Author: Noelle Cook

In the United States alone, there are an estimated 1 million cases of shingles a year, and one in three people can expected to develop the condition during their lifetime. One in five people who have shingles will develop post-herpetic neuralgia.

Some doctors only treat symptoms of shingles, such as pain, when the disease is diagnosed later than 72 hours after the rash develops. Pain relievers, such as acetaminophen (Tylenol, for example), ibuprofen (Advil, for example), naproxen (Aleve), or tricyclic antidepressants are examples of some pain medications that may be used. Topical creams (for example, calamine lotion) may help reduce itching.

^ Brisson M, Edmunds WJ, Law B, et al. (2001). “Epidemiology of varicella zoster virus infection in Canada and the United Kingdom”. Epidemiol. Infect. 127 (2): 305–14. doi:10.1017/S0950268801005921. PMC 2869750 . PMID 11693508.

Several studies have investigated the efficacy of complementary and alternative medicines in reducing the pain of nerve damage left over after shingles. Alternative approaches that seem to offer hope for managing long-term pain with few side effects include:

Older adults are most likely to develop shingles, which is why the shingles vaccine is recommended for people age 60 and older. Zostavax is currently the only vaccine approved by the U.S. Food and Drug Administration (FDA) to prevent shingles. According to the CDC, the vaccine can reduce your risk of getting shingles by more than half, but the older you are the less effective the vaccine becomes. As a result, some people who get the vaccine may still get shingles. The ideal time for getting vaccinated is between 60 and 69 years old.

This is the most common complication. It is where the nerve pain (neuralgia) of shingles persists after the rash has gone. This problem is uncommon in people aged under 50. However, up to 1 in 5 people with shingles, over the age of 60, have pain that lasts more than a month. The older you are, the more likely it will occur. The pain usually eases gradually. However, in some people it lasts months, or even longer in a few cases.

The rash usually lasts about 10 to 15 days. During that time, a scaly crust might appear. Once the attack is over, the skin usually returns to normal, but there can be some scarring or a secondary bacterial infection in severe cases. 

In historical shingles studies, shingles incidence generally increased with age. However, in his 1965 paper, Dr. Hope-Simpson suggested that the “peculiar age distribution of zoster may in part reflect the frequency with which the different age groups encounter cases of varicella and because of the ensuing boost to their antibody protection have their attacks of zoster postponed”.[19] Lending support to this hypothesis that contact with children with chickenpox boosts adult cell-mediated immunity to help postpone or suppress shingles, a study by Thomas et al. reported that adults in households with children had lower rates of shingles than households without children.[95] Also, the study by Terada et al. indicated that pediatricians reflected incidence rates from 1/2 to 1/8 that of the general population their age.[96]

Transcutaneous electrical nerve stimulation (TENS): this device sends small electrical impulses through electrodes into the affected area. The TENS unit can be switched on or off depending on the level of pain experienced.

The first sign is usually a tingling feeling, itchiness, or stabbing pain on the skin. After a few days, a rash appears as a band or patch of raised dots on the side of the trunk or face. The rash develops into small, fluid-filled blisters which begin to dry out and crust over within several days. When the rash is at its peak, symptoms can range from mild itching to extreme and intense pain. (Source: excerpt from NINDS Shingles Information Page: NINDS)

Shingles is an outbreak of a rash or blisters on the that may be associated with severe pain. The pain is generally on one side of the body or face. (Source: excerpt from Facts About Shingles (Varicella-Zoster Virus): NIAID)

Hepatitis C infection is not a contraindication for either zoster vaccine. However, if someone with hepatitis C is receiving a medication that can cause immunosuppression, they should consult with their healthcare provider and consider delaying vaccination with ZVL or RZV until they have completed treatment.

A dose of varicella vaccine has 1,350 plaque forming units (PFUs) of varicella vaccine virus, MMRV contains 9,800 PFUs (7 times higher than varicella vaccine), and live zoster vaccine contains 19,400 PFUs (14 times higher than varicella vaccine) at the date of expiration. RZV does not contain live varicella zoster virus.

