Around 1 in 3 people who have had chickenpox will get Shingles in their lifetime.1
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Shingles in New Zealand
Almost all New Zealand adults have had chickenpox, so they are already carrying the virus that causes Shingles. By age 85, 50% of them will have experienced Shingles.1
Survey reveals that Kiwis are confused about Shingles2
A survey of 1048 people aged 50+, conducted via grownups.co.nz shows that New Zealanders have limited understanding of Shingles and its impact. Here's what the survey found:
Awareness is high.
91% of the survey participants had heard of Shingles.
Confusion about the cause.
46% of those who responded (n=538) believed incorrectly they won't get Shingles because they have had chickenpox.
10% correctly identified that if you haven't had chickenpox then you can't get Shingles.
People think they are 'immune'.
Only 1 in 8 thought they were likely to get Shingles.
Men get Shingles too.
Though they may not think so!
Of the 325 male participants who responded, 37% did not believe they will get Shingles.
You have a role to play
Approximately 35,000 New Zealanders have chosen to vaccinate themselves against Shingles (as at end of April 2016).4
1 in 5 people in the survey outlined above, that are aware of Shingles, have considered getting the Shingles vaccine (n=153). As there are 1.3 million New Zealanders over the age of 50, some of your patients will be among those considering protecting themslves against Shingles.5
97% of NZ adults
have had chickenpox3
so it is likely some
patients don't realise
they are at risk.
Did you know?
Currently 1 in 3 Kiwis are aged 50+. Read more
Did you know?
Currently 1 in 3 Kiwis are aged 50+. Within the next 10 years this age group will make up 40% of the population.
References: 1. ZOSTAVAX Data Sheet. 2. GrownUps Survey Oct 2015. 3. NZ Immunisation Handbook 2014. 4. Data on file 5. Statistics NZ.
The Impact of Shingles
When the chickenpox virus reactivates to cause Shingles, a severe haemorrhagic inflammation occurs as the virus replicates, which leads to scarring and loss of nerve cells and fibres.1
Risk
When it comes to your patients you cannot predict who will develop Shingles or when they will get it.
1 in 3 people will experience Shingles in their lifetime.2 Starting at age 50 the risk for reactivation increases markedly due to age-related decline in cell-mediated immunity (immunosenescence).3
But by age 85, 1 in 2 will have experienced Shingles.3
Rash
Shingles can cause unsightly blisters on one side of the face or body that can take up to 30 days to heal. Before the rash develops there is often a prodrome of pain in the area where the rash will develop.
Did you know?
Shingles is not contagious. However... Read more
Did you know?
Shingles is not contagious. However, during the active phase fluid within the Shingles rash blisters may shed the varicella virus and infect someone who has never had chickenpox.
Pain
For patients that develop Shingles you cannot predict how severe or long lasting their pain will be.
In a 2004 study designed to describe the acute pain of Shingles and assess its impact on Shingles patients (n=110):7
96% experienced ACUTE PAIN
Of these patients:
- 45% reported that they experienced PAIN EVERY DAY
- 42% reported that their worst Shingles pain was HORRIBLE or EXCRUCIATING
Why it's important to protect your patients as they age
Katz and Melzack compared total pain rating index scores from multiple studies of chronic pain and acute pain from diverse causes, using the short-form McGill Pain Questionnaire. Pain scale indexes ranged from 0 to 50. Adapted from Katz J, Melzack R. 1999.7
About 1 in 5 people with Shingles will get postherpetic neuralgia (PHN).9
This is chronic neuropathic pain that persists for more than 90 days after rash onset.
Age is the primary risk factor for PHN. Other risk factors include the presence of prodromal pain, severity of rash, severity of acute pain, Shingles involving the cranial nerves and immunosuppression.10
Allodynia occurs in 90% of patients with PHN.3
Complications beyond PHN
Beyond PHN, Shingles can have other severe presentations and complications.
