Shingles warning for patients with CVD risk

The herpes zoster virus may increase the risk of stroke and heart attack in the weeks and months after infection.

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Patients with CVD risk factors should be offered vaccination against shingles even if they do not meet the criteria for subsidised vaccine, says an expert.

A shingles webinar hosted this month by the Immunisation Coalition revealed the herpes zoster virus can significantly increase the rise of stroke and heart attack in the weeks and months after infection.

Leading Australian infectious diseases physician Professor Paul Griffin said many GPs would not be aware of the degree of risk and the need to counsel patients about vaccination against shingles.

“I think some of these complications might be useful for GPs to know about to be able to have those conversations with people who might be eligible for that vaccine, to hopefully help them make the right decision,” he told The Medical Republic.

“It also highlights that a lot of these infections and viruses have mechanisms that we’re still learning about. Hopefully we can better understand some of these consequences, but it is important to factor this in when we are looking what we can do to prevent disease.”

The Shingles in Australia webinar was presented by immunisation education consultant Angela Newbound.

She said shingles may increase the risk of stroke in the six months after infection, and a 1.7-fold increased risk of heart attack had been observed in the first week after diagnosis.

She said the risk was linked to the inflammatory response from the virus causing shedding of plaque build-ups, highlighting the importance of vaccination in eligible patients with CVD risk.

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.

In some circumstances Zostavax can be used for immunocompromised adults. ATAGI altered its clinical advice in the Australian Immunisation Handbook in July to say that Zostavax may be given to those who are mildly immune compromised 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 but is registered for use in patients from 50 years. A Zostavax vaccine costs about $220. Australians are likely to pay up to $600 for a two-dose course of Shingrix. Rebates may be available through patients’ private health insurance.

Professor Griffin said the covid landscape had made conversations around vaccination far more common and even sought-after by patients who wanted to understand the efficacy of vaccines to a greater degree.

This presented opportunities for GPs to discuss the potential risks of the shingles virus in a potentially vulnerable patient, as well as the costs that may be involved.

“This will just help add some weight to that risk benefit discussion for people and hopefully more people making the right decision,” he said.

“In addition to immunological and actual disease risk factors, now it’s also a matter of cardiovascular disease risk factors coming into play as well. If people have a number of risk factors for stroke in particular, this would be a good thing to talk to them about as well.”

Professor Griffin said that while the cost factor of shingles vaccination for those patients not eligible for a subsidised vaccine was an issue, the risk of serious complications from the virus was a compelling motivator.

“The thing about all infectious diseases and their complications is that the best time to prevent them is as upstream as possible and these vaccines contribute to that,” he said.

“It’s always hard for people to recognise the cost savings of not going on to getting the disease, while the shingles itself is something that has a cost associated with therapies and visits, to GPs et cetera.

“Then there’s the pain syndromes themselves that are clearly worthwhile preventing, and then you factor in something as significant as stroke as well. If you had all that up, it seems like a very cost-effective intervention.”