The Shingles Prevention Study, which included 40000 people over the age of 60 years, found that the vaccine reduced the incidence of shingles by 51.3{c7b83ef3f28a5a4d1b92af1005aa96857b6821a19c5bf7bda4f75f8b16806b7f}, the burden of illness from shingles by 61.1{c7b83ef3f28a5a4d1b92af1005aa96857b6821a19c5bf7bda4f75f8b16806b7f} and PHN by 66.5{c7b83ef3f28a5a4d1b92af1005aa96857b6821a19c5bf7bda4f75f8b16806b7f}. A subsequent study demonstrated that vaccination of individuals 50-59 years of age resulted in vaccine efficacy for the prevention of shingles of 69.8{c7b83ef3f28a5a4d1b92af1005aa96857b6821a19c5bf7bda4f75f8b16806b7f}. In both studies the vaccine was well tolerated.

Pregnant females who get shingles are not at as high a risk for viral complications as those pregnant females who become infected with chickenpox. However, if shingles develops within a few weeks of the delivery date, the infant may be at risk for viral complications, and the affected woman should notify her OB-GYN doctor immediately. In addition, shingles at any time during pregnancy may require special treatments; the OB-GYN physician needs to be contacted to help arrange individualized treatment plans.

So if you haven’t had chickenpox, talk to your doctor about getting vaccinated against it. And if you need more motivation, let it be known that adult chickenpox really is worse. Once you’re fully vaccinated, you can be around people with shingles without worrying about catching anything. And if you have shingles, it’s not a bad idea to give a heads up to anyone around you who may not have had the chickenpox virus or vaccine yet.

Yes. CDC’s General Best Practice Guidelines for Immunization advise that non-live vaccines, such as RZV, can be administered concomitantly, at different anatomic sites, with any other live or non-live vaccine. They should be given as separate injections, not combined in the same syringe.

Staphylococcus or Staph is a group of bacteria that can cause a multitude of diseases. Staph infections can cause illness directly by infection or indirectly by the toxins they produce. Symptoms and signs of a Staph infection include redness, swelling, pain, and drainage of pus. Minor skin infections are treated with an antibiotic ointment, while more serious infections are treated with intravenous antibiotics.

Vaccine Rates Against Shingles, Flu And Pneumonia Still Lag : Shots – Health News Beyond annual flu shots, older adults need protection against shingles, pneumonia, tetanus, diphtheria and pertussis, federal health officials say. But many aren’t getting vaccinated.

A person with shingles can pass the varicella-zoster virus to anyone who isn’t immune to chickenpox. This usually occurs through direct contact with the open sores of the shingles rash. Once infected, the person will develop chickenpox, however, not shingles.

Dr. William Schaffner, preventive disease specialist at the Vanderbilt University School of Medicine, said, “This vaccine has spectacular initial protection rates in every age group. The immune system of a 70- or 80-year-old responds as if the person were only 25 or 30.”

Almost one out of three people in the U.S. will develop shingles during a lifetime. As you get older, your risk goes up, since studies show that most people (over half) who develop shingles are over the age of 60.

The rash from shingles tends to develop in a certain pattern, most commonly on the trunk. It is sometimes referred to as a “shingles band” due to the striped pattern. The rash may start as red patches but changes over time and develops into fluid-filled blisters. These blisters may ooze.

A review by Cochrane concluded that the live vaccine was useful for preventing shingles for at least three years.[7] This equates to about 50% relative risk reduction. The vaccine reduced rates of persistent, severe pain after shingles by 66% in people who contracted shingles despite vaccination.[51] Vaccine efficacy was maintained through four years of follow-up.[51] It has been recommended that people with primary or acquired immunodeficiency should not receive the live vaccine.[51]

As with Zostavax, the recommendation is that those who are or will soon be on low-dose immunosuppressive therapy (such as less than 20 mg a day of the steroid prednisone), and those who have recovered from an illness that suppresses the immune system, such as leukemia, can get the vaccine. 

There is a vaccine against the varicella virus which has been used routinely in the USA since 1996 to protect children against chickenpox. It is not given routinely in the UK but is available for prescription on the NHS if the doctor thinks it is needed. The vaccine has reduced the incidence of chickenpox in the USA. If fewer people get chickenpox, then fewer people will get shingles later in life.

