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

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

Almost all adults over the age of 50 may already have the virus that causes shingles. In about one in three people, the latent virus reactivates over the course of their life and causes shingles.¹

Infectious disease specialist Dr. Hasan Bhally, says New Zealand has an aging population. The number of Kiwis aged 65+ is expected to rise to 1 million by 2028 and reach 1.5 million by the 2050s. Shingles is a particular problem in these groups, so it is important to raise awareness of the risk of shingles and the possible complications in these patient groups.^{2 3 4 11}

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

He says this could take the form of complications such as the infection spreading to the brain (encephalitis), involvement of the eye (called herpes zoster ophthalmicus), or the development of postherpetic neuralgia (PHN).^{6 14}

“Patients may complain of throbbing, burning or stabbing pain that lasts 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 increased risk.¹¹

“The characteristics and pattern of the shingles rash are unique. This makes clinical diagnosis relatively easier as many doctors are familiar with this infection. Early diagnosis also allows for immediate intervention with antiviral drugs,” he says.⁸

Dr. Bhally says Kiwis over the age of 50 who may have been exposed to chickenpox during their lives should speak to their GP about how to prevent the development of shingles.¹⁵

Brett Marett, medical director at GSK NZ, says two doses of the shingles vaccine, Shingrix, will be funded for people aged 65.⁹

He says Pharmac has now expanded access to the vaccine to certain people aged 18 and over who are immunocompromised and at increased risk of developing shingles.^{9 15}

“While it is important that immunocompromised people have access to funded Shingrix, we note that people over the age of 50 are also at increased risk of developing shingles. We continue to work with Pharmac in this area,” he says.^{1 10 11 15}

Marett says the current funding for Shingrix does not address all people who are at increased risk of developing shingles and PHN, as the risk of shingles increases sharply after age 50.^{9 11 15}

“People over the age of 50 are at increased risk of shingles and PHN and are not covered by the current funding program. Giving this group access to Shingrix would help protect those at increased risk,” he says.^{1 10 11 15 16}