Beth Longware Duff

 after causing chickenpox decades earlier. Virtually every person over the age of 40 in the United States carries the virus, and their chances of developing shingles are approximately 1 in 3. For individuals over the age of 80, the odds increase to 1 in 2.

Characterized by a red, blistering rash and considerable discomfort, 

 (herpes zoster, or HZ) is consistently ranked among the 

 experienced by humans. Early diagnosis and 

 with antivirals can not only shorten the course and lessen the impact of the disease, but also reduce the chances of developing the serious complication called postherpetic neuralgia (

The most effective approach is to begin antivirals within 3 days of the onset of the rash. There are also simple steps that shingles patients can take to care for their physical and mental well-being. Pharmacists can play a role in counseling on self-care tips for patients who are experiencing symptoms of shingles. 

Shingles begins with pain, itching, or tingling of the skin, followed within a few days by the eruption of a blistering rash, usually in a stripe along 1 side of the torso or face. The sores eventually break open, releasing a fluid that contains the virus.

Pain associated with the rash can be relieved with wet compresses, calamine lotion, and colloidal oatmeal baths. A thin layer of petroleum jelly covered by a non-stick cotton bandage can keep the skin safe and prevent the virus from spreading. Loose clothing made of natural fibers can also help patients feel more comfortable by lessening pressure on the rash.

Another concern is avoiding permanent skin damage, according to Marie Jhin, MD

 a board-certified dermatologist in San Francisco, California. “The shingles virus is very deep, and that’s why there’s a higher likelihood of scarring,” she told 

. “The virus causes killing of the skin cells, or necrosis. You don’t want to touch or pick it because it’ll make the scars worse.”

Some dietary supplements and herbal medicines are thought to help the body fight the HZ virus, as well as treat insomnia and anxiety related to the illness. The list includes:

Oregano, eucalyptus, tea tree, or chamomile oil

Patients should be advised to consult medical providers before taking any supplements.

A healthy diet is particularly important during an illness. Eating a nutritious, well-balanced variety of food helps boost the immune system and aids in healing.

Ingesting vitamins A, B12, C, and E can be beneficial for patients with shingles, as well as lysine, an amino acid that inhibits the growth of the HZ virus.

Lots of vegetables and fruits—particularly those that are green, red, orange, or yellow—along with protein-rich foods like eggs, red meat, and chicken are recommended. Cut back on foods that are high in saturated fat, sugar, and refined carbohydrates.

Stress-reducing light exercise is also advised. Suggestions include simple movements like walking, gentle stretching, or yoga.

A course of shingles can last 2 to 6 weeks and is considered to be healed when the blisters have dried up. Once that happens, individuals who are 50 years or older can be vaccinated with recombinant zoster vaccine (RZV) (

; GlaxoSmithKline) against a future recurrence.

RZV was licensed by the FDA in 2017 to help protect against shingles. It has been shown in clinical trials to be over 90% effective in preventing the disease and related complications. RZV is included on the CDC’s 

Articles

Pharmacists can advise patients on easy home remedies to cope with the pain.

Self-Care Tips for Dealing with Shingles

The results of a recently published study concluded that the effectiveness of the recombinant zoster vaccine (RZV) (

; GlaxoSmithKline) is high in a real-world setting. The findings support the results of earlier clinical trials for the RZV that showed it was over 90% effective in preventing herpes zoster (

RZV’s effectiveness in general practice had not been investigated previously to the new study. “Understanding the effectiveness of RZV in practice, outside of clinical trial settings, is crucial given the differences between clinical trial and general practice settings,” noted Yuwei Sun, MS, one of the study’s authors and an analyst with the University of California, San Francisco’s Francis I. Proctor Foundation for Research in Ophthalmology. “The clinical trials had standardized protocols for vaccine storage, administration, and herpes zoster diagnosis. In general practice, patients often have more health comorbidities.”

, demonstrated that RZV is 85% effective in preventing HZ.

The retrospective cohort study looked at 4.7 million non-immunocompromised, vaccine age-eligible individuals from a deidentified claims database. A total of 173,745 adults were given 2 doses of RZV.

