Eligible patients encouraged to get shingles vaccine

Transcript: AMA Queensland President, Dr Maria Boulton, ABC Radio North Queensland, mornings with Susan Graham-Ryan, Monday 26 February 2024

Subjects: Shingles

SUSAN GRAHAM-RYAN: One in three people will get shingles at some point in their life, and the older you get, the more the risk increases. So, while there have been reports of increased cases in over 60s, cases for those under 60 are also on the rise. So, what do you do if you do end up with a case of shingles, and what can you do to prevent it? I'm joined now by the President of the Australian Medical Association Queensland, Dr Maria Boulton. Good morning.

DR MARIA BOULTON: Good morning.

SUSAN GRAHAM-RYAN: Firstly, what is shingles and how do people typically get it?

DR MARIA BOULTON: Shingles is a viral illness and it's basically a reactivation of the chicken pox virus. So, many of us have had chicken pox at one stage or another, and especially if you're an older adult, because the vaccines weren't available when we were younger. And what happens is that the chickenpox virus then lays dormant in your nerves and your spine, and then those viruses become reawakened because you're stressed or immunosuppressed. Then they travel down that nerve, and then you get a blistering rash along that nerve. And that's why you tend to only get the rash on one side of your body, because that nerve basically is distributed just along the one side.

So, you can get the rash, you can get a headache, a fever, and then if you're unlucky, you can get persistent symptoms where that nerve becomes irritated and hurts for a lot longer than the rash lasts. And that's what most people complain about because it is quite debilitating.

SUSAN GRAHAM-RYAN: The first time I saw that rash on somebody's back, I thought it was sweat rash. It sort of has that similar kind of appearance to it. Is that a common confusion early on and especially in Queensland?

DR MARIA BOULTON: Oh absolutely, and it can be quite tricky especially if it's early on, because it can be a very non-specific rash that looks like every other rash. But then if you give it some time, then it becomes clearer and clearer what it is. The other thing is that some people present with pain. So, sometimes they'll get pain in that area before a rash develops. I've seen people present to hospital with chest pain or pain where their appendix is, and we think, oh my goodness, they're either having a heart attack or maybe they're having appendicitis. And then the rash comes out and then you think, no, it's shingles. It can be that painful.

SUSAN GRAHAM-RYAN: So, what's behind this rise in cases of shingles?

DR MARIA BOULTON: It's really interesting because shingles has been around for a long, long time. But what we're seeing is because many of us are now vaccinated against chickenpox, there's not a lot of chickenpox circulating in the community. So, for some reason, that is why if somebody has had chickenpox earlier on, they're just not exposed to as much. So, it's much easier for the virus that's been dormant in your spine to wake up.

The other thing is that it's really difficult to keep track of the data because it's not something that we always report because it's not a notifiable disease. But certainly, it is something that we see a lot of, especially in general practice. We see it when people become immunosuppressed or when people go through a stressful time in their lives. So, for example, as a GP we used to see it a lot in people who perhaps left their home and went into an aged care facility. And the transition itself, because it was very stressful, would bring out a shingles outbreak in that patient. And that's why we used to recommend that patients have the shingles vaccine prior to making the transition.

SUSAN GRAHAM-RYAN: So more younger Aussies are getting it, though. You said typically it is over those that over 60 age group. Why are younger Aussies getting it, is it about that vaccine element?

DR MARIA BOULTON: I think it's because chickenpox is just not as prevalent now. I'm not an immunologist, but certainly the youngest people I've seen with shingles have been 13, 14-year-olds, but that's uncommon. It is more common in older people, and it tends to have more debilitating effects in older people.

But the good news is that there's a very effective vaccine out there. People need two doses, and the government made it more accessible for people, in that it's free for certain populations. So, people over the age of 65, Aboriginal and Torres Strait Islander people over the age of 50, and people who have certain immunocompromising conditions can access the vaccines for free. And all you require is two doses.

The vaccines have been around for a very long time. They're very effective, they're very safe and certainly after speaking to so many people who have had shingles, which they always tell you it's awful, it's much better to have the vaccine than to actually suffer through shingles.

SUSAN GRAHAM-RYAN: You are on ABC Radio Queensland, Susan with you. And I'm speaking with the President of AMA Queensland Dr Maria Boulton. So how do we avoid it then if that seems to be the best way? Other than vaccines, what are some ways that we can prevent getting shingles?

DR MARIA BOULTON: The best way to prevent getting shingles is to access a chickenpox vaccination. So, once again, in Australia chickenpox vaccines are free for children in certain age groups and certainly through the National Immunisation Program when a child turns 18 months, they can access the vaccine for free. You can vaccinate someone a little bit younger if they need it. We do recommend and ATAGI does recommend that people have their child vaccinated again so that they get a booster dose. The issue is that the booster dose is currently not funded. So, part of our advocacy work is to get that second dose funded, because currently there's still a few kids who still get chickenpox.

The other thing is to consider having that shingles vaccine as well. And perhaps if you don't fit into that age group, we know that the vaccine is available for people who are over 50, it's also available for people who are over 18 if they have certain chronic conditions. However, there may be a fee attached to that. And perhaps making that vaccine free for more people rather than the smaller cohort that it covers now would be a really great idea. But vaccination is really the key.

Also, if you have shingles, it's best that you stay home. You can't give someone shingles, but if you come in contact with someone and they touch the fluid in the blisters or they touch your linen or your towels, they can become infected with chickenpox if they haven't had chickenpox or if they haven't had the chickenpox vaccinations.

SUSAN GRAHAM-RYAN: Dr Maria Boulton, the President of AMA Queensland, thanks so much for your time this morning.

DR MARIA BOULTON: Thank you.