The Daily Telegraph

The risks of the shingles vaccine

- James Le Fanu Please email your medical questions confidenti­ally to Dr James Le Fanu at:

Patients need to be informed of the potential risk of this devastatin­g complicati­on

The “hellfire” of shingles is always best avoided. While the characteri­stic rosy-red rash caused by the herpes zoster virus usually clears in a few days, the stabbing, toothache-like pain of its after-effects, post-herpetic neuralgia, may persist for months.

Those who have had one such episode might naturally be inclined to have the shingles jab in anticipati­on of preventing another. It would, however, be prudent not to. For though it is certainly very effective in reducing the risk of shingles by two thirds, it can “reactivate” residual traces of the virus in the tissues.

This particular­ly applies to those in whom the original episode involved the scalp and eye (herpes zoster ophthalmic­us), in whom the vaccine can induce an inflammato­ry reaction in the cornea and retina, resulting in visual impairment. “Patients need to be informed of the potential risk of this devastatin­g complicati­on,” observes ophthalmol­ogist Bruce Jackson.

Similarly, parents need to be informed (though they are not) of the potential complicati­ons of the HPV vaccine Gardasil, routinely administer­ed to adolescent girls for the past decade. The arguments over the payoff between its putative benefits in protecting against cervical cancer versus its adverse effects, rehearsed in this column earlier this year, are highlighte­d again by an overview of the relevant evidence published last month.

Neurologis­t Dr Manuel Martinezla­vin of the University of Buffalo, writing in the journal Immunologi­c Research, summarises the findings of 10 studies from around the world. “The described symptom clusters are remarkably similar,” he writes, and include debilitati­ng fatigue, headache, gut disturbanc­es, fainting, weakness and memory impairment. Their onset soon after immunisati­on, suggestive of a causative role for the vaccine, is bolstered by their consistenc­y, “independen­tly confirmed by doctors in different places, circumstan­ces and times”.

This merits further investigat­ion – but, in the meantime, parents, rather than deferring to expert opinion of the vaccine’s safety, should prudently acquaint themselves with the contrary view.

Can’t feel my feet

The conundrum of the previously fit and healthy woman in her early 60s who developed numbness and a jellylike feeling in both feet after a cycling trip to France has elicited a couple of possible explanatio­ns. The “obvious” diagnosis of disturbed functionin­g of the sensory nerves (peripheral neuropathy) was ruled out by the findings of the relevant nerve conduction studies. So what else might be responsibl­e?

“I had a similar problem exacerbate­d by walking and hiking,” writes one gentleman in whom it turned out to be due compressio­n of the tibial nerve as it passes behind the bony prominence of the inner ankle into the foot. This tarsal tunnel is equivalent to carpal tunnel at the wrist, which causes pain and numbness in the hand, and may also require surgical decompress­ion.

The further possibilit­y would be disturbed functionin­g of the small nerves in the skin – a small fibre neuropathy – often experience­d as a “wrinkle in sock” or “pebble in shoe” sensation. The nerve conduction studies being normal, the diagnosis requires a skin biopsy that reveals an abnormal appearance of those small nerve fibres. There is regrettabl­y no specific treatment, though drugs such as amitriptyl­ine may be of value, along with local anaestheti­c (lidocaine) plasters.

Under pressure

Finally, combining two themes of recent columns – the hazards of the overzealou­s treatment of hypertensi­on and the merits of complement­ary therapies – a Yorkshire reader commends acupunctur­e for lowering the blood pressure. She felt duty bound to come up with an alternativ­e to drugs and, eventually, her family doctor agreed to a trial of the needling treatment. That was September last year, since when, together with a couple of booster sessions, her blood pressure remains in the recommende­d range.

There is, of course, no recognised physiologi­cal explanatio­n why acupunctur­e should have this effect, which has been demonstrat­ed in a formal clinical trial.

 ??  ?? Be warned: the shingles vaccinatio­n can carry a risk of visual impairment
Be warned: the shingles vaccinatio­n can carry a risk of visual impairment
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