The results revealed that the HZ incidence rate was 258.8 cases per 100,000 person-years among those who received the vaccine compared with 893.1 per 100,000 person-years among the unvaccinated individuals.

RZV’s overall effectiveness was calculated to be 85.5%. Among patients aged 50 to 79 years, the rate was 86.8%, and 80.3% among patients aged 80 years or older. Among patients with a history of live zoster vaccine within 5 years of their inclusion in the study, the effective rate was 84.8%.

“Whenever you transition from a clinical trial to the real world, you wonder whether the results achieved in the clinical trial—in this case, excellent results—translate comparably to a real-world setting,” said William Schaffner, MD, medical director at the National Foundation for Infectious Diseases, in a prepared 

 “Clinical trials are a very refined environment in which certain patients are excluded from participation. But in the real world, everybody gets the vaccine.”

, shingles vaccination is the only protection available against shingles and postherpetic neuralgia (

), the most common serious complication from shingles. It recommends the vaccine for healthy adults 50 and older. There is no maximum age for receiving the vaccine.

RZV is the only vaccine against shingles currently available in the United States. In clinical trials, it was not associated with serious adverse events. The short-term 

 most often experienced with RZV typically last 2 to 3 days, far shorter than a bout of shingles or PHN.

Individuals who have had shingles in the past can be vaccinated with RZV to help prevent future occurrences of the disease. There is no specific wait time indicated between having shingles and getting vaccinated, but it is recommended that the shingles rash has totally healed before getting the vaccine.

1. Sun Y, Kim E, Kong CL. Effectiveness of the recombinant zoster vaccine in adults aged 50 and older in the United States: a claims-based cohort study. 

2. Dreisbach EN. Real-world data trumpet effectiveness of recombinant zoster vaccine. Published February 27, 2021. Accessed March 31, 2021. 

https://www.healio.com/news/infectious-disease/20210226/realworld-data-trumpet-effectiveness-of-recombinant-zoster-vaccine

Study reports recombinant zoster vaccine is more than 85% effective overall.

Shingrix’s Efficacy Supported by Real-world Data	

 from the CDC regarding vaccination against 

 during the COVID-19 pandemic designates it as an essential preventive care service for older adults that should not be delayed or discontinued unless a patient is suspected or confirmed to have COVID-19.

In general, the health organization noted that efforts to reduce transmission of the COVID virus through stay-at-home and shelter-in-place orders have resulted in a decreased use of routine preventive medical services, including immunization.

“Ensuring that routine vaccination is maintained or reinitiated during the COVID-19 pandemic is essential for protecting individuals and communities from vaccine-preventable diseases and outbreaks,” the CDC stated in the 

 section of its website.2 It adds that communicating the importance of vaccination and the related safety protocols and procedures to patients, parents, and caregivers can help reassure individuals who may hesitate to get vaccinated during this period of uncertainty.

Leverage Pharmacy Technician Roles to Improve Your Team's Workflow

Specific to shingles vaccination, the CDC encourages health care providers to administer both doses of Shingrix to eligible patients within the recommended interval of 2 to 6 months. If more than 6 months elapse between the first and second doses, the second dose should be administered as soon as possible.

 has become even more critical during the pandemic because some AEs of the vaccine may be similar to symptoms of COVID-19, the CDC cautioned.2“Before administering Shingrix, health care providers should counsel patients about the risk of self-limited vaccine-associated [adverse] effects and the appropriate steps to take if [adverse] effects occur after vaccination,” the agency said.

Typical AEs associated with Shingrix include local reactions like redness, pain, and swelling at the injection site, as well as systemic reactions like fever, chills, headache, and body aches. All of these reactions normally resolve within 72 hours after vaccination.

As a result of concerns related to COVID-19, the CDC advised that patients who develop fever after vaccination should stay home until they have been fever-free for 24 hours without the use of fever-reducing medications.

