What You Should Know
By Adam W. Cooper, Pharm D, North Dallas LIVING WELL Magazine
Herpes zoster, or shingles, is a heavy hitting diagnosis generally occurring in adults over the age of 50. The disease will affect approximately one million adults each year and carries a nearly 30% lifetime chance of disease contraction. As one ages, the chance of experiencing the disease increases so much that approximately 50% of those aged 85 and older will experience shingles. These facts create a significant health care concern for this population.
Who gets shingles?
Anyone who has been exposed to chicken pox is at risk for contracting shingles. Nearly all of the adult population has been exposed to chicken pox as a child and, therefore, is at risk for the disease. The virus that causes chicken pox is not killed by the body. Instead, the virus retreats along certain nerve lines in the body and becomes latent, or hibernates. Later in life, certain stressors (weak immune systems, aging, and other risk factors) may activate the virus. The virus reemerges along the nerves in the form of shingles.
What are the complications of shingles?
Some of the early symptoms of shingles include headache, sensitivity to light, fever, fatigue, and abnormal skin sensations or pain. One to five days later a rash may appear on one side of the body in the face, shoulder, or abdominal area, or in a combination of any of the areas. The rash may make a number of progressions. Each progression can be characterized by red, itchy, and fluid filled vesicles that weep and crust over lasting upwards of two to four weeks for the entire process. As a consequence of open skin lesions, secondary bacterial skin infections can complicate the course of infection. However, the most significant complication of shingles may present itself greater than 30 days after the skin lesions have subsided. This complication is known as post-herpetic neuralgia, or PHN. PHN is painful nerve stimuli that is experienced by 18-30% of patients following a shingles episode and can range from mild to excruciating pain. The condition may last from weeks to months and occasionally years. PHN may affect sleep, work, or daily activities and has been known to cause depression in certain individuals. Topical treatments, like capsaicin creams, and other oral pain relievers are available, although the benefits of these medications vary from individual to individual.
One of the most important steps that can be taken to diminish the impact of shingles is to get vaccinated. Zostavax®, the vaccine for shingles, is FDA approved for the immunization of adults 50 years of age and older. However, the 2012 recommendations by the Advisory Committee for Immunization Practices (ACIP) stand by a prior age recommendation of 60 years and above. The decision to immunize before the age of 60 should be made between you and your doctor.
The vaccine itself is a live, attenuated vaccine. That is to say that the vaccine has been made with virus that has been shocked to the point that it will illicit an immune response without generating full-blown shingles. However, due to the live nature of the vaccine, caution should be taken and advice from a physician should be solicited for individuals who have compromised immune systems such as: patients with cancers that affect the bone marrow or have leukemia, patients with AIDS, patients using cancer treatments such as chemotherapy or radiation, or patients on long-term immunosuppressive therapy such as corticosteroids. The effect of the vaccine may be more pronounced in these individuals. Additionally, patients who have true allergies to gelatin or the antibiotic, neomycin, should not receive this vaccination as these components are part of the process of making the vaccine.
Disclaimers aside, the documented benefits of this vaccine reflect how important it is. The incidence of shingles has been diminished 51% and the risk of PHN is 67% less likely in vaccinated patients. While the vaccine does not protect 100% against shingles, the duration and severity of the illness is sharply diminished should the disease arise. This fact alone warrants vaccination given the multiple complications that could occur with a full-blown outbreak.
How your pharmacist can help
A recent news media outlet reported that pharmacists in Florida will soon be able to vaccinate. The news anchor quipped that he hoped the rest of the country would follow this example. The fact of the matter is that pharmacists in many states, including Texas, have been vaccinating for a number of years. The news report simply highlighted the lack of public knowledge in regard to this valuable medical service. Prescriptions are required for this service, except where the pharmacy has an agreement with a physician to provide a specific vaccine. Vaccines that pharmacists may administer include flu vaccine, hepatitis A and B, shingles, pneumonia, tetanus, and travel vaccines to name a few. Consult your pharmacy to determine which vaccines it provides and which vaccines may require a prescription.
The shingles vaccine is greatly important. However, routine vaccinations like the flu vaccine and tetanus vaccine have great benefit in fighting illness also. In fact, vaccine protection goes beyond protecting yourself. Vaccinations may prevent those that you come in contact with from acquiring disease also. Talk to your pharmacist and doctor and make certain that you are up to date on all of your vaccines. Your health may depend on it.
Adam W. Cooper, Pharm D, is employed by Preston Road Pharmacy. Call 214-521-999 or visit the pharmacy at 6901 Preston Road, Dallas, TX, or view www.prestonroadpharmacy.com for information about vaccines and ways that Preston Road Pharmacy can serve your healthcare needs.