The location of the shingles rash can vary. Though shingles can appear almost anywhere on the body, it most commonly affects the torso and the face (including the eyes, ears, and mouth). It is often present in the area of the ribcage or the waist. This characteristic rash is in a stripe or band-like pattern that affects only one side of the body (the right or the left), and it usually does not cross over the midline. In some cases, the rash can affect adjacent dermatomes (an area of skin that is supplied by a single spinal nerve), and rarely it can affect three or more dermatomes (a condition termed disseminated zoster). Disseminated zoster generally occurs only in individuals with a compromised immune system.

In the prodromal stage, various symptoms can start to emerge slowly that resemble other illnesses, making a diagnosis hard at first. For example, some of the early shingles symptoms include feeling fatigued, having headaches, experiencing body aches and swollen lymph nodes, or becoming more sensitive to light. It’s easy to mistake these shingles symptoms for the flu, a stomach virus, a cold or even normal hormonal fluctuations.

Risk factors for shingles are common, and the majority of people have at least one or more risk factors. For example, anyone who has had the chickenpox infection or chickenpox vaccine (live attenuated virus) may carry the herpes zoster virus that causes shingles. Older people (over 50 years of age), those with cancer, HIV, or organ transplant, or people who have a decreased ability to fight off infection due to stress or immune deficiency have a greater chance of getting shingles.

Shingles, or herpes zoster, is a very common painful, blistering viral rash. Shingles is caused by reactivation of the chickenpox virus called varicella zoster virus (VZV). Shingles occurs in people who have previously been infected with the chickenpox virus at some point in their lives. Shingles usually occurs as a unilateral (one side of the body) pain, burning, or tingling and blistering rash extending in a local pattern in the distribution of nerves. Common areas affected by shingles include the face, abdomen, back, buttocks, and chest. Red, itchy patches form across these areas and become small blisters that may be similar in appearance to chickenpox. The rash begins to clear after the blisters break and dry into scabs within two to three weeks.

Senior citizens with shingles are more likely to experience complications than the general population, including more extensive rashes and bacterial infections from open blisters. They are also more susceptible to both pneumonia and brain inflammation, so being seen by a doctor early on for anti-viral treatment is important.

In addition, anyone who was eligible for immunisation in the previous three years of the programme but missed out on their shingles vaccination remains eligible until their 80th birthday. This includes:

Diagnosis of complications of varicella-zoster, particularly in cases where the disease reactivates after years or decades of latency, are difficult. A rash (shingles) can be present or absent. Symptoms vary, and there is significant overlap in symptoms with herpes-simplex symptoms.[104]

Why the discrepancy between kids and grown-ups? Cost can be a big deterrent for adults who are considering some vaccinations. The federal Vaccines for Children Program helps whose kids are eligible for Medicaid or are uninsured cover the cost of vaccines up to age 19.

The CDC also recommends that people who have already gotten Zostavax should now get Shingrix as well and that Shingrix is officially the preferred vaccine over Zostavax, a single-dose vaccine. Those who’ve had shingles, which occasionally recurs, should also receive Shingrix. 

^ Sigurdur Helgason; et al. (2000). “Prevalence of postherpetic neuralgia after a single episode of herpes zoster: prospective study with long term follow up” (PDF). British Medical Journal. 321 (7264): 794–96. doi:10.1136/bmj.321.7264.794. PMC 27491 . PMID 11009518. Archived from the original on 2009-02-09.

People with weakened immune systems due to immune-suppressing medications, HIV disease, cancer treatment, or organ transplants should not receive the shingles vaccine because it contains live, weakened virus particles.

A viral illness, shingles is caused by varicella zoster virus, the same virus that causes chickenpox. The virus lives in your body and reactivates more readily when your immune system is suppressed. to the U.S. Centers for Disease Control and Prevention, approximately 1 million people in the United States experience a shingles outbreak every year.

Shingles: An acute infection caused by the herpes zoster virus, the same virus as causes chickenpox. Shingles is most common after the age of 50 and the risk rises with advancing age. Shingles occurs because of exposure to chickenpox or reactivation of the herpes zoster virus. The virus remains latent (dormant) in nerve roots for many years following chickenpox.

Also known as the winter vomiting bug – when people are ill with vomiting and diarrhoea, it’s important to drink plenty of fluids to prevent dehydration. Young children and the elderly are especially at risk

At some point, the virus can reactivate and cause shingles. The reason the virus reactivates is not entirely clear. According to the Mayo Clinic, it may become active again if a person’s immune system becomes weakened or stressed.