Additionally, it’s important to note that Shingrix does not cause the respiratory symptoms associated with COVID-19. “If a vaccine recipient develops symptoms of COVID-19 (eg, cough or shortness of breath), or if fever does not resolve within 72 hours of vaccination without the use of fever-reducing medications, the recipient should contact their health care provider,” advises the CDC. “If a vaccine recipient develops emergency warning signs for COVID-19, emergency medical care should be sought immediately.”

The CDC also asks health care providers to defer vaccination for patients with suspected or confirmed COVID-19, regardless of symptoms, until they have met the 

. When scheduling or confirming appointments for shingles vaccination, the provider should ask patients to notify them in advance if they develop any symptoms of COVID-19.

“Health care personnel, whether they administer vaccines or not, should take steps to ensure that their patients continue to receive vaccines according to the 

Standards for Adult Immunization Practice

 “If vaccination is deferred, older adults and adults with underlying medical conditions who subsequently become infected with a vaccine-preventable disease, are at increased risk for complications.”

1. CDC. Frequently asked questions about Shingrix. Last updated October 5, 2020. Accessed March 1, 2021. 

https://www.cdc.gov/vaccines/vpd/shingles/hcp/shingrix/faqs.html

2. CDC. Interim guidance for routine and influenza immunization services during the COVID-19 pandemic. Last updated October 20, 2020. Accessed March 1, 2021. 

https://www.cdc.gov/vaccines/pandemic-guidance/index.html

CDC advises not to delay shingles vaccination.

Shingles Vaccination Counseling During the COVID-19 Pandemic	

Shingles, or herpes zoster (HZ), is a common viral infection that affects about 1 million individuals in the United States each year. Long considered to be primarily a health concern for the elderly, 

 are on the rise in younger age groups. Approximately half of the population that reaches 80 years of age will experience shingles, sometimes with 

 that are long lasting and life changing.

Despite abundant available information about shingles, plenty of myths remain in circulation that can endanger not only individuals who are most at risk, but also the population at large. 

 addresses some of those misconceptions with the help of Jeffrey Cohen, MD, chief, Laboratory of Infectious Diseases at the National Institute of Allergy and Infectious Diseases.

 Shingles is caused by a reinfection of the varicella zoster virus (VZV).

 Shingles occurs when the opportunistic VZV, which has laid dormant in the body’s nervous system since an earlier episode of chickenpox, 

 decades later and takes a different path. “During chickenpox, the virus spreads in the bloodstream and it infects skin potentially all over the body, as well as organs in the body,” Cohen explained. “But during reactivation in healthy people, the virus spreads from the ganglia along the nerves to the skin.”

 The shingles rash is the worst aspect of the infection.

 Although the rash is a painful and unsightly 

, it typically resolves within a few weeks. However, in up to 20% of all shingles cases, patients develop a debilitating and far more serious condition known as postherpetic neuralgia (

). “Postherpetic neuralgia is unrelenting pain for weeks to months or even a year or more,” said Cohen, who calls it the major shingles concern. “There is clear medication for postherpetic neuralgia, but just like everything else in the elderly it has more side effects and it doesn’t truly get rid of all the pain.”

 VZV can reactivate as shingles more than once.

 Cohen said the vast majority of people who experience shingles have only 1 episode, although it depends primarily on an individual’s 

. “Typically, if one gets shingles, it might be another 20 years before the immune system declines and doesn’t recognize the virus as strongly, and people can get a second episode,” he said.

 is the varicella zoster virus, which spreads easily through the air. If a person with no immunity to VZV is infected with it, they are likely to develop chickenpox. The virus will then go dormant in their nervous system, with the potential to reactivate at a later date. “If somebody in the family has zoster, keeping the lesions covered makes it less likely that it’s going to spread in the air,” Cohen advised.

 If a person already has VZV in their body, little can be done to prevent shingles.

 has been proven to drastically reduce a person’s risk of developing shingles. “Shingrix is about 90% protective against zoster in people who are 70 and above, and about 97% in people who are 50 to 69 years old,” noted Cohen.

Shingrix is recommended for use in immunocompetent individuals age 50 and older, and is administered in 2 doses given 2 to 6 months apart. It is included on the CDC’s Advisory Committee on Immunization Practices’ 2021 

Addressing misconceptions about herpes zoster.