Shingrix vaccine is now recommended for the immunocompromised.
Shingles is a viral disease that appears as a painful skin rash and blisters – something we’d all like to avoid. It’s a common disease that affects an estimated one in three Canadians, with over 130,000 diagnoses made every year. Since 2018, Canadians over 50 have had access to a highly effective vaccine called Shingrix. Unfortunately, this still left other vulnerable individuals at risk.
Thankfully, recent studies have shown that the vaccine is safe and effective for immunocompromised individuals. As a result, in November 2021, Health Canada approved Shingrix for use in immunocompromised and immunosuppressed patients aged 18 and above.
What causes shingles and is it contagious?
Shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox. After we contract chickenpox, the virus hides away in the cells of our nervous system. There, it can remain “asleep” and undetected in the body for decades. However, years later the varicella-zoster virus can be triggered and cause shingles. If you never had chickenpox, you have no risk of getting shingles. If you have had chickenpox, whether it has resulted in shingles or not, you should learn more about the Shingrix vaccine.
Our patients often ask whether shingles is contagious. The answer is no. It is not possible to catch shingles from another person who has shingles. However, individuals who have never had chickenpox (or the chickenpox vaccine) can develop chickenpox after direct (skin-to-skin) contact with a shingles blister, or by inhaling the airborne varicella-zoster virus. For example, if a grandparent has shingles, they could pass on the virus to their grandchildren who have never contracted chickenpox or been vaccinated against it.
Signs and symptoms of shingles
Shingles starts with an unusual sensation on the skin. Itching, burning, pain or tingling sensations can occur in an area of the body. A painful rash with blisters appears within one to two days. The blisters can progress into open sores or ulcers within 3-4 days. The rash starts to dry off and usually scabs over within 7-10 days and disappears completely after three to four weeks. Scarring and skin discoloration may persist long after the shingles have resolved.
Shingles treatment to accelerate healing
Treatment of shingles usually includes a combination of antiviral medications and pain-relieving medications. Early recognition is crucial to start antiviral treatment. Antiviral medications stop the virus from multiplying, accelerate healing of skin lesions, and reduce both the severity and duration of pain.
Complications from shingles
In most individuals, shingles runs its course without resulting in any lasting health problems. However, in some individuals, complications can occur.
About one in five people with shingles will develop post-herpetic neuralgia (PHN). People with PHN continue feeling pain or discomfort, even after their rash disappears. This can last for months – or even years – and can lead to other complications such as sleep loss, weight loss and depression.
Other rare complications of shingles include pneumonia, loss of hearing or vision (if the rash is near the ear or eye), skin infections, scarring, inflammation of the brain and, in extreme cases, death.
Individuals with immunocompromising conditions are at higher risk
Unfortunately, individuals who have immunocompromising conditions or who take immunosuppressive medications are at a higher risk for developing shingles. For example, individuals who have solid tumours or hematologic malignancies, rheumatoid arthritis, multiple sclerosis, inflammatory bowel disease, psoriasis, diabetes, asthma or are transplant recipients (including stem-cell transplants) are all considered to be at a higher risk.
Symptoms and complications of shingles in immunocompromised individuals may be more severe and long-lasting. The presentation of shingles for these individuals is more exaggerated: blisters are often larger and more numerous; their formation may last longer; and they may tend to bleed. Rather than being grouped in one specific area of the skin, in immunocompromised individuals, blisters may be spread out wider over the body, resembling chickenpox.
Studies show that the risk of shingles-related complications is also higher in immunocompromised individuals, as is the chance of recurring shingles. There is also an increased risk of post-herpetic neuralgia.
A highly effective shingles vaccine
In healthy individuals over the age of 50, Shingrix reduces the risk of shingles by more than 90% and reduces the occurrence of post viral complications by 88%. Further studies have shown that the vaccine’s efficacy remains high (90.9%) for up to approximately 7 years post-vaccination. Modelling studies show that efficacy may persist even longer. Currently, a booster is not recommended.
Multiple studies that included immunocompromised individuals, confirmed that the Shingrix vaccine is also effective in this population. For example, studies in stem-cell transplant recipients show 68% efficacy, and in patients with certain cancers, the efficacy was 87%. There is no difference in side effects compared to healthy patients over 50. Shingrix vaccine does not cause more reactions in immunocompromised patients.
Shingrix vaccine requires two doses given 2-6 months apart. However, immunocompromised patients may receive their second dose as early as 1 month after the first dose.
Who should consider getting the Shingrix vaccine?
Shingles can affect people of all ages but is most commonly seen in individuals above the age of 50 or in those with immune systems weakened by medication or disease.
Contact your Harrison Healthcare team, or your primary care provider, to learn more if you
- are over 50 years of age
- had chickenpox earlier in life
- have had a previous outbreak of shingles
- have an immunocompromising condition or are taking immunosuppressive medications
- have any further questions about shingles