The Advisory Committee on Immunization Practices, which advises the CDC on vaccine usage, also recommended that adults who received Zostavax, a shingles vaccine made by Merck, be revaccinated with Shingrix.

Reconstitute ZVL using only the diluent provided. Administer ZVL by the subcutaneous route immediately after reconstitution to minimize loss of potency. If the vaccine is not administered within 30 minutes of reconstitution it must be discarded.

Shingles, also known as herpes zoster, can occur at any age but usually occurs in adults over the age of 50 years.  Females appear to be more frequently affected than males.  Groups at an increased risk of developing shingles include people whose immune systems have been impaired due to ill health, medications or diseases that lower the immunity.

myDrReferences 1. National Health and Medical Research Council (NHMRC). The Australian Immunisation Handbook, 10th Edition. Chapter 4.24 – Zoster (Herpes zoster) [accessed Sept 2015]. Available from: http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home~handbook10part4~handbook10-4-24

A person who has ever had a life-threatening or severe allergic reaction to gelatin, the antibiotic neomycin, or any other component of shingles vaccine. Tell your doctor if you have any severe allergies.

Colloidal or powerderized oatmeal baths are an old standby for relieving the itch of chickenpox and can help with shingles, as well. To speed up the drying out of the blisters, try placing a cool, damp washcloth on the rash (but not when wearing calamine lotion or other creams.) If your doctor gives you the green light, stay active while recovering from shingles. Gentle exercise or a favorite activity may help keep your mind off the discomfort.

Some patients develop postherpetic neuralgia (PHN), in which the localized pain of shingles remains even after the rash is gone. As many as 15% of people with shingles develop postherpetic neuralgia; most of these cases occur in people over 50 years of age.

Chickenpox can be dangerous for some people. Until your shingles blisters scab over, you are contagious and should avoid physical contact with anyone who hasn’t yet had chickenpox or the chickenpox vaccine, especially people with weakened immune systems, pregnant women and newborns.

The pain may be a constant, dull or burning sensation and its intensity can vary from mild to severe. You may have sharp stabbing pains from time to time, and the affected area of skin will usually be tender.

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Some vaccines are life saving such as measles or polio, and these are also vaccines that provide herd immunity to protect some of the unvaccinated. The current vaccine for shingles (medically known as herpes zoster) is a variation of the chickenpox (also called varicella) vaccine given to kids. Both of these vaccines are live virus vaccines and their administration produces a small locally contained infection that stimulates the immune system. In the case of chickenpox, the vaccine is highly effective in preventing the acquisition of varicella from other kids via the normal respiratory route.

^ Colebunders R, Mann JM, Francis H, et al. (1988). “Herpes zoster in African patients: a clinical predictor of human immunodeficiency virus infection”. J. Infect. Dis. 157 (2): 314–18. doi:10.1093/infdis/157.2.314. PMID 3335810.

Longo DL, et al., eds. Varicella-zoster virus infections. In: Harrison’s Principles of Internal Medicine. 19th ed. New York, N.Y.: McGraw-Hill Education; 2015. http://accessmedicine.mhmedical.com. Accessed May 9, 2017.

Mycobacterium chimaera is a type of bacterium known as a non-tuberculous mycobacterium (NTM). There is a risk that heater cooler units (HCUs) used in cardiac (heart) surgery may be contaminated with…

RZV is currently licensed for all persons 50 years of age and older. Immunosuppression is not included as a contraindication in the manufacturers’ package insert. However, immunocompromised persons and those on moderate to high doses of immunosuppressive therapy were excluded from the clinical efficacy studies so data are lacking on efficacy and safety in this group. ACIP has not made a recommendation regarding the use of RZV in these patients. This topic is anticipated to be discussed at upcoming ACIP meetings as additional data become available.

Thanks for your comment, Jason, and for pointing out my error. I deleted the reference to freezing being required: prescribing information clearly states that the vaccine components should be stored between 2 and 8 degrees C (36-46 degrees F) and discarded if previously frozen.

Susan, without knowing what stage of treatment you are or how your body is responding to chemotherapy; it is difficult to answer this question. You need to raise when to have the shingles vaccine with your oncologist. In the normal population it is being offered to special year groups over the age of 70 years.

