Don’t risk losing your quality of life to a vaccine-preventable disease
As children, about 95 per cent of today’s North American adults endured the itch and misery of chickenpox. And while we may not even remember being sick, we’re still harbouring its cause – the dormant varicella zoster virus – in nerve structures near the spine called the dorsal root ganglia.
That can be a problem, because as our immune systems become less robust, the virus can once again emerge. The result is shingles, a very common illness among those in the second half of life, starting at about age 50. By the age of 80, the chance of having shingles is about 50/50, says Toronto-based family physician and healthy aging expert Dr. Vivien Brown.
Shingles manifests as a painful rash, and symptoms may include itchy, uncomfortable blisters and flu-like symptoms. The shingles lesions tend to crust over by about 10 days; however, the entire rash can take longer, and anywhere from two to five weeks to resolve. For 80 per cent of those who get shingles, their bout with the disease is over when the rash is gone.
For the other roughly 20 per cent of individuals, however, shingles can have longer-lasting and more serious consequences: nerve damage called post-herpetic neuralgia. This potentially disabling condition can range in intensity from hyper-sensitivity that makes it difficult to tolerate clothing on the affected areas to severe chronic nerve pain. For most people, post-herpetic neuralgia improves over time, but it has also been associated with depression, fatigue, sleep and appetite loss, difficulty concentrating and other, rarer complications.
Fortunately, vaccines are available, says Dr. Brown, author of A Woman’s Guide to Healthy Aging. “The first, Zostavax by Merck, was approved for use in Canada in 2008.” According to the National Advisory Committee on
Immunization (NACI), the vaccine has demonstrated a 51 per cent reduction in shingles and 67 per cent reduction in post-herpetic neuralgia However, NACI states that the duration of protection provided by Zostavax beyond five years as well as the efficacy of booster doses remain unknown.
Recently, GSK introduced a new vaccine, Shingrix, which includes two shots, administered at two to six months apart. “Its efficacy, as published in the New England Journal of Medicine, is superb – over 90 per cent, even 97 per cent, in some age groups,” Dr. Brown reports. While pain at the injection site is the most commonly reported side-effect, there is also a “risk of generally mild to moderate headache and malaise, something to consider if you’re about to travel or have a big business meeting,” she adds.
Recent Express Scripts Canada Drug Trend reports reveal that more than half of Canadian private plan members with a drug claim live with multiple chronic diseases; one in five has four or more chronic conditions.
Yet many of these individuals enjoy a high quality of life – until their situations may be destabilized by an acute disease such as shingles, says Dr. Brown. “For example, an individual can have high blood pressure and high cholesterol, diabetes and a bit of asthma, and still be functioning really well; all of those diseases are well controlled. But when she has a bad episode of shingles and ends up in significant pain – I’m thinking of someone in their late 60s, 70s or 80s – she is put on medication. Too often, the medication has side-effects, and she slips and falls in the middle of the night because she’s groggy from the narcotics. She breaks her hip, and suddenly, this relatively healthy person [who was] living in the community is a dependent person living in an institution.”
Living well as we age requires being “really aggressive about immunizations to reduce the risk of significant disease,” Dr. Brown stresses. “Shingles is one of those things; I would say the same of pneumonia and flu immunization. Vaccinations prevent significant disease; even if they don’t prevent the disease 100 per cent, they decrease the severity.
“If we want to be independent as we age, we have to be very proactive about vaccines.”
Who is at risk of shingles?
Should you get a shingles vaccination? Family physician and author Dr. Vivien Brown provides a risk checklist:
• The number one risk is age itself, starting at age 50. (Younger people do get shingles, but much more rarely, and rarely experience complications.) The older you are, the higher your risk.
• Women are at greater risk than men.
• People with impaired immune systems due to illness or drug treatment are at higher risk.
• If your siblings or parents have had shingles, recent research shows you have a higher genetic risk of getting the disease. Even one first-degree relative is associated with a three- to four-fold risk increase. Two or more is even higher.
• People with other chronic diseases, including diabetes and COPD, are also more likely to get shingles.
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