Greater awareness of shingles complications risk needed - expert

More needs to be done to raise awareness of the debilitating complications of shingles to protect older Kiwis and the immunocompromised, according to an infectious diseases expert.¹

Shingles is a viral infection caused by the reactivation of the varicella-zoster virus (VZV), the same virus that causes chickenpox.¹

Almost all adults aged over 50 years may already have the virus that causes shingles. In around 1 out of 3 people, the latent virus reactivates in their lifetime and causes shingles.¹

Infectious disease specialist Dr Hasan Bhally says New Zealand has an ageing population. The number of Kiwis aged 65+ years is expected to grow to 1 million by 2028 and reach 1.5 million by the 2050s. Shingles is a particular concern in these groups, which means it is important to raise awareness of the risk of shingles and its potential complications among these patient groups.^{2 3 4 11}

The shingles virus can cause a painful, itchy rash, with blisters that wrap in a linear form around one side of the face, trunk or body. In addition to the initial painful condition there can be other debilitating complications which for some people can include long lasting nerve pain, vision and hearing loss, scarring and neurological problems, and rarely cardiovascular and stroke events.^{1 5 6 7 12 13}

He says this could be in the form of complications like an extension of infection into the brain (encephalitis), involvement of the eye (called herpes zoster ophthalmicus), or development of postherpetic neuralgia (PHN).^{6 14}

“Patients can complain of throbbing, burning, or shooting pain which can last for years, and can cause depression and anxiety,” he says.^{1 14}

Up to 30 percent of patients are at risk of developing PHN after shingles, with older age contributing to an increasing risk.¹¹

“The characteristic and pattern of shingles rash is unique. This makes clinical diagnosis relatively easier as many doctors are familiar with this infection. Early diagnosis also allows prompt intervention with anti-viral medicines,” he says.⁸

Dr Bhally says Kiwis aged 50+ years and who may have been exposed to chickenpox during their lifetime should check with their GP about how to prevent the development of shingles.¹⁵

Brett Marett, medical director at GSK NZ, says two doses of the vaccine for shingles, Shingrix, are funded for those aged 65 years.⁹

He says Pharmac has now widened access to the vaccine for certain individuals aged 18 years or older who are immunocompromised and at increased risk of developing shingles.^{9 15}

“While it’s important that access to funded Shingrix is available for immunocompromised people, we note that people over 50 years are also at an increased risk of developing shingles. We are continuing to work with Pharmac in this space,” he says.^{1 10 11 15}

Marett says current funding of Shingrix does not address all those at elevated risk of developing shingles and PHN, since the risk of shingles rises sharply from age 50 years.^{9 11 15}

“Individuals aged 50+ years are at increased risk of shingles and PHN and are not covered under the current funding programme, providing access to Shingrix for this group would help protect those who have elevated risk," he says.^{1 10 11 15 16}