Shingles vaccine good for seniors and health-care budgets

Shinglesis a debilitating condition that affects mostly older Canadians. It causes a painful blistering skin rash. For as many as one in four sufferers, the pain can last for months and even years. There are two vaccines that can prevent shingles. A study published Monday in the Canadian Medical Association Journal gives the thumbs-up to one of them.

Shingles or herpes zoster is caused by varicella, the same virus that causes chickenpox. After recovering from chickenpox, the virus hides in the nervous system and is reactivated much later in life as a localized rash.Nearly onein threeCanadians develops shingles in their lifetime and the severity increases after age 50, according toCanada's Immunization Guide. The rash consists of blistersthat follow the course of one sensory nerve of the body. The blisters typically scab over in about a week, the U.S. Centers for Disease Control and Prevention says.

Two vaccines to prevent shingles are approved in Canada for people age 50 years and older. Zostavax is a live,attenuated vaccine containing a weakened form of the virus that was approved in 2008. Shingrixis a recombinant non-live vaccine that was approved in 2017.

Clinical trials of Zostavax show that the live vaccine is less effective the older the patient, and its effectiveness decreases over time. Shingrix has greater than 96 per cent effectiveness for patients 50 to 59 years of age and is close to 98 per centeffective patients greater than 70 years of age. Its effectiveness in one study was maintained for nine years following vaccination. For every 38 people vaccinated, you prevent one episode of shingles.

Shingles vaccines are costly. One dose of Zostavax costs about $200; each dose of Shingrixcosts roughly $150. Prices vary across Canada. Some health insurance plans cover the cost of these vaccines. Ontario provides the older Zostavax vaccine free of charge to residents 65 to 70 years old. British Columbia, Quebec and most other provinces do not pay for shingles vaccines.

To make the case for wider coverage, these vaccines need to be proven not only effective but cost-effective.

Using a computer modelling system, a team of researchers led by Mlanie Droletat the Centre de research du Centre hospitalier de l'Universit de Qubec and the Universit Laval, Qubec, found that the Shingrix vaccine was cost-effective for adults age 60 years and up, and likely more cost-effective than Zostavax.

Expand coverage?

The researchers found that 78 people had to be vaccinated with the older vaccine to prevent one case of shingles among 60-year-olds.Only 18 such people needed to be vaccinated with the newer vaccine to prevent one case.

The results were consistent with similar studies in the U.S. and the Netherlands.

The study's authors say the cost-effectiveness analysis was persuasive enough to convincethe National Advisory Committee on Immunization (NACI) to recommend that adults 50 years of age and older to be vaccinated with Shingrix.

Although the current study predicted that the vaccine would to be cost-effective in adults age 60 years and up, NACI concluded that it may not be feasible to vaccinate everyone at that age. Therefore, in the case of publicly funded shingles vaccine programs like the one in Ontario, NACI recommended vaccinating adults 65 to 79 years of age would be most cost-effective.

Still, if moving the needle means that the provinces expand coverage of the vaccine, so far, that hasn't happened.

Anyone who had chickenpox is at risk of developing shingles, but it occurs most frequently among older adults and those with compromised immune systems. More than 80,000 of the 130,000 cases that occur every year in Canada happen in people age 50 years and older. This age-related risk may be due to waning immunity as a result of natural aging processes.

Debilitating pain complication

You can also get shingles after getting the chickenpox vaccine. However, people who get the chickenpox vaccine are less likely to have shingles later in life than people who have had chickenpox disease.

The kindest thing one can say about shingles is that risk of dying of it is low. The severity increases with age, and up to 10 per cent of people over 65 years of age are admitted to hospital. The most frequent complication of shingles is postherpetic neuralgia, which is a prolonged and often debilitating type of pain that lasts for more than 90 days from the onset of the rash. Older adults, people living with chronic conditions such as diabetes or autoimmune diseases, and people with compromised immune systems may be at greater risk of developing neuralgia.

Shingles can crop up along any sensory nerve in the body. A rash on the forehead and the tip of the nose means the eye is at risk of being affected. People with suppressed immune systems can develop widespread or disseminated shingles which can look just like chickenpox.

Healthy or living with a compromised immune system, shingles is an unpleasant illness. The fact it can be prevented is good news for seniors.

The study was funded by the Public Health Agency of Canada, Quebec's ministry of health and social services, the Canadian Institutes of Health Research and Quebec's funding agency for health research. One of the authors reported receiving research grants or reimbursement for travel expenses from four vaccine manufacturers.