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Monday, April 9, 2012

Shingles!!

So, I've been dealing with a case of shingles. Anyone not familiar with this can Google it. I strongly believe that administering the shingles vaccine is what led to this. I am immune compromised due to the meds I take for rheumatoid arthritis (Remicade, Imuran, prednisone) and within 6 weeks of starting to administer the shingles vaccine I end up with shingles. I've been on these medications for 3 years now with no adverse events and suddenly I have shingles. It's too coincidental for me to believe it's cause was random. In case your not familiar with shingles in an immune compromised patient, the disease can disseminate causing wide spread consequences. The pain doesn't just stay localized to the rash area, but spreads along all nerve roots on that side of the body. Fun!
My big concern with this happening it that we spend alot of time learning safety measures for administering the vaccine to patients, but very little, if any, time on safety measures for those doing the administering. I have staff members who have never had chicken pox or the vaccine. Are they at risk? We toss the vaccine vial in the trash when we're through with it, but it still contains live virus. How safe is this? What exactly are the risks to the healthcare professional who handles live virus vaccines? Our employers aren't going to address this topic because all they want is for us to sell, sell, sell these vaccines. Is this a legitimate workers' comp claim? Are they going to compensate me for the hearing loss I now have?  Should I have known better than to administer this vaccine with my current health issues? Was this really the cause of my shingles? It's not like I experienced a needle-stick, but the event is too coincidental for me to believe otherwise. I am contacting the CDC to see if there is some way to report this kind of event. We use VAERS to report adverse events that patient experience, but I can't find any info on the web site on adverse events experienced by the healthcare professionals. Why is this subject not even addressed by the CDC? We talk about needle-stick injury all the time, but never about virus exposure injury. This subject needs to be addressed. I'm sure I'm not the first healthcare professional to become ill after exposure to a live virus vaccine. Any thoughts on this issue?

6 comments:

Anonymous said...

Seems highly doubtful to me. There has been very few reports of immunocompromised individuals developing shingles after someone they are in close contact with received Zostavax (CDC says the risk is practically nil unless the vacinnee develops a zoster like rash after vaccination.) which seems fairly similar to what you think has happened to you. But who knows. Would be interested to hear CDCs response.

lovinmyjob said...

As a follow-up, I contacted the CDC. They say it is absolutely possible that my shingles were caused by repeated contact with the live virus vaccine. Immunocompromised patients are warned not to TAKE live virus vaccines, but no one ever thinks about us giving the vaccine. Anyone who gives this vaccine knows that there is still some serum left in the vial after withdrawing the dose we need for the patient. How is this being disposed? I know it's only viable for 30 minutes after mixing, but 30 minutes of contact is sufficient to cause disease. Anyway, the CDC had me file a VAERS on this incident. Maybe it will open some eyes to protecting the vaccinator.

Anonymous said...

This matter brings up the issue of healthcare worker acquired illness.

My father was a schoolteacher and he used to say that he and his whole family were immune to anything new by the third week of school (no, I just made that up, but the point was that teachers' kids were widely exposed to common viruses.)

When designing a pharmacy, I think a sink located near the intake window is a real plus, so pharmacy personnel can easily wash their hands to take in scripts and for a contagious pharmacist. If not there, then at least the 99% alcohol foam.

People wearing masks when ill would be helpful. (Why are there so many sensible people in Japan?) And, where do the masks come from?

bcmigal said...

I wear gloves from start to finish. Our empty vials never ever go in the trash. We have a "hazardous" waste bin that is emptied monthly by a waste service. Sorry to hear about your shingles. Your situation does remind us that we need more education if you are "immunizers'.

Anonymous said...

Should a healthy person age 60 years or older receive zoster vaccine if they are going to be in contact with an unvaccinated infant or an immunocompromised person?


Neither situation is a contraindication to zoster vaccination. A person who gets vaccinated with zoster vaccine who has close household or occupational contact with people who are at risk for developing severe varicella or zoster infection need not take any precautions after receiving zoster vaccine. The only exception is in the rare instance when a person develops a varicella-like rash after receiving zoster vaccine. A vaccine rash is expected to occur less frequently after zoster vaccine is given than after varicella vaccine is given. If a rash develops, the vaccinated person should restrict contact with an immunocompromised person if the immunocompromised person is susceptible to varicella.

Directly from CDC website. Interesting they are saying differently. Hope you are feeling better and please keep us updated with any more pertinent info.

The Phrustrated Pharmacist said...

My two cents on the situation - if any of the vaccine "leaked" back outside of the injection site, you have just been exposed to live, active virus. If at any time you used less-than-perfect technique and had even the tiniest of drops on the top of the vial, or end of the syringe, you have been exposed. If you over or under-filled the air space and had a "burp", you have been exposed. If you are already immunocompromised, you could more than easily contract the virus.

I'm not really sure why it wasn't on your radar (and I don't mean that as a personal-type attack - it's not your fault if you weren't taught or exposed to information), but there have been concerns regarding adminstrators (as in, those who give the drug, not the suits in offices), compounders (i.e. those who mix it), etc. and exposure since the early '90s, if not before.

That should have been a topic in your vaccine education, but as I'm learning, many chains aren't even educating - CVS has just been the object of a State Board action in North Carolina, for not once, but twice, not properly training the same group of pharmacists and allowing them to give injections. The trainer basically gave the pharmacists the answers to the exam and did not have them demonstrate their technique as required. Our profession has just plummeted down the tubes in the past 10 years.

The concern is discussed more in the hospital environment, especially in the IV rooms and chemo rooms, but I have heard and had discussions, and done education, for retail pharmacies regarding the dispensing techniques and precautions that should be used when counting certain medications, especially chemotherapuetic agents.

Most of the tablets are coated and there is not an exposure problem, but no pregnant woman is allowed to dispense any hormone-based medication, and trays and areas are cleaned after any such items are dispensed (Tamoxifen, finasteride, Premarin, Provera, etc.) Any woman of child-bearing age is to use gloves for any of the chemo agents, and use of gloves and masks are strongly encouraged.

Anyone who is trained to work in the compounding area must either have base-line blood tests done that measure hormone levels, (or sign a waiver of liability if they refuse the blood tests) after I have counseled them on the dangers of exposure to the chemicals. They must sign a statement of understanding regardless, and then the responsibility lies with them if they choose not to glove and mask up.

I have worked in hospitals, chains, and independents, and these types of precautions have been the norm in these locations, in several states. It was first brought to my attention in pharmacy school, and was reiterated several times before I graduated, and the chain stores I worked for provided education and reminders often.

If that has fallen by the wayside, we must become more vocal about protections for ourselves, and involve OSHA as well as the CDC. State Boards (I'll have a blog post soon regarding this)do not respond, nor is it their job to respond, to workplace condition issues, unless they are directly related to patient harm.

State Boards of Pharmacy are a consumer protection agency, and exist solely to protect the consumer, not protect the pharmacist. A common misperception, but a very important distinction that pharmacists need to be aware of.

Anyway - thanks for letting me ramble on and on. I suffer from a chronic illness, and I am so sorry you had to have shingles added to what already must be a daily hell.

--T.Ph.RPh.