Shingles is a disease characterized by a painful, blistering skin rash that affects one side of the body, typically the face or torso. This condition may also be referred to as herpes zoster, zoster, or zona. The word shingles comes from the Latin word cingulum, which means belt. There are approximately 1 million estimated new cases per year in the U.S., with almost one out of every three people developing shingles at some point in their lifetime. Though most people who develop shingles will only have a single episode, there are some who develop recurrent cases of shingles. Shingles is more common in older individuals and in those with weakened immune systems.

The frequency of CNS infections presented at the emergency room of a community hospital is not negligible, so a means of diagnosing cases is needed. PCR is not a foolproof method of diagnosis, but because so many other indicators have turned out to not be reliable in diagnosing VZV infections in the CNS, screening for VZV by PCR is recommended. Negative PCR does not rule out VZV involvement, but a positive PCR can be used for diagnosis, and appropriate treatment started (for example, antivirals can be prescribed rather than antibiotics).[102]

Image Source: Medscape.com, Aasi SZ. Dermatologic Diseases and Disorders. In: Pompei P, Murphy JB, eds. Geriatrics Review Syllabus: A Core Curriculum in Geriatric Medicine. 6th edition. New York, NY: American Geriatrics Society; 2006:314. Reprinted with permission.

Zostavax, which was approved by the Food and Drug Administration (FDA) in 2006, has been shown to offer protection against shingles for about five years. It’s a live vaccine given as a single injection, usually in the upper arm.

Both lyophilized RZV and the adjuvant solution must be stored at refrigerator temperature, between 2° and 8°C (between 36° and 46°F). Protect the vials from light. Do not freeze. Vaccine or adjuvant solution that has been frozen must be discarded. If vaccine that was frozen was administered, the dose does not count and should be repeated. The repeat dose can be administered immediately. There is no interval that must be met between these doses.

Progression of shingles. A cluster of small bumps (1) turns into blisters (2). The blisters fill with lymph, break open (3), crust over (4), and finally disappear. Postherpetic neuralgia can sometimes occur due to nerve damage (5).

Shingles is most commonly diagnosed and treated by a primary care physician (family practitioner, pediatrician, and internist) or an emergency medicine physician. For certain individuals who develop complications of shingles, a specialist in ophthalmology, neurology, or infectious disease may also be involved. Select patients with postherpetic neuralgia may require the care of a pain specialist.

^ Johnson, Robert W; Alvarez-Pasquin, Marie-José; Bijl, Marc; Franco, Elisabetta; Gaillat, Jacques; Clara, João G; Labetoulle, Marc; Michel, Jean-Pierre; Naldi, Luigi; Sanmarti, Luis S; Weinke, Thomas (2015). “Herpes zoster epidemiology, management, and disease and economic burden in Europe: A multidisciplinary perspective”. Therapeutic Advances in Vaccines. 3 (4): 109–20. doi:10.1177/2051013615599151. PMC 4591524 . PMID 26478818.

The varicella zoster virus is generally transmitted during childhood through the respiratory system. A child would inhale the virus from a sick person’s sneeze, for instance, or from chicken pox particles in the air. The virus would then infect the tonsils and lymph nodes, get picked up by the white blood cells and spread all over the body, thereby causing chicken pox.  

Shingles can be spread when a person comes into contact fluid contained in the blisters. The virus can be spread by direct contact with the lesions or by touching any dressings, sheets or clothes soiled with discharge from the spots. 

The vaccine against the varicella-zoster virus has been shown in large studies to be effective in reducing the risk of older people developing shingles. The vaccine has been shown to be safe with very few side-effects.

Shingles usually only affects people who are over 50, but anyone who has had chickenpox is at risk. Once you’ve had chickenpox, the varicella-zoster virus remains dormant or inactive in your body for a number of years. However, as you age, this virus can suddenly reappear and present as shingles.

The shingles rash can be a distinctive cluster of fluid-filled blisters — often in a band around one side of the waist. This explains the term “shingles,” which comes from the Latin word for belt. The next most common location is on one side of the forehead or around one eye. But shingles blisters can occur anywhere on the body.

