Shingles appears as a rash or blisters. Photo / 123RF
Shingles appears as a rash or blisters. Photo / 123RF
Vaccine programmes may need to be expanded to protect older Kiwis, Māori and the immunocompromised against a potentially debilitating disease, according to a population health academic.
The call comes as new research into the shingles virus shows that New Zealand’s population may become increasingly vulnerable to the disease as they age.
Shingles is a viral infection caused by the reactivation of the varicella-zoster virus (VZV), the same virus that causes chickenpox. Even those who appear healthy but are aged 50-plus are at risk of developing shingles.
Almost all adults aged over 50 already have the virus that causes shingles in their bodies due to an initial chickenpox infection. Around a third of these will develop shingles in their lifetime when the virus reactivates.
The shingles rash or blisters occur on one side of the body, most commonly the torso but the disease can affect other areas such as the face and scalp. Shingles can be intensely painful and can impact sleep and being able to do daily activities. Some people may go on to develop complications, which include long-lasting nerve pain, vision and hearing loss, scarring and neurological problems, and rarely cardiovascular and stroke events.
Professor of Population Health at Victoria University of Wellington, Colin Simpson, says new research suggests there may be a need to expand our current vaccination model to adapt to our ageing population.
The number of Kiwis aged 85+ is expected to grow by 115 per cent to 200,000 by 2040 - a demographic shift from one in 50 to around one in every 20 New Zealanders, therefore there is a need to keep people healthy for longer.
He says with our ageing population and high prevalence of chronic diseases that can compromise the immune system, particularly among Maori, we may need to expand the immunisation programme for shingles prevention.
“The risk of shingles tends to increase with age. However, as we get older, our immunity weakens and it becomes harder to sustain vaccine effectiveness,” Simpson said.
“This has repercussions for New Zealand’s ageing population who are living longer and expected to grow significantly in number.
“We need to start looking at research programmes now to investigate vaccine effectiveness and safety, and vaccine uptake amongst different groups within the New Zealand population.”
Dr James Mbinta, Research Fellow at Victoria University of Wellington School of Health, says other vulnerable groups in our population include those living with chronic diseases whose immune systems may be compromised.
“Pre-existing diseases of the kidney, heart and autoimmune system may trigger a resurgence of the shingles virus within the body, even among younger age groups.
“We know that Māori have higher rates of some chronic diseases, and research is needed to evaluate the vaccine effectiveness against shingles and severe outcomes over time in people with these conditions.
“The complications include postherpetic neuralgia (PHN) which can cause excruciating and continuous nerve pain and impact around a third of people with shingles lasting in some cases for years,” he says.
Brett Marett, medical director at GSK NZ, says two doses of the vaccine for shingles, Shingrix, are funded for those aged 65, and GSK NZ and the vaccine can be bought for other at-risk groups.
He says it is also recommended, but not funded, for use from age 50 years. Pharmac is currently consulting on a proposal to fund a group of individuals aged 18 years or older with an increased risk of shingles due to immunocompromise.
The Australian Government recently launched a more extensive funding programme for shingles. It is understood to be one of the most comprehensive and widely available shingles vaccine programmes in the world with the vaccine funded and free to anyone aged 65+; First Nations people 50+ and immunocompromised people 18 years and over at high risk of shingles infection.
