En France, on observe 5 à 10 cas de zona pour 1000 personnes âgées de 60 ans et plus par an.
Vacciner pour prévenir les fortes « douleurs post-zostériennes »
Lors d’un zona, le virus se propage le long des fibres nerveuses et provoque une éruption douloureuse. Celle-ci débute par de petites plaques roses, suivies de vésicules semblables à celles observées lors d’une varicelle. Ces lésions peuvent s’accompagner d’une légère fièvre. L’éruption affecte généralement un seul côté du thorax ou de la taille, formant une bande en « demi-ceinture ». Plus rarement,elle peut toucher le visage,notamment sous la forme d’un zona ophtalmique.L’épisode aigu dure environ dix jours. Des surinfections bactériennes après grattage des plaies, des atteintes neurologiques (méningites, encéphalites) peuvent aussi survenir.
Une particularité du zona réside dans l’apparition possible de douleurs persistantes après la disparition des lésions cutanées. Ces douleurs, appelées “névralgies (ou douleurs) post-zostériennes“, concernent environ un quart des personnes de plus de 75 ans atteintes. Ces sensations de brûlures ou de douleurs en coup de poignard,essentiellement dans la zone intercostale,peuvent être intenses et très fortement altérer la qualité de vie pendant quelques jours à plusieurs mois. La personne constate aussi une perte temporaire de la sensibilité de petites zones de la peau de la région atteinte par le zona.
Le zona peut également entraîner une paralysie faciale, toucher la bouche et le pharynx (fausse-route, troubles du goût), le bas de l’abdomen (rétention urinaire) ou encore la zone auriculaire (acouphènes, bourdonnements, diminution de l’audition…)
Près de 90 % des cas de zona guérissent, souvent après plusieurs poussées de vésicules sur deux à trois semaines. Le traitement repose sur l’administration d’un médicament antiviral dans les 3 jours suivant l’apparition de l’éruption. Son efficacité est limitée. des antalgiques sont souvent nécessaires pour soulager la douleur.
Un vaccin, mais lequel ?
Jusqu’en 2024, la vaccination n’était recommandée que pour les personnes âgées de 65 à 74 ans inclus. En effet, en 2013, le Haut conseil de la santé publique (HCSP) avait recommandé l’utilisation du vaccin Zostavax pour réduire l’impact du zona. Il s’agissait d’un vaccin vivant atténué qui ne pouvait être utilisé chez les personnes à l’immunité fragile.
Mais depuis, un autre, le vaccin Shingrix (vaccin recombinant avec adjuvant), a montré qu’il permettait d’élargir l’accès à la vaccination, en particulier pour les populations à risque (adultes immunodéprimés, les personnes vivant avec le VIH, les personnes greffées, celles atteintes de cancer ou souffrant de maladies chroniques, telles que la polyarthrite rhumatoA new vaccine for shingles, Shingrix, has been recommended by the Haute autorité de Santé (HAS) for all immunocompetent adults aged 65 and older, as well as immunocompromised individuals aged 18 and above. This vaccine, which boasts a real-world efficacy of 79.3%, significantly outperforms its predecessor, which is no longer available. Starting December 14, 2024, the vaccine will be reimbursed at 65% by Assurance Maladie. The vaccination schedule requires two doses administered at least two months apart,and it can be given together with other vaccines,including the seasonal flu shot. Healthcare professionals, including pharmacists and nurses, are now authorized to administer Shingrix, enhancing accessibility for those at risk. for more data on shingles and vaccination, visit vaccination-info-service.
Discussion between the Time.news Editor and dr. Alain Lefevre, Virologist
Editor: Good morning, Dr. Lefevre. Today, we are discussing a crucial public health issue: the incidence of shingles, or zona, notably among the elderly in France, where we see 5 to 10 cases per 1,000 people aged 60 and over annually.
Dr. Lefevre: Good morning! Yes, this statistic highlights a significant health concern for our aging population. Shingles can lead to severe complications, particularly post-herpetic neuralgia, which is chronic pain following the rather painful vesicular rash associated with shingles.
Editor: It sounds quite debilitating. Can you explain why shingles is notably common among older individuals?
Dr. Lefevre: Certainly! Shingles is caused by the reactivation of the varicella zoster virus, the same virus that causes chickenpox. After a person has chickenpox, the virus remains dormant in the body and can reactivate later, often triggered by weakened immunity due to age or stress. This reactivation leads to shingles.
Editor: So, vaccination plays a key role in prevention. How effective are vaccines like Shingrix in reducing the risk of shingles and its complications?
Dr. Lefevre: Shingrix is highly effective; studies show it can reduce the risk of developing shingles by over 90% in older adults. WhatS even more significant is its effectiveness in preventing post-herpetic neuralgia, which is a major concern for those who have had shingles.
Editor: Given the public health landscape, how are vaccination rates among seniors in France? Are we seeing an increase?
Dr. Lefevre: Vaccination rates have been improving, especially with increased awareness of the pain and complications associated with shingles. However, there’s still a considerable gap. Initiatives to educate the public on the importance of vaccination, particularly for those over 60, are vital as we have the means to substantially lower the incidence of shingles.
Editor: It’s encouraging to hear we have effective tools at our disposal. How about the logistical aspects? Are vaccines widely available at pharmacies like for the flu, which begins its seasonal campaign in France on October 17?
Dr. Lefevre: Yes, exactly! In france, many pharmacies are authorized to administer vaccines, including shingles vaccines. This accessibility is critical for older populations who may find it easier to visit a local pharmacy rather than a hospital or clinic. Expanding these services can further raise vaccination rates.
Editor: That is good news for public health. As we look forward, what are some recommendations for our readers, particularly those who are eligible for the shingles vaccine?
Dr. Lefevre: My recommendation for readers, especially those 60 and older, is to consult with their healthcare provider about vaccination. They should consider getting vaccinated not only for shingles but also for the flu,particularly since these vaccinations can often be scheduled together,making it more convenient.
Editor: Thank you, Dr. Lefevre, for this insightful discussion.It’s clear that education and access are key to improving health outcomes for the elderly and preventing shingles.
Dr.Lefevre: Thank you for having me. Let’s continue spreading the word about the importance of vaccination!