Shingles risk after covid in over-50s

Patients are more at risk if they were hospitalised with covid, a study has found.

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Unvaccinated people aged over 50 who have had covid may be at “significantly increased risk” of developing shingles in the six months after their covid infection, a study has found.

And the risk rises even more if the patient was hospitalised due to covid, according to the study, published in the Open Forum Infectious Diseases journal.

Dr Rod Pearce, an Adelaide-based GP and Chair of the Immunisation Coalition, told The Medical Republic the study provided further evidence of the need to include the non-live varicella zoster vaccine Shingrix on the National Immunisation Program (NIP).

Shingrix is privately available in Australia for people aged over 50 and immunocompromised patients aged over 18. In immunocompromised adults, Shingrix should be used in favour of the live-attenuated varicella zoster virus vaccine, Zostavax.

However, last month ATAGI announced it was updating its clinical advice in the Australian Immunisation Handbook to say that Zostavax may be given to those with mild immunocompromise where Shingrix is not accessible, after careful assessment of the degree of immunocompromise using the ‘Live shingles vaccine (Zostavax) screening for contraindications’ tool.

Zostavax is funded under the NIP for patients aged 70 years or more. Australians are likely to pay between $250-300 per dose for a two-dose course of Shingrix.

“If Australia wants to keep its reputation for a good vaccine program it should be having Shingrix as a recommended and funded one,” Dr Pearce said.

“The other issue is similar to what we see with a lot of adult vaccines in Australia, where they’re recommended but not funded. There needs to be cooperation between the GPs and specialists to actually inform the patients that this vaccine is there, and even though it will cost them money, it will be useful in their particular scenario.”

Researchers from the recent study analysed data collected from almost two million people in the US prior to the country’s mass covid vaccination rollout, between March 2020 – February 2021.

They compared almost 400,0000 people aged over 50 years who had been diagnosed with covid, against 1.6 million who had not yet had covid.

The researchers found that those who had covid were 15% more likely to develop herpes zoster compared to people who had not been diagnosed with covid. Those hospitalised with covid were 21% more likely to develop the condition.

And the herpes zoster risk was elevated for up to six months after a covid diagnosis, the researchers found.

“Previous case reports, case series, and descriptive analyses have suggested a possible association between covid-19 and herpes zoster,” they wrote.

“However, as these types of studies provide low-grade evidence for an association, it has not previously been possible to determine whether patients with covid have a higher risk of developing herpes zoster.

“To our knowledge, our study is the first large, retrospective cohort study designed to investigate the hypothesis that covid-19 could increase the risk of herpes zoster.”

The research was also presented at presented at the Communicable Diseases & Immunisation Conference in Sydney and the Australian and New Zealand Society for Geriatric Medicine’s (ANZSGM) virtual Annual Scientific Meeting, both in June.

The researchers reported that in published case reports and case series, more than half of the described herpes zoster cases occurred within one week after covid diagnosis or hospitalisation, but some cases were also reported after 8–10 weeks.

“This is consistent with the results of the present study, in which an increased risk was observed up to six months after covid-19 diagnosis,” the authors wrote.

“No increased risk of developing herpes zoster was seen beyond six months after covid-19 diagnosis in our study, which may indicate a recovery of cell-mediated immunity.”

The researchers concluded that health care professionals should consider covid to be a risk factor for shingles.

“As herpes zoster is a vaccine-preventable disease, maintaining recommended herpes zoster vaccination in??50-year-olds may help reduce the herpes zoster burden during the pandemic,” they said.

GSK Australia applied to PBAC for the vaccine to be listed on National Immunisation Program in 2018 but was unsuccessful. A GSK spokesperson said the company had not ruled out making another application.

A spokesman for GSK, which makes Shingrix, told The Medical Republic it had “been unsuccessful in securing access to the Australian National Immunisation Program (NIP) for Shingrix because our current health system undervalues prevention.”

“In 2018, GSK put forward a robust, evidence-based submission to the PBAC for the inclusion of Shingrix in the NIP, outlining with detailed economic modelling how the vaccine would represent a value for money investment in the Australian health system. This submission was rejected,” the spokesman said.

“We believe there is strong evidence underpinning the community health benefits of wider access to Shingrix and these have been recognised by the Australian Technical Advisory Group on Immunisation (ATAGI), the expert panel established to advise the Minister for Health and Aged Care on the NIP.

“We continue to engage with the Federal Government both around a way forward for Shingrix funding in Australia and the broader policy changes required to bring Australia’s access to new vaccines in line with other highly developed countries.

“At this time, we are able to provide access to the vaccine in the private market so that some Australians can benefit without further delay.”