With Shingles, An Ounce Of Prevention Is Worth A Pound Of Cure
Prevention and Treatment Immunization is a lifelong process.
While Canadians generally have a good understanding of the importance of infant and childhood vaccination, there remains a large knowledge gap when it comes to adult vaccines.
There are a plethora of vaccines recommended and approved for use in adults, particularly targeted at preventing debilitating conditions in our aging population. For a number of reasons, however, the uptake of these vaccines is startlingly low. Older Canadians are often very busy, and may have other medical conditions that continually take priority when they speak with their health care providers. Add to this the fact that many of these vaccines are unfunded, and it is too easy for adult immunization to fall by the wayside.
In part due to a laudable trust in our public health organizations, there is a common perception that if a vaccine is unfunded, it must not be truly necessary. But one does not have to look too deeply into the conditions these vaccines protect against to see that this is not the case.
A future of pain for one in three Canadians
Shingles (also known as herpes zoster) is a painful condition caused by the varicella virus, the same virus that causes chicken pox in children. About one in three older Canadians will develop the condition, and the effects can be devastating and long-lasting. “There are two phases with shingles,” explains Dr. Aline Boulanger of the Canadian Pain Society. “There is the acute phase, where the virus comes back from a dorsal root ganglion close to the spine and back, through the nerves, and into the skin. This is extremely painful. After that comes the chronic phase where, for a portion of the population, the pain decreases or disappears, but for many the pain stays for a long time, sometimes their entire life.”
This is a classic situation in which an ounce of prevention is worth well more than a pound of cure. In addition to long-lasting chronic pain, shingles can result in blindness, scarring and facial paralysis. And none of these effects can be easily treated once the damage is done. “It’s the nerves themselves that are creating the pain, which makes the treatment very difficult,” says Dr. Boulanger. “In the acute phase, painkillers and anti-inflammatory drugs may work, but in the chronic phase often many of the pain medications don’t work at all.”
When you put all this together, it becomes clear that protecting against this condition should be a priority, given that we have a vaccine that is recommended for all Canadians ages 60 and older. And while the vaccine is not 100 percent effective in preventing shingles, it results in much better outcomes, even for those who do develop the condition. “What the vaccine will do is decrease your chance of getting shingles by half,” says Dr. Boulanger. “And if you do get it, it will be milder. And the chance that you will develop chronic pain is decreased by another 60 percent.”
Unfunded too often means unused
Unfortunately, although the vaccine is approved and recommended, it is currently unfunded in Canada, which means that patients must pay for it out of pocket, usually at a cost of nearly $200. For the amount of protection provided, this is a bargain, but many older Canadians are living on a fixed income and may simply be unable to pay.
The good news is that as the generation that was vaccinated against varicella in childhood (immunization began in the late 1990s and early 2000s) grows older and eventually becomes our oldest cohort, shingles is expected to virtually disappear on its own. But that remains many decades away, and in the meantime, it behooves us to protect all adult Canadians against this and other vaccine-preventable conditions.