10% to 25% of Shingles patients develop ophthalmic zoster.11
Of these patients, 50% to 72% will suffer chronic, recurring ocular disease and visual loss.12
Other complications can include:10
- Bacterial superinfection
- Hearing loss
- Meningoencephalitis
- Motor neuron palsies
Increased risk of stroke within six months following Shingles13*
In a UK study of HZ patients:
- The overall rate of stroke was increased up to six months following the episode of Shingles
- An even greater rate of stroke was observed in patients who experienced an episode of HZ opthalmicus
*Study Design: A population study in the United Kingdom evaluated the rate of strokes in 6,584 patients aged ≥ 18 years who experienced an acute episode of Shingles, using a computerised database of patient records.
Did you know?
The first vaccine used in New Zealand... Read more
Did you know?
The first vaccine used in New Zealand was for diphtheria in 1926. Tetanus was next, in 1940.
References: 1. Schmader K, Gnann JW Jr, Watson CP. The epidemiological, clinical, and pathological rationale for the herpes zoster vaccine. J Infect Dis. 2008;197(suppl 2):S207–S215 2. NZ Immunisation Handbook 2014 3. ZOSTAVAX Data Sheet 4. www.cdc.gov/shingles/hcp/clinical-overview.html 5. Insinga RP. et al. J Gen Intern Med. 2005;20(8):748-753. 6. Nagasako EM, Johnson RW, Griffin DRJ, et al. Rash severity in herpes zoster: correlates and relationship to postherpetic neuralgia. J Am Acad Dermatol. 2002;46(6):834–839. 7. Katz J. Cooper EM. Walther RR. Et al. Acute pain in herpes zoster and its impact on health-related quality of life. Clin Infect Dis 2004;39(3):342-348). 8. Katz J, Melzack R. Surg Clin North Am. 1999;79(2):231-252. 9. http://www.aafp.org/afp/2011/0615/p1432.html 10. Oxman MN. Clinical manifestations of herpes zoster. Cambridge University press;2000:246-275 11. Centers for Disease Control and Prevention (CDC). Prevention of herpes zoster: recommendations of the Advisory Committee on Immunisation Practices (ACIP). MMWR Recomm Rep. 2008:57(RR-5):1-30. http://www.cdec.gov/mmwr/PDF/rr/rr5705.pdf. Published June 6, 2008. 12. Pavan-Langston D. Ophthalmic zoster. In: Arvin AM, Gershon AA, eds. Varicella-Zoster Virus: Virology and Clinical Management. Cambridge, UK: Cambridge University Press; 2000:276–298. 13. Langan SM et al. Clin Infect Dis. 2014;58(11):1497-1503
How we can support you
To assist you to support your patient's choice to protect themselves against Shingles, MSD has a number of resources and is undertaking a variety of activities you might find useful.
Watch the latest Television Commercial
ZOSTAVAX Advertising Timeline 2016
See when ZOSTAVAX will be advertised and where
Shingles Prevention Programme
Shingles Prevention Programme
A Shingles Prevention Programme has been developed aimed at giving patients the information they need to make a choice about vaccination before they see you, to help them to discuss the risks and benefits.
ZOSTAVAX Advertising Timeline 2016
From March to June Zostavax advertising raises awareness that people aged 50+ may be able to get the Shingles vaccine at the same time they get their flu vaccine.
Order Practice Resources
Frequently Asked Questions
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ZOSTAVAX (zoster virus vaccine, live) 19,400 PFU as 0.65 mL vial for injection:
Indications: for immunisation of individuals 50 years of age or older for the prevention of herpes zoster (shingles), the prevention of postherpetic neuralgia (PHN) and the reduction of acute and chronic zoster-associated pain.
