name for herpes zoster, a viral condition that can erupt in persons who have had chicken pox (varicella) in the past. The virus lies dormant in the tissues for many years and can erupt in the form of a painful rash – usually on one side of the body only. Although it can affect anyone who has previously had chicken pox, it is more common in persons over 65, those who may be suffering from emotional stress, persons taking immune suppressants and those who may have a chronic disease or malignancy. The incidence in older adults is more than double that of younger persons.
Chicken pox vaccine was introduced in Canada for universal use in children in 2004 and was publically funded. Since that time, the vast majority of children have received protection against the virus and would be unlikely to develop shingles as adults. Direct contact with an individual with the shingles rash when in the blister phase has resulted in rare cases of the virus causing chicken pox in a previously uninfected individual. For those of us born before the use of the chicken pox vaccine, most of us have had chicken pox (even those who don’t remember having it) and are therefore susceptible to developing shingles.
Typically, the initial symptom is pain that may be moderate or intense with a tingling or burning feeling on one side of your face, head, chest, back or waist. Sometimes, there may be a mild fever, headache, fatigue or chills along with the pain. This is usually followed in a few days by a rash in the area where you felt the pain. The rash initially appears as red bumps that, in two to three days, usually develop into fluid-filled blisters. These then dry up and fade after several weeks.
Treatment consists of medication for pain relief, as well as local treatment at the site involved. This may include a numbing agent such as lidocaine or other cream or gel applied to the rash. There are several anti-viral drugs that are commonly prescribed, including Acylovir or Valacyclovir. These drugs may reduce the intensity and duration of symptoms, as well as reducing the risk of long-term pain. They should be taken as early in the outbreak as possible.
Aside from the misery of these general symptoms, the two most common complications of shingles are the potential damaging effects to your cornea and your vision if the herpes infection happens to affect the area around your eye, and the possibility of the shingles pain (postherpetic neuralgia) lasting for months…or even years after the acute illness. I remember an elderly patient whom I treated for more than 10 years who suffered constant post-shingles pain.
The first vaccine for shingles (Zostavax) was introduced in 2006, but was limited in its use and only effective in about half of the recipients. A vaccine introduced in 2017 (Shingrix) is now the preferred vaccine, and data show vaccine efficacy in more than 90% in all age groups for at least seven years – and possibly longer. The vaccine is given in two intramuscular shots, two to six months apart. Those who had previously taken Zostavax should receive the Shingrix vaccine because of its greater efficacy.
The cost of Shingrix is variable across all provinces. In Ontario, the full cost of the vaccination (two doses) is covered for individuals between the ages of 65-70 years. Others in Ontario and other provinces including Alberta and British Columbia will have to pay the pharmacist about $300.00 for the necessary two injections. For those with prior approval from a private supplementary health-care plan, the cost may be covered. In Quebec, beginning just in May 2023, the vaccine is free of charge to people aged 80 and older, as well as for people aged 18 and older who are immune compromised. Check with a pharmacy in your province to determine the cost.
Many organizations are calling on the Canadian governments to improve their financial support for the critical immunizations that seniors in particular need in order to avoid such serious illnesses as shingles, influenza and pneumococcal pneumonia. One such organization – CanAge – is a strong advocate for improving promotion, support and financial aid to the provincial immunization programs. This organization states that only three per cent of Canada’s older population are protected against the easily preventable diseases that pose such a potentially fatal threat.
Family medical practice used to include – for most patients – a yearly physical examination, along with a review of your current medications and your immunizations. These preventive health measures and timely look at one’s needed immunizations are, in many cases, a thing of the past. The preoccupation with immunization programs for Covid has accentuated this problem. On your next visit, be sure to ask your doctor if you are up to date on your immunizations. The estimated six million persons in Canada who do not have a family doctor now have a particular need to take charge of their immunization requirements.
Have you had your shingles immunization? If not, don’t wait any longer. Talk to your physician or local pharmacist and plan on getting this very important protection. And, if you’re a snowbird and away in the winter, you do not want to risk spoiling the holiday with weeks of suffering!