Aucklander Victoria Elmes had a fairly typical Covid-19 infection, with flu-like symptoms and fatigue. She was recovering from the virus when she spotted a small bump on the side of her face that, at first, she assumed was only a pimple.
“Then I had these awful shooting, stabbing pains in my head,” she says. “They were like nothing I’d ever experienced before.”
Elmes, 50, saw a doctor as quickly as possible and was surprised to be diagnosed with shingles.
Shingles is a painful blistering rash that develops on one side of the body or head. It is caused by the reactivation of varicella- zoster, the virus that causes chicken pox, which remains in the body, lying dormant in nerves near the spine.
A strong immune system will keep varicella-zoster inactive, but it may re-emerge as shingles later in life when the immune system isn’t working as well.
Anyone who has had chickenpox at some point is at risk of getting shingles, and there is now evidence that it is occurring at a greater rate in people shortly after a Covid-19 infection.
Last year, a US study looking at 50-year-olds found those who had been diagnosed with Covid-19 had a significantly higher risk of developing shingles, particularly if they had been hospitalised. The theory is that T-cell immune dysfunction caused by Covid-19 leaves the body more vulnerable. This increased risk is believed to fade after about six months, once the immune system is functioning properly again.
If you are diagnosed quickly – as Elmes was – shingles can be treated successfully with antiviral drugs and pain relief. However, it is debilitating for some patients, and possible complications include nerve damage and harm to the eyes. Getting shingles on the face or scalp may result in weakness and drooping on one side of the face that takes months to clear.
Shingles – otherwise known as herpes zoster – is fairly common. One in three of us will develop it, and the risk is one in two once you are over 85.
There is an effective vaccine, Shingrix, but in New Zealand it is funded for a very narrow band of people. Only those aged 65 are eligible. Anyone older or younger than 65 will have to pay for Shingrix, and it isn’t cheap – it costs up to $800 for two doses, which are generally given six months apart.
Edwin Reynolds, a GP, immunologist and medical adviser to the Immunisation Advisory Centre, says the hope is that Shingrix will be more widely funded in time.
“I’d love to see it extended down to age 50 and beyond 65, because you’re not just going to get shingles in your 65th year,” he says. “And, for the immunocompromised, extended right down to age 18. That’s on the wish list.”
Pharmac is assessing an application to make Shingrix available for Māori and Pacific people aged 60 and over. It is also considering the options for those in their 50s, younger immunocompromised people and anyone older who may have had the previous vaccine, Zostavax, which offers protection for only about five years.
Shingrix has been shown to be more than 90% effective and it is believed that having two doses will offer longer-lasting protection – at least seven years has been shown so far. It works by stimulating increased production of a specific type of T-cell that mounts an immune response when the virus starts circulating around the body.
Since Shingrix isn’t a live virus vaccine, as the now-discontinued Zostavax was, it is safe even for those who are immunocompromised.
“And it’s been shown to be very effective for older people whose immune systems aren’t working as well as they used to,” says Reynolds.
Elmes has now recovered from shingles and has been advised to wait 12 months before getting vaccinated with Shingrix. The thinking is that if the immune system has recently been activated against the virus, there is likely to be little additional short-term benefit.
“The pain was really unpleasant,” she says. “I’d urge anyone who is at risk of shingles to get vaccinated.”
