Controversy and the Shingles Vaccination

Rather than jingles this Christmas, Santa brought me shingles. The real question that arises is when you should have an inoculation for shingles. This personal story offers a moral tale—don’t get caught out—but is there a political angle? The risk increases from fifty years of age onwards.

Keywords: UK shingles policy, symptoms, and dorsal root ganglion

Christmas is about family, having fun with grandchildren, singing carols, unexpected presents, laughter, and overindulgence. On Boxing Day, I felt a peculiar sensory tenderness around my left thigh. There was nothing visible, but the sensation was quite uncomfortable. Analgesics merely subdued the discomfort. You will also find more information on the dorsal root ganglia on my RC Blyth site – click  here.

Protection is a Vaccination

After three days, something in the back of my mind niggled; could it be shingles, better known as the virus Herpes or varicella – zoster. Of course, I had a chicken box as a child, but my wife, who is a little older, had a sudden bout of shingles on holiday three years earlier.

Aware of her plight, discomfort, and skin irritations, I approached the GP surgery because, being over 65, a vaccination would protect me. It all made sense until I found I was outside the criteria. I appealed to the practice and even offered to pay. No deal. The formal poster states that I had to fall into the category ‘If you are 65 on or after 1 September 2023, you are eligible for your shingles vaccination.’

I was 65 in 2021 and NOT eligible! This was the NHS trying to save money and create a policy and protocol, which, of course, was in tablets of immovable stone. As my symptoms became clearer, so did my pain and discomfort. I felt pretty awful. My job as a writer-journalist was affected; I stopped the gym and had to have periods where I did not want to walk, let alone function. The window of opportunity had soon passed when Acyclovir would have been of value. 

Area that the varicella chickenpox pain on body and skin itching rash Shingles Herpes Zoster virus blister sores of torso Vaccine

The Government’s website advised,

‘In 2028, the vaccine offer will also be extended to those turning 60, as well as those turning 65. In 2033, the Shingrix shingles vaccine will become a routine offer at age 60 (by which time all those turning 65 years will have already been offered the vaccine). Once you have become eligible, you will remain eligible for the shingles vaccine until your 80th birthday.’

 While I am not a virologist, I knew enough to know I was royally stumped and would have to do what my wife did: soldier on. It was Christmas, and it took nearly four days for the skin to change into a painful, sensitive rash. The GP practice was working on a skeleton staffing, and I was away from home. By the time I reached the surgery, I was beyond first-line help.

Symptoms

Skin sensitivity was notable and persisted for several days. It took five days before small areas that had begun as a rash around day three developed into a pattern. By day seven, blisters appeared as patchy clusters and spread around the left pelvic girdle (see figure below, and you can download the picture for greater clarity), encircling the back. Symptoms increased with intense burning and bouts of itching. Moving was not only uncomfortable, but one had to cope with standing up as the gluteal (postural) muscles worked together, irritating the nerves. By this time, paracetamol and ibuprofen, along with antihistamines, were being used, especially before sleep. When it came to sleeping, lying down was not too bad, but I still felt exhausted, and my stomach seemed to rebel after eating, yet I maintained a normal appetite for food. The stomach features were unusual partly because there was no diarrhoea. It seemed as if this was tied in with the neurology.  For anyone wanting to know a bit more about neurology, I have written a brief article on the dorsal root ganglion.

Day 7 -Day 35 and location left thigh—varicella-zoster blisters. You can download the picture or click on the picture.

To find out more about the location of the virus, click here to read a simplified account of the nerves.

Home treatment

During the first two weeks, a combination of ibuprofen, paracetamol, and antihistamine became routine. Scratching the itch had to be avoided, as these troublesome lesions can become infected. Before the rashes appeared, the pain varied from hypersensitivity to stabbing sensations. The burning sensation ranged from three to seven on a scale of 0 to 10, with 10 indicating the worst pain. Itchiness (pruritic) caused discomfort, varying from a mild sensation to severe itchiness.

While I could discuss the vast array of advice available here, it can readily be found on the internet, and no one wants to read a clichéd story. I have provided a snapshot of the skin changes, from rash to blisters, followed by scabs and blemishes, which persist as I write this blog now 50 days in. All but the blemish has cleared, and I count myself luckier than some, as post-herpetic neuralgia can become chronic and last for a long time.

In the USA, individuals in their 50s have been advocating for the Shingrix vaccine. The U.S. Centres for Disease Control and Prevention (CDC) indicates that 33% of people will experience shingles at some point in their lives. Most individuals who contract shingles are over 50 years of age.

Expediency Over Safety

The NHS has a blind spot that will affect a population born before the dates stipulated of 1 September 2023, which implies my group is affected across a band of seven years.

Between 1951 and 1958, approximately 650,000 -740,000 births arose for each year. However, between 2016 and 2023, it isn’t easy to know how much this age group shrank. Statistics are for the UK rather than England, and we know healthcare varies across the UK countries.

The best estimates come from knowing the expected life predictions and suggest this age group could expect to live between 68.93 and 70.61 years. We do not know the deaths, and even if we compared data from different collection methods, these would not really help as the error would not be in doubt. If we allow 20% deaths (as an arbitrary figure because the actual data is unknown), then assuming the cohort at some point could have been 5,900,000 – 20%, the NHS will have excluded over 4 million people who fell outside the vaccination protocol. If the death rate is higher, then the decision-making seems better if you want to hedge your bets.

Preventative vaccination should be a health objective. Yet several million people who desperately need coverage have not had access to it, a problem that the USA has at least recognised. Doubtless, my fellow cohort members, especially those who are immunocompromised, have been placed at risk.

Given that the phrase allegedly came from a past politician, Benjamin Disraeli, “Lies, damned lies, and statistics” has resurfaced, I wonder who decided to ignore the risks that have been present for ages.

N.B. The calculations given have been estimated from graphs and data from Government agencies, but since the collection of data improved in the sixties and later, only assumptions can be made. The figures purely illustrate how someone might decide if they could afford to exclude a cohort on the basis of reasonable savings and numbers. This claim has not been put to any external agency, but at a time when British medicine is under huge demand, it would be unlikely a change would be met given only those born between 1957 & 1958 would be affected.

Additional viewpoint. Shingles Vaccine: The Controversy Behind The Recommended Age. Lauren Petty (2020)

Thanks for reading ‘Shingle Bells Don’t Get Caught’ by David Tollafield. Make sure you read the dorsal root ganglion here to accompany this article.

David is a blogger, author, and former consultant podiatric surgeon who writes for ConsultingFootPain under Busypencilcase Communications, established in 2015. His sub-clinical interests have been rheumatology, pain neurology and pathology. He has written several books as guides for patients, comparing his own experiences with medical health. His latest book is A Complete Patient’s Guide for Bunion Problems.