Contraindications: patients who are hypersensitive or allergic to any vaccine component including gelatin or neomycin; have a primary or acquired immunodeficiency state or condition; are receiving immunosuppressive therapy; have untreated tuberculosis; are or may potentially be pregnant. Pregnancy should be avoided for 3 months following vaccination. ZOSTAVAX is not recommended for paediatric use, nursing mothers, or those with a fever, epinephrine should be available in case of anaphylactic reaction. Common side effects are: headache, localised injection site reactions and pain in the arm or leg. ZOSTAVAX is a private purchase prescription only medicine that the patient will need to pay for. For detailed prescribing information, consult the data sheet, phone 0800 500 673 or refer to the Medsafe website www.medsafe.govt.nz. Based on data sheet prepared 29 April 2015 Supplied by: Merck Sharp & Dohme (NZ) Limited, Newmarket, Auckland.
PNEUMOVAX® 23 (Pneumococcal vaccine polyvalent) Single dose vial containing 25mcg/serotype/0.5mL and phenol preservative (0.25%) as a sterile clear, colourless solution: Pneumovax 23 is indicated for routine vaccination of persons 50 years and over, and at risk patients 2 years and over against pneumococcal disease. Pneumovax 23 should not be given to patients who are hypersensitive to any component of the vaccine. Caution is advised in patients: with active infection or febrile respiratory illness; receiving immunosuppressive therapy; with severely compromised cardiovascular and/or pulmonary function; who require antibiotics for pneumococcal infection prophylaxis; who are pregnant or nursing mothers; under 2 years of age. Adrenaline injection should be available in case of anaphylactic reaction. Common side effects are: fever, injection site reactions such as pain and swelling. Others: see full Datasheet. Pneumovax 23 is a prescription only medicine, fully funded for those who meet specified criteria, otherwise a charge will apply. For detailed prescribing information, consult the data sheet phone 0800 500 673 or refer to the Medsafe website www.medsafe.govt.nz. Based on Datasheet prepared 10/04/2013. Marketed by bioCSL, Auckland.
ROTATEQ (rotavirus vaccine, live, oral, pentavalent) Single dose 2 mL unit dosing tube containing an oral suspension of 5 rotavirus reassortant strains: RotaTeq is indicated for the prevention of rotavirus gastroenteritis in infants (from 6 weeks old) and children (caused by serotypes G1, G2, G3, G4 and P1). RotaTeq should not be given to patients who are hypersensitive to any component of the vaccine or have had previous hypersensitivity after receiving RotaTeq; have Severe Combined Immunodeficiency Disorder (SCID). Caution is advised if giving RotaTeq to patients; with acute or febrile illness; with gastrointestinal dysfunction including intussusception; with growth retardation, neutropaenia, congenital heart disease, cystic fibrosis or cancer; aged under 6 weeks or over 32 weeks; may be immunocompromised or living with immunodeficient close contacts. Adrenaline injection should be available in case of anaphylactic reaction. RotaTeq is not recommended for adult use. Common side effects are: vomiting, diarrhoea and elevated temperature. Review the Datasheet before prescribing. RotaTeq is a prescription only medicine, fully funded for those who meet criteria outlined in the New Zealand immunisation schedule. For detailed prescribing information, consult the data sheet, phone 0800 500 673 or refer to the Medsafe website www.medsafe.govt.nz. Based on data sheet prepared 03/07/2013. Supplied by: Merck Sharp & Dohme (NZ) Limited, Newmarket, Auckland.
