CPS supports NACI recommendations for new shingles vaccine

CANADIAN PAIN SOCIETYFeb 3 2010

The Canadian Pain Society (CPS) supports the National Advisory Committee on Immunization (NACI) recommendations for the use of a vaccine to significantly reduce the risk of developing herpes zoster (shingles) and post herpetic neuralgia in adults over the age of 60 without contraindications.

In August 2008, Health Canada approved ZOSTAVAX(R) for the prevention of shingles in individuals 60 years of age or older. In the Shingles Prevention Study (SPS) of 38,546 subjects 60 years of age or older, the new shingles vaccine reduced the risk of developing herpes zoster compared with placebo by 51 per cent for all age groups.(1) The vaccine also reduced the incidence of severe and long-lasting zoster-associated pain by 73 per cent compared with placebo.(2)

"The NACI recommendations make it clear that this new vaccine is an effective measure for reducing the risk of shingles and its complications in people 60 and older by approximately 60%. Although the vaccine can also be given to those over 50, its effectiveness in this age group is yet to be determined," said Dr. Roman Jovey, chronic pain expert and a past president of the Canadian Pain Society. "The Canadian Pain Society wants to create awareness about this common, unpredictable and very distressing disease that can lead some people to develop chronic and debilitating nerve pain that is difficult to treat effectively. An estimated six million Canadians already suffer from various types of chronic pain and the available pain management programs are inadequate to meet the need. Pain experts therefore support any scientifically credible intervention that can actually prevent chronic pain."

"The CPS encourages the federal and provincial governments to consider the costs of a public immunization program for all Canadian seniors compared to the high costs of treating this preventable cause of severe pain," said Dr. Aline Boulanger, Director of the pain clinics at the Hôtel-Dieu (CHUM) and Hôpital du Sacré-Cœur in Montreal and member of the Canadian Pain Society.

"The Canadian Pain Society is the national voice on pain management and takes a leadership role in advocating for adequate research, education and treatment resources for patients with pain," said Dr. Pam Squire, a family physician in Vancouver, pain expert and member of the Canadian Pain Society. "Access to shingles vaccination, as recommended by NACI, is an important tool for the prevention of pain."

The painful reality of shingles

Shingles results from the reactivation of the varicella zoster virus,(3) the same virus that causes chickenpox.(4) When people suffer from shingles, they may initially feel itching, tingling, burning or pain(5) in a defined section of their skin and within a few days a characteristic skin rash with fluid-filled blisters appears.

Pain occurs in 90 per cent of persons with shingles who are 60 years of age or older.(6) For most people, the pain associated with a shingles rash usually lessens as it heals. For some people, shingles can cause debilitating pain called post-herpetic neuralgia (PHN) that can last for months or even years.(7) For more than 50 per cent of shingles sufferers over 60, shingles can progress into PHN.(8)

In addition to severe pain, shingles can cause fatigue, disrupted sleep, social withdrawal and depression,(9) and 50 to 72 per cent of people with shingles of the eye suffer from recurrent ocular disease and vision loss.(10) Up to 10 per cent of shingles patients 65 and older are hospitalized(11) with an average length of stay of 20 days.(12) PHN - debilitating pain - is the most common serious complication of shingles.(13)

In Canada, it is estimated that nearly one out of three people will develop shingles in their lifetime.(14) The incidence and severity of shingles and its complications increase with age,(15) with more than two out of three shingles cases occurring in people over 50.(16) It is estimated that one out of two people who reach age 85 will have shingles during their lifetime.(17)