Ask the Pharmacist

Q: My doctor has been talking to me about getting the shingles vaccine. Should I go ahead and get it done now?

A: The answer to this question for most of us has just changed as Health Canada has announced that Shingrix will be available to Canadians by the first week of January, 2018. Shingrix is the alternative vaccine to Zostavax which has been available in Canada since 2009, and by almost every comparison point, Shingrix seems to be a better option.

Shingles is a virus that over 95 per cent of Canadians are at risk of experiencing simply because they suffered from the chicken pox at an earlier stage of their life. After a child (or less-commonly, an adult) recovers from the chicken pox, the causative virus (known as varicella-zoster or V-Z) lies in a dormant state (the equivalent of being asleep) in the nerve cells that are known as ganglia. In this way, the V-Z virus is rather unique since most viruses, such as those that cause us to have a cold, are completely destroyed over time by our immune system.

The virus is held in check over the decades by two different aspects of our immune system. One is the antibodies we create in response to the initial chicken pox illness, and the other is called our cellular immunity which helps against all the infections we encounter throughout life. It is this cellular immunity which tends to be reduced as we age that, in turn, allows the virus, through a variety of factors, to come back into our life in the form of shingles.

Thirty per cent of people will get shingles in their lifetime and some of us, unfortunately, will get it more than once (although the initial shingles attack does boost your natural defences, making it somewhat uncommon).

Not surprisingly, the chance of getting shingles increases dramatically as we age (two out of every three cases occur in the 50-plus crowd), as do the chances of suffering complications after the initial illness. More than 50 per cent of shingles sufferers over 60 years of age, progress into the excruciating pain syndrome known as post-herpetic neuralgia which can go on for an extended period of time and is the single biggest reason why over 10 per cent of those over the age of 65 require hospitalization (these are United States numbers) often for extended periods of time.

So, the case for preventing this illness is fairly obvious and as far as we are concerned. So is the choice of which vaccine is preferable for a couple of reasons.

The first comparison point is how well they work. Shingrix is 97 per cent effective while Zostavax is only about 53 per cent. This is because Shingrix has had an ingredient added to it called an adjuvant which boosts our body’s immune response to the vaccine (some of the new so-called high-dose flu vaccines use the same technology). It’s also a dead vaccine whereas Zostavax is not giving us hope that people with impaired immune systems will be able to receive Shingrix. At this point in time, this is more of a theoretical advantage as Shingrix has still not been cleared to be used by the immunocompromised as of yet.

Shingrix is also expected to offer protection for significantly longer than Zostavax seems to, lessening the number of booster shots needed in the future or the chances of people coming down with shingles after the effects of the vaccine wear off.

On the down side, Shingrix has two distinct disadvantages. One is that two shots are required rather than the single dose that Zostavax needs. The second shot must be at least two months from the initial one but not more than six months after. As well, Shingrix is a little more expensive. For those who pay cash, the combined two shots are likely to be about $30 more than Zostavax would cost them.

However, for one specific age range, the difference is a lot more than that. That's because right now, Ontario pays the full cost of Zostavax for all seniors between the ages of 65 and 70. There has been nothing announced yet whether this offer will apply to Shingrix at some point in the future.

For those who want to receive Shingrix even though they have already had a Zostavax shot in the past, they must simply ensure that at least eight weeks have passed in between. In theory, this should further enhance their immunity to shingles. Side effects seem to be mild, with the most common ones being pain and redness at the injection site.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/?fref=ts