VARIVAX (varicella virus vaccine, live) 1,350 PFU as 0.5 mL single dose vial for injection: Indications: for vaccination against varicella (chickenpox) in individuals 12 months of age and older. Contraindications: patients who are hypersensitive or allergic to any vaccine component including gelatin; history of anaphlactoid reaction to neomycin; are receiving immunosuppressive therapy; have primary or acquired immunodeficiency states, or certain blood disorders (see full datasheet); have untreated tuberculosis; have a fever; or are or may potentially be pregnant. Precautions: Pregnancy should be avoided for 3 months following vaccination. VARIVAX is not recommended for children under 12 months of age or nursing mothers. Epinephrine should be available in case of anaphylactic reaction. To prevent vaccine virus transmission, avoid close association with susceptible high risk individuals for up to 6 weeks after vaccination. Vaccination should be deferred for at least 5 months following blood or plasma transfusions. Common side effects: fever, pain and redness at the injection site and a varicella-like rash. Rare side effects include pneumonitis. Dosing: children 12 months to 12 years of age should receive at least one dose; patients over 13 years of age should receive two doses. For subcutaneous injection. VARIVAX is a private purchase prescription only medicine that the patient will need to pay for. Review the datasheet before prescribing. For additional product information, consult the datasheet available on request on 0800 500 673 or the Medsafe website www.medsafe.govt.nz. Based on datasheet prepared 7/11/2013. Supplied by: Merck Sharp & Dohme (NZ) Limited, Newmarket, Auckland.
Articles & Resources
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A clinical update on Shingles, postherpetic neuralgia, antiviral treatment and much more.
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How to Treat Adult Vaccination
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Frequently Asked Questions
- What causes Shingles?
- After the primary infection (chickenpox), the varicella-zoster virus stays latent in the cells of the dorsal root ganglion. Read moreUpon reactivation it causes Shingles - a painful, blistering rash. From age 50 the risk for reactivation increases markedly due to age related decline in cell mediated immunity (Immunosenescence).1
- What is the most important risk factor for Shingles?
- Age is the most important risk factor for Shingles.2 Read more97% of adults are at risk for Shingles because they have had chickenpox,3 however over two thirds of cases occur over the age of 50, and the frequency and severity of complications increase markedly with age.1
- How do you know which patients will be affected by Shingles?
- You can't tell which patients will be affected by Shingles. Read moreThere is no way to predict when the varicella-zoster virus (VZV) will reactivate, who will develop zoster, or how severe any individual case may be. Around 1 in 3 people will experience Shingles in their lifetime and by 85 years 50% will have experienced an episode of Shingles.1
- Is Shingles contagious?
- Shingles cannot be passed to someone through exposure to another person with Shingles. Read moreShingles can only occur if a person has had chickenpox. However, if a person has never had chickenpox and has direct contact with the Shingles rash when it is still blistering, he or she can get chickenpox, which can later resurface as Shingles.
- Are Shingles complications common, and what are they?
-
Postherpetic neuralgia (PHN) is the most common serious complication of zoster.2 Read morePHN is chronic neuropathic pain lasting for at least 3 months after rash onset and can last months or even years. The incidence of PHN increases with age.1 Patients have described PHN as: burning, throbbing, stabbing, shooting, and/or sharp pain.1
In addition to PHN, other complications of Shingles can vary in degree of severity.
- 10% to 25% of Shingles patients suffer from ophthalmic zoster.4
- 50% to 72% of patients who develop ophthalmic zoster will suffer chronic, recurring ocular disease and visual loss.7
1 in 4 zoster patients will experience 1 or more complications, some of which may be severe, including:5
- Scarring
- Bacterial superinfection
- Pneumonia
- Cranial and motor neuron palsies
- Visual impairment, when eye area is involved
- Hearing loss, when ear area is involved
- Can I get Shingles more than once?
- Yes, Read morealthough uncommon, patients have experienced two or more cases of Shingles.6
- Can ZOSTAVAX treat Shingles?
- No. Read moreZOSTAVAX is not a treatment for Shingles. It is a vaccine that will help to reduce the risk of getting Shingles in the future. ZOSTAVAX cannot be used to treat Shingles or PHN.
- Can a patient who has already experienced an episode of Shingles be vaccinated with ZOSTAVAX?
-
The efficacy of ZOSTAVAX has not been assessed in patients with a previous history of Shingles. Read more
A trial of 100 subjects with a history of Shingles was undertaken to assess the immunogenicity of ZOSTAVAX and its safety profile. It demonstrated no additional safety concerns than when ZOSTAVAX was administered to patients who had not previously had Shingles. Data showed the vaccine did elicit an antibody response in these patients.1
For further information around vaccinating patients who have previously had Shingles, refer to http://www.immunize.org/askexperts/experts_zos.asp
- What is ZOSTAVAX indicated for?
