Lauren Howell, PharmD
According to a study published in the Journal of the American Heart Association on November 16, 2022, herpes zoster (more commonly known as shingles) is associated with an almost 30% higher long-term risk of a major cardiovascular event. This new information highlights the importance of herpes zoster vaccination and the role it may play in preventing more than just the virus itself.
Background information and study findings
Most individuals who are older than 50 years living in the United States have been infected with the varicella zoster virus (VZV), which is also called chicken pox. All of these individuals are at risk for developing herpes zoster.
There is a multitude of information to show that serious chronic complications such as postherpetic neuralgia and opthalmicus can occur following a herpes zoster episode. Because VZV has been found to replicate in arteries and lead to vasculopathy, many have hypothesized that herpes zoster may be associated with an increased risk of cardiovascular events.
Previous data have shown an elevated risk of a major cardiovascular event in the weeks following herpes zoster infection. Despite previous evidence, this study of the association between herpes zoster and major cardiovascular events was the first to include a long duration of follow up, control for potential confounding cardiovascular risk factors, and capture individuals who may not have sought out medical attention for herpes zoster.
Curhan and colleagues found that herpes zoster was significantly and independently associated with higher long-term risk of stroke and congenital heart disease (CHD). This increased risk was found to persist for far longer than symptoms, and for greater than 12 years after the herpes zoster episode. This risk of a major cardiovascular event was found to be potentially even greater among individuals with immunocompromising conditions or on immunosuppressive regimens.
Impact on pharmacist practice
As easily accessible health care providers, pharmacists are in the best position to discuss vaccination status, recommend appropriate vaccinations, and provide these vaccinations to patients.
The availability of a safe and effective vaccine enhances pharmacists’ ability to reduce the burden of herpes zoster and reduce the risk of subsequent cardiovascular complications among their patients. It is crucial that pharmacists are knowledgeable about vaccines, particularly herpes zoster vaccines, and are able to counsel patients confidently on them.
CDC recommends 2 doses of Shingrix (recombinant zoster vaccine–GlaxoSmithKline) separated by 2 to 6 months for the prevention of herpes zoster in immunocompetent adults aged 50 years and older. This recommendation is applicable whether or not patients report a prior episode of herpes zoster and whether or not they have received a prior dose of Zostavax (Merck).
In those aged 19 years or older who are or will be immunodeficient or immunosuppressed, CDC recommends 2 doses of recombinant zoster vaccine. While it is preferable for the second dose to be given 2 to 6 months after the first dose, if the patient would benefit from completing the series over a shorter span of time, the second dose can be administered 1 to 2 months after the first dose.
Patients do not need to wait a certain amount of time following a herpes zoster episode before receiving Shingrix. It is important, however, that patients do not receive the vaccine during an acute episode.
What to tell your patients
When counseling patients on the Shingrix vaccine, it is important to inform them that most people experience a sore arm after receiving the vaccine.
Additionally, patients can have redness and swelling of the arm, fatigue, headache, fever, stomach pain, or nausea. Due to these adverse effects, patients should be advised to plan to avoid strenuous activities for a few days after vaccination.
Pharmacists should be aware that if a patient has a reaction to the first dose of Shingrix, it does not guarantee that they will have a reaction to the second dose. Additionally, if a patient does not have a reaction to the first dose, they may or may not have a reaction to the second dose.
While these symptoms may be inconvenient to patients, pharmacists may remind them that these effects only last 2 to 3 days whereas complications from herpes zoster, including major cardiovascular events, can be detrimental to their overall health and well-being.
Pharmacists can also help patients mitigate these symptoms by encouraging them to take OTC pain medicine to ease discomfort after receiving Shingrix. However, it is not recommended that patients take these medications before vaccination. ■
Pharmacists can visit apha.us/ShingrixVaccine for more information about the Shingrix vaccine and resources for speaking with patients about the vaccine.