An antidepressant medicine in the tricyclic group. An antidepressant is not used here to treat depression. Tricyclic antidepressants, such as amitriptyline, imipramine and nortriptyline, ease nerve pain (neuralgia) separate to their action on depression; or

It’s easy to ignore minor aches and pains, especially in middle age, but pay attention to the location. “One symptom that people might ignore is pain in a certain area even with no evidence of a rash,” says Patrick Fratellone, MD, an integrative physician and registered herbalist practicing in New York City. “There are a few patients who have shingles and no rash.” In those cases, a blood test can help with the diagnosis.

Some individuals may experience shingles or chickenpox-like rashes within 42 days after receiving zoster vaccine. Transmission of VZV virus from vaccinated individuals to other individuals occurs rarely.

Chickenpox (chicken pox) is a contagious childhood disease caused by the varicella-zoster virus. Symptoms have an incubation period of 14 to 16 days and include a couple days of mild fever, weakness, and red, raised rash that progresses to blisters that eventually burst and crust over. Complications include bacterial infection of the open sores, scarring, encephalitis, nerve palsies, and Reye’s syndrome.

The culprit is a germ called the varicella zoster virus (VZV), the chickenpox virus. When it first enters the body, as it does in the case of 90% of all children, it leads to chickenpox. But the body is never totally rid of VZV, which belongs to a family of viruses known as the “herpes viruses” that become latent in their host after causing the first infection. Herpes viruses manage to hide in certain types of nerve cells near the spine and brain. There they lie dormant, literally for decades, because chickenpox is a childhood disease and shingles occurs mostly among people over 50. When the virus is reactivated it will cause shingles, not chickenpox.

Shingles has no relationship to season and does not occur in epidemics. There is, however, a strong relationship with increasing age.[19][38] The incidence rate of shingles ranges from 1.2 to 3.4 per 1,000 person‐years among younger healthy individuals, increasing to 3.9–11.8 per 1,000 person‐years among those older than 65 years,[8][19] and incidence rates worldwide are similar.[8][67] This relationship with age has been demonstrated in many countries,[8][67][68][69][70][71] and is attributed to the fact that cellular immunity declines as people grow older.

The development of shingles in pregnant women is very uncommon; although shingles poses little or no risk for the fetus, the mother may require treatment with antiviral medication. Pregnant women with shingles should seek a doctor to manage their care. In contrast, pregnant women who develop chickenpox may have a risk to the fetus; these individuals need to seek care immediately.

Ramsay Hunt syndrome (also known as herpes zoster oticus) consists of weakness of the face due to infection with the varicella zoster virus.  Five cases arise per 100,000 of the population per year in the US.  It is more common among those over 60 and rare in children. Other symptoms may include severe ear pain and small blisters on the outer ear or in the mouth.  Prompt diagnosis and treatment (ideally within 72 hours of the onset of symptoms) are crucial to secure the best outcomes. In cases where treatment has been started within this time period, facial weakness recovers in up to 75% of patients. Standard treatment is with antiviral therapy (most commonly acyclovir). Corticosteroids are known for their anti‐inflammatory properties and are commonly used together with antivirals to reduce the inflammation in the facial nerve.  This is thought to be the cause of the facial weakness.  The aim of the review was to see if corticosteroids, used at the same time as antiviral drugs, improved outcomes in patients with Ramsay Hunt syndrome.  However the review found no trials matching the inclusion criteria, and no conclusions can be drawn about the effectiveness of using corticosteroids in this way.   It is recommended that high‐quality randomised controlled trials be undertaken to address this issue.

Living with a shingles rash can be made more comfortable by taking steps to relieve the symptoms. Keeping any rashes clean and dry helps to reduce the risk of them becoming infected. Wearing loose clothing can also help people to feel less uncomfortable while waiting for a rash to clear.

The Shingles Prevention Study involved individuals age 60 years and older and found found that Zostavax significantly reduced disease in this age group. The vaccine is currently recommended for persons 60 years of age and older.

Shingles is caused by the same virus that causes chickenpox (varicella-zoster virus or VZV), a member of the herpes family of viruses. After a person has chickenpox, the virus can live dormant in the nervous system for life. Sometimes the virus remains dormant forever, but in other cases, the virus reactivates along a nerve of sensation.