-
In adults 50 years of age or older, ZOSTAVAX is indicated for:
- Prevention of herpes zoster (shingles)1
- Prevention of Post Herpetic Neuralgia (PHN)1
- Reduction of acute and chronic Shingles-associated pain1
- How effective is ZOSTAVAX?
-
- In the ZOSTAVAX Efficacy and Safety Trial (ZEST), a placebo-controlled, double-blind clinical trial of 22,439 subjects, ZOSTAVAX reduced the incidence of Shingles by 69.8% in people 50 to 59 years of age (95% CI: [54.1 to 80.6%]).1 Read more
- In the Shingles Prevention Study (SPS), a placebo-controlled, double-blind clinical trial of 38,546 subjects, ZOSTAVAX reduced the incidence of Shingles by 64% in people 60-69 years of age (95% CI: [56 to 71%]) and by 38% in people ≥70 years of age. (95% CI: [25 to 48%]).1
- In the same SPS trial, the protective efficacy of ZOSTAVAX against PHN in the overall study population was 67% (95% CI: [48 to 79%]) and the reduction was similar for the two age groups (60-69 and ≥70 years of age).1
For additional efficacy data, please review the Actions section in the ZOSTAVAX Datasheet.
- What are the side effects of ZOSTAVAX?
-
ZOSTAVAX is generally well tolerated.1 Read more
In clinical trials, ZOSTAVAX has been evaluated for general safety in more than 32,000 adults 50 years of age or older.3 The side effects that were noted included:
- Very Common (≥1/100, <1/10): Erythema, pain, swelling, pruritus.3
- Common (≥1/10): Headache, haematoma, warmth, induration, pain in extremity.3
For full product information please consult the ZOSTAVAX Datasheet.
- What are the contraindications for ZOSTAVAX?
-
Patients for whom ZOSTAVAX is contraindicated include: Read morethose with a history of hypersensitivity to any component of the vaccine, including gelatin or neomycin; have a weakened immune system; have active TB (tuberculosis) that is not being treated; and are pregnant.3
For full product information please consult the ZOSTAVAX Datasheet.
- Can ZOSTAVAX be given with other vaccines?
- Yes, ZOSTAVAX can be administered concomitantly with the influenza vaccine.3 Read moreHowever, it is not recommended that ZOSTAVAX and pneumococcal polysaccharide vaccine are given concomitantly.3
- For more information see below:
- http://www.health.govt.nz/publication/immunisation-handbook-2014
http://www.medsafe.govt.nz/profs/Datasheet/z/zostavaxinj.pdf
http://www.medsafe.govt.nz/consumers/cmi/z/zostavax.pdf
http://www.immunize.org/askexperts/experts_zos.asp
http://www.shingles.co.nz
References: 1. ZOSTAVAX Data Sheet. 2. Oxman MN. Clinical manifestations of herpes zoster. Cambridge University press;2000:246-275. 3. NZ Immunisation Handbook 2014. 4. Centers for Disease Control and Prevention (CDC). Prevention of herpes zoster: recommendations of the Advisory Committee on Immunisation Practices (ACIP). MMWR Recomm Rep. 2008:57(RR-5):1-30. http://www.cdec.gov/mmwr/PDF/rr/rr5705.pdf. Published June 6, 2008. 5. Yawn B.P., Saddier P. Wollan P.C., et al. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc. 2007;82(11):1341-1349. 6. http://www.immunize.org/askexperts/experts_zos.asp 7. Pavan-Langston D. Ophthalmic zoster. In: Arvin AM, Gershon AA, eds. Varicella-Zoster Virus: Virology and Clinical Management. Cambridge, UK: Cambridge University Press; 2000:276–298.