Shingles: over-60s at risk of pain and scarring

June 9, 2014
shingles vaccine1

“It was excruciating, like scissors being dug into my palm.” That’s how retired school principal Tony Strong described the pain caused by shingles. It’s a nasty affliction most commonly striking people over 50, and spiking in over-60s. No matter how much you exercise, watch your weight, and limit your alcohol intake, bad stuff can still happen as you get older. But shingles is one affliction that can be prevented. A vaccine is widely available in Australia that greatly reduces your chance of a shingles attack, especially a bad one. But how many people know about it? And costing between $220 and $250 how many can afford it?

The immunisation of children is rightly a major concern of government health authorities. But immunisation is not just for kids. Older people deserve equitable access to a vaccine against a condition that can cause shocking pain, scarring, sight loss and life-long disability.

Tony Strong suffered the worst complications of shingles: The blisters on the heel of his hand and on his fingers appeared out of the blue last August just before he was to fly to China on holiday. He saw his doctor, was given appropriate treatment, prescribed pain killers and wished a happy holiday. The agony set in a few days later. He couldn’t bear to touch anything, hold anything or have anyone touch his hand. “Everyone in the tour party was supplying me with pain killers,” he said. The Chinese doctor he consulted advised moving his hand as much as possible and gently rubbing it with different textured materials, neither of which he could bear to do. On return to Australia, he tried acupuncture, saw a naturopath and took the recommended medications; he tried liquid oxygen. And still the terrible pain persisted. It was weeks before he got some relief after the pain specialists at St Vincent’s hospital in Sydney applied weekly high-dosage pain patches and prescribed a neuralgia pain drug which he still takes.

Unfortunately the attack has left his left hand disabled, and he can hardly use it despite weeks of physiotherapy. Three of his fingers are bent. He can hardly grip anything, including a fork. What is particularly cruel is that Tony is an accomplished pianist. Since his retirement he’s accompanied lots of singers for concerts, eisteddfods, and exams. He can’t do this now. And no-one’s been able to say how long this situation will last. “I’m aware of it all day long,” Tony told me. “It affects everything I want to do, restricts most of it, and prevents some of it.”

About one-third of Australians will suffer a painful attack of shingles in their lifetime. And just about any one of us is susceptible. Shingles is a re-activation of the virus that causes chicken pox. So if we’ve had chicken pox or been exposed to the virus – that’s 95 per cent of adults over 30 – it’s possible the virus is lying dormant and could strike us out of the blue, too. The risk of getting the condition and its severity increases with age. By age 85 it’s estimated one in two Australians will suffer an attack. For many people the symptom is confined to a painful, tingling rash with blisters, usually around the back, waist or stomach though it can also appear on the face or neck. (The hands are an unusual site). It can last a month. But between 25 per cent and 50 per cent of people over 50 (and 70 per cent of those over 70) who get shingles experience, like Tony, the extreme version. The condition, called postherpetic neuralgia, causes ongoing, debilitating nerve pain. And if all this isn’t enough, new British research shows that in the six months after a shingles attack you may face a much higher risk of having a stroke.

So why don’t we know more about this vaccine? And why isn’t it free or affordable – like the flu vaccination? In 2008 the Pharmaceutical Benefits Advisory Committee did recommend to the federal government that the shingles vaccine, Zostavax, be made available to people aged 60, and a catch-up group aged 61-79, under the National Immunisation Program. This would have meant it was free to that age group. But unfortunately there was a world-wide shortage of the vaccine at the time. The PBAC recommendation lapsed after five years. Now supply problems have been remedied, and the vaccine has been available (at full price) since October. The PBAC approval process – a pre-requisite for government subsidy – has had to begin all over again. The company bioCSL which distributes the vaccine in Australia, in its new submission has limited the targeted group to people aged 70 with a catch-up group of those aged 71-79. In the UK it’s available free under the National Health Scheme to a similar age group. It would cost Australian taxpayers $18 million a year to provide free immunisation for 70-year-olds and a one-off cost of about $104 million for a catch-up program for 71-79 year-olds, a spokeswoman for bioCSL told me.

Hopefully the PBAC will move quickly, and hopefully, a cost-cutting government – which doesn’t have to accept the PBAC’s recommendation – will see the vaccine’s value. No-one should have to face torture because they can’t afford the vaccine, or don’t know about it. If you’re able to pay, it’s worth shopping around. I rang half a dozen pharmacists in my area and was quoted between $210 and $235 for the vaccine. When I asked the most expensive quoter for a better price, she immediately dropped it to $225. A friend in Perth was originally quoted $300 by two pharmacists on opposite corners. When he stared down one of them, the price suddenly became the more standard $225.

Keep an eye on the approval progress. Concerted lobbying to get the government subsidy may one day be required, and Tony Strong said if it comes to that, he’d be happy to play a part.

What’s your experience? Please leave a comment.

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