“In people with diabetes, anti-Herpes Zoster is important and all vaccinations are important, such as anti-flu, anti-meningococcal and anti-pneumococcal. In diabetics, however, anti-Herpes Zoster is particularly important because the disease itself causes diabetic neuropathy affecting the peripheral nerves and the complication of shingles is post herpetic neuropathy, characterized by burning pain, particularly disabling”. This was explained to Adnkronos Salute by Graziano Di Cianni, president of the Diabetologists’ Association (AMD), director of the complex operating unit of Diabetes and Metabolic Diseases of the North West Tuscany ASL – Diabetes Clinic Network.
“The complication of Herpes Zoster – he underlines – greatly worsens the clinical picture of the diabetic. For this reason, the official documents recommend vaccination in these people as early as 18 years old. Let us also remember that this virus affects women with particular clinically important virulence. and those with type 1 diabetes, known as juvenile or insulin dependent.
Herpes Zoster, known as shingles, is the reactivation of the Varicella Zoster virus contracted in childhood, which affects the nervous structures. Reactivation is usually associated with a painful rash in the form of streaks of vesicles. Among the most feared sequelae is postherpetic neuralgia. About one in three adults will develop an episode of shingles in their lifetime. The incidence and severity increase with age, after the age of 50, reaching one in two people over 85 years of age. In a joint document dated 25 January, the Italian Society of Hygiene, Preventive Medicine and Public Health (Siti), the AMD and the Italian Society of Diabetology (SID) recommend vaccination against Herpes Zoster with an adjuvanted recombinant vaccine starting from 18 years of age, to complement the others available (anti-influenza, anti-pneumococcal, anti-meningococcal B and ACWY, anti-hepatitis B, anti-diphtheria, tetanus, pertussis and anti-measles, mumps, rubella and chickenpox).
“There is awareness-raising work to be done – underlines Di Cianni – because we are still far from understanding these vaccinations as a common clinical practice. We need to work on the educational and cultural level at the level of doctors and patients. In this historical moment even more We saw it with Covid: up to the third dose we did very well in adherence, in the fourth we also saw a certain resistance in diabetics due to the skepticism of public opinion, but not only. The patient with diabetes – reiterates the specialist – is part of a fragile population. Vaccinations are important to avoid the complications of infections that can worsen the clinical picture: the immune response is less rapid in diabetics and glycemic control is altered”.
The anti-Hepes Zoster vaccination is provided for in the 2017-2019 National Vaccine Prevention Plan (Pnpv), in the vaccination calendar, as well as in the Essential Levels of Assistance (Lea) of the National Health Service for the 65-year-old cohort and for subjects starting from 50 years of age, with the presence of diseases such as diabetes mellitus, cardiovascular disease and chronic obstructive pulmonary disease (COPD), or candidates for treatment with immunosuppressive therapy, factors that increase the risk of developing shingles or aggravate the picture symptomatological.
“In Italy we have different health systems and vaccination schedules – observes Di Cianni – The Regions must decide, but it is unlikely that they will not, considering that the anti-Herpes Zoster is given free of charge, and recommended, in people with diabetes from 18 years of age “. The problem remains adherence to vaccinations. For the flu shot “there is a good recovery in the over 60s – notes the AMD president – For the others we are at a niche level. We need to reap the benefits of the joint January document and extend it to general medicine, public opinion and patient associations. However, there is a step forward – concludes Di Cianni – because until a few years ago there was no talk of vaccinations “.
