After varicella zoster virus causes chickenpox, it remains dormant in the central nervous system and can later reactivate to cause shingles
The lifetime risk of developing shingles, a viral infection characterized by a painful rash, is 20%-30%. After varicella zoster virus causes chickenpox, it remains dormant in the central nervous system and can later reactivate to cause shingles.
The rash will eventually clear, but complications may be long-term or permanent. These complications include postherpetic neuralgia (PHN), skin necrosis, bacterial superinfection, and ocular problems.
In December 2021, Swiss Medical Weekly published a retrospective study that analyzed the medical records of 355 shingles patients treated at the University Hospital of Basel, Switzerland between 2005 and 2019.1 The researchers found that complications and hospitalizations are the main drivers of shingles-related treatment costs.
The study population had a complication rate of 30% (with PHN as the most common complication), a hospitalization rate of 19%, and a mortality rate of 0.85%. Complications increased costs by a factor of 4.3 in outpatients and 6.6 in inpatients. Hospitalization increased costs by a factor of nearly 27.
Consistent with findings from other studies, researchers found age to be a significant risk factor for shingles complications. For each additional year of age, the odds for a complication increased by 3.5%.
Even more concerning, for each additional 10 years of age, the odds for a complication increased by 40%. A large spike in cases and complications occur in adults 50 years of age and older, suggesting this age group would benefit the most from shingles vaccination. This aligns with the US Advisory Committee on Immunization Practices (ACIP) recommendations.
Cancer, including both solid and hematological cancers, is another risk factor significantly associated with a higher complication rate. This was true even in younger patients, suggesting an age-independent association. Swiss vaccine guidelines have yet to incorporate this fact.
But interestingly, in October 2021, the US ACIP unanimously voted to expand shingles vaccine recommendations to adults 19 years of age and older with immunocompromising conditions (e.g., cancer). This recommendation is still pending review and approval.2
Shingrix, the recombinant shingles vaccine, is more than 95% effective in preventing shingles infection, which will subsequently prevent shingles-related complications and hospitalizations, and thus drive down treatment costs. This study supports the notion that older adults and patients with cancer are at increased risk for complicated shingles. Thus, they should be the focus of vaccination efforts.
Pharmacists must stay up to date with current immunization recommendations and clinical studies to help patients make informed decisions about getting vaccinated.
About the Author
Ms. Espeso is a 2023 PharmD candidate at the University of Connecticut.