In 2021, Marcy came into Pavithra Ravinatarajan’s pharmacy with a handful of blisters on her face, which she thought was the result of a new moisturizer or detergent. Ravinatarajan could tell that wasn’t the case: it was clear the patient, whose name has been changed, had shingles.
When Marcy went to see a doctor at a walk-in clinic, she needed to take a day off work. The physician at the clinic realized the shingles had reached her ocular lens. She was prescribed anti-virals, told to stay home from work for a few days and referred to an ophthalmologist, who prescribed eye drops to prevent shingles from impacting her sight.
Marcy spent six days off of work and, in addition to the eye drops, was prescribed pain medication to address a condition called post herpetic neuralgia, which affects one in 10 people who contract shingles and can become chronic. For Marcy, PHN lasted three months. She also went back to see Ravinatarajan a third time to get antibacterial cream to address a skin infection that resulted from scratching her face.
Marcy’s case represents the impact a case of shingles can have on both individual plan members and the workplace, said Ravinatarajan, a pharmacist, in a session supported by GSK during Benefits Canada’s 2023 Chronic Disease at Work conference in early February.
She encouraged plan sponsors to hold shingles vaccination campaigns in the workplace. “[Marcy] had absenteeism from work and presenteeism at work because, even though her shingles were crusted over, she didn’t feel comfortable seeing anyone and it was on her mind.”
Shingles, which is often referred to as herpes zoster, presents as red and itchy blisters. Once it onsets, a person will continue to develop blisters for five days and they can remain on the body for anywhere from two to four weeks. Immunocompromised people or those taking immune-suppressing medications are more than five-times more likely to develop shingles and can have a much longer bout with the virus, said Ravinatarajan, noting one in three Canadians will contract shingles at some point in their life.
While people often connect shingles with chickenpox, she said the two conditions are actually quite different and people who’ve had chickenpox in their life are still at risk of contracting shingles.
Shingles most frequently presents on the chest and back, with the face the second most common place for it to occur. “We often think, ‘OK, if I’ve got shingles I can cover it up, I can still go about my day-to-day tasks,’ . . . but [having shingles on the face] can have huge complications for plan members and how they go about their lives,” said Ravinatarajan.
People with shingles aren’t supposed to be around others during the part of the illness when their blisters are still full and haven’t yet crusted over because they risk infecting others with the virus, which she said can have absenteeism implications for workplaces.
A 2012 study of individuals who had shingles in the journal Vaccine found that 64 per cent of patients missed at least three days of work because they had shingles and 76 per cent said they were less productive while at work due to the condition.
But Ravinatarajan also noted people who have shingles may continue to be absent from work even after they’re no longer contagious because they’re worried about their blisters being seen by others. “It goes back to having an impact on your mental health as well. When you’re not comfortable with yourself, you don’t have that confidence and, if it does end up as ocular shingles, it can impact your day-to-day sight as well.”
While shingles is understood to affect Canadians over the age of 60, she said anyone who’s 50 or older should be vaccinated against it, as well as anyone 18 or over who’s immunocompromised. While the Shingrix vaccine has a minimum 90 per cent efficacy at preventing the onset of shingles, she noted many Canadians aren’t up-to-date on this and other vaccines.
Ravinatarajan encouraged plan sponsors to include it in their vaccine programs. “Prevention plays a huge part when it comes to health outcomes for individuals — we saw that through the pandemic when it came to COVID-19. And we see that in multiple other conditions where there is a vaccine.”
Read more coverage of the 2023 Chronic Disease at Work conference.