^ Harpaz R, Ortega-Sanchez IR, Seward JF (June 6, 2008). “Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP)”. MMWR Recomm. Rep. 57 (RR–5): 1–30; quiz CE2–4. PMID 18528318. Archived from the original on November 17, 2009. Retrieved 2010-01-04.

Most people first notice shingles when they feel itching and burning on their skin, followed by signs of a rash, including redness and bumps that develop on only one side of the body (such as the left side of the back, in one eye or on one arm). The blisters associated with shingles can look similar to those caused by herpes simplex virus, although the two viruses are different.

If you have had chicken-pox as a child the virus could return from dormancy, decades later, in the form of shingles. Clumps of blisters erupt on the skin, following the path of the infected nerve. It may circle around the abdomen or chest, and can sometimes affect the neck, lower back, forehead and eyes. During an attack of shingles, you tend to feel pretty lousy all over. The area around the blisters can be excruciating, and for some people this may last for weeks after the blisters have disappeared: when this happens it is called postherpetic neuralgia.

There is lots of evidence showing that the shingles vaccine is very safe. It’s already been used in several countries, including the US and Canada, and no safety concerns have been raised. The vaccine also has few side effects.

Do not scratch the skin where the rash is located. This may increase the risk of secondary bacterial infection and scarring. Over-the-counter (OTC) antihistamines (Benadryl) and topical creams (Lidocaine can relieve the itching.

You cannot get shingles from someone who has shingles. However, it is possible for someone who has not had chickenpox or the chickenpox vaccine to get chickenpox from someone with shingles. This is uncommon and requires direct contact with the fluid from the shingles blisters. For more information about chickenpox and the chickenpox vaccine, see HealthLinkBC File #44a Facts About Chickenpox and HealthLinkBC File #44b Chickenpox (Varicella) Vaccine.

Shingles usually appears in a recognizable belt-like or girdle pattern along the left or right side of the body. The shingles rash may cover a wide swath across the waist, chest, stomach, back, breasts, or buttocks, but it rarely wraps all the way around the body.

RZV is currently licensed for all persons 50 years of age and older. Immunosuppression is not included as a contraindication in the manufacturers’ package insert. However, immunocompromised persons and those on moderate to high doses of immunosuppressive therapy were excluded from the clinical efficacy studies so data are lacking on efficacy and safety in this group. ACIP has not made a recommendation regarding the use of RZV in these patients. This topic is anticipated to be discussed at upcoming ACIP meetings as additional data become available.

In pre-licensure clinical trials of RZV the most common adverse reactions were pain at the injection site (78%), myalgia (45%), and fatigue (45%). Any grade 3 adverse event (reactions related to vaccination which were severe enough to prevent normal activities) was reported in 17% of vaccine recipients compared with 3% of placebo recipients. Grade 3 injection-site reactions (pain, redness, and swelling) were reported by 9% of vaccine recipients, compared with 0.3% of placebo recipients. Grade 3 solicited systemic events (myalgia, fatigue, headache, shivering, fever, and gastrointestinal symptoms) were reported by 11% of vaccine recipients and 2.4% of placebo recipients. The occurrence of local grade 3 reactions did not differ by vaccine dose. However systemic grade 3 reactions were reported more frequently after dose 2.

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Both lyophilized RZV and the adjuvant solution must be stored at refrigerator temperature, between 2° and 8°C (between 36° and 46°F). Protect the vials from light. Do not freeze. Vaccine or adjuvant solution that has been frozen must be discarded. If vaccine that was frozen was administered, the dose does not count and should be repeated. The repeat dose can be administered immediately. There is no interval that must be met between these doses.

Anyone who has had chickenpox can develop shingles. However, people who have never had chickenpox can catch the virus from another person with shingles. A person who has never had chickenpox, but comes into contact with a case of shingles, would develop chickenpox (not shingles).

Antiviral drugs may reduce the severity and duration of shingles;[55] however, they do not prevent postherpetic neuralgia.[56] Of these drugs, aciclovir has been the standard treatment, but the new drugs valaciclovir and famciclovir demonstrate similar or superior efficacy and good safety and tolerability.[52] The drugs are used both for prevention (for example in HIV/AIDS) and as therapy during the acute phase. Complications in immunocompromised individuals with shingles may be reduced with intravenous aciclovir. In people who are at a high risk for repeated attacks of shingles, five daily oral doses of aciclovir are usually effective.[24]

By preventing shingles, the vaccine also drastically reduces the overall incidence of severe nerve pain, a lasting complication for about one in three people who get shingles. GlaxoSmithKline said it tested the vaccine in more than 38,000 people.

Shingles can often be diagnosed by your doctor based upon the distinctive appearance and distribution of the characteristic shingles rash. A painful, blistering rash that is localized to defined dermatomes is a sign highly suggestive of shingles. Blood work or other testing is usually not necessary. Diagnosing shingles before the appearance of the rash or in cases of zoster sine herpete (zoster without rash) can be challenging. In cases where the diagnosis is unclear, laboratory tests are available to help confirm the diagnosis. Depending on the clinical situation, testing can be done using either blood work (to detect antibodies to the varicella zoster virus) or by specialized testing of skin lesion samples.

A viral illness, shingles is caused by varicella zoster virus, the same virus that causes chickenpox. The virus lives in your body and reactivates more readily when your immune system is suppressed. According to the U.S. Centers for Disease Control and Prevention, approximately 1 million people in the United States experience a shingles outbreak every year.

Shingles is a painful rash that’s caused by varicella zoster, the same virus that’s responsible for chickenpox. If you had chickenpox as a child, the virus hasn’t completely gone away. It hides dormant in your body and can reemerge many years later as shingles. There are about 1 million cases of shingles each year, according to the Centers for Disease Control and Prevention (CDC). About half of these cases occur among people over the age of 60.

“Now that the new vaccine is available, it is just as important for adults over 50 to be vaccinated against shingles”, says Raff. “I would recommend that everyone over the age of 50 should speak to their doctor about getting vaccinated,” Raff added.

Shingles may have additional symptoms, depending on the dermatome involved. The trigeminal nerve is the most commonly involved nerve,[21] of which the ophthalmic division is the most commonly involved branch.[22] When the virus is reactivated in this nerve branch it is termed zoster ophthalmicus. The skin of the forehead, upper eyelid and orbit of the eye may be involved. Zoster ophthalmicus occurs in approximately 10% to 25% of cases. In some people, symptoms may include conjunctivitis, keratitis, uveitis, and optic nerve palsies that can sometimes cause chronic ocular inflammation, loss of vision, and debilitating pain.[23]

Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.

People with shingles are contagious to persons who have not had chickenpox and can catch chickenpox from close contact with a person who has shingles. The Herpes zoster vaccine is effective in preventing or reducing the symptoms of shingles, and it is recommended for people 60 years and older. Treatment includes antiviral medication and pain medication.

Pregnant women are susceptible to shingles. Fortunately, shingles in pregnancy is very rare. The antiviral medications described previously are considered safe to use in pregnant women, as are most pain-relieving drugs. Women should not take nonsteroidal anti-inflammatory medications such as ibuprofen (Advil) or naproxen (Aleve) in the later stages of pregnancy, but acetaminophen (Tylenol) is considered safe. Having chickenpox during pregnancy has the potential to cause birth defects, depending upon when in the pregnancy the infection occurs. The risk of birth defects is believed to be lower with shingles than with primary chickenpox infection.

Antiviral medicines, usually taken as tablets, can help to control the symptoms of shingles if you take them in the early stages of the illness. They help control the rash and minimise damage to your nerves; this reduces the likelihood of post-herpetic neuralgia.

If shingles is suspected, it should be treated as soon as possible with acyclovir/valacyclovir and adequate pain management. This reduces the duration of the episode and the risk of developing complications including PHN.

Pain may last after the rash is gone. This is called postherpetic neuralgia (PHN). About 10%-15% of all shingles patients get PHN. The older the patient, the more likely they will develop PHN, and the pain that develops frequently is severe. PHN pain often lasts months and occasionally may go on for years. A new drug, Horizant (described above), may reduce the PHN symptoms.

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Tablets are convenient and easy to take to ease the pain after caesarean section, which involves cutting through the abdomen and uterus to deliver the baby. We aimed to assess the effectiveness, safety and cost-effectiveness of different types of tablets for the pain. Different types of pain tablets relieve the pain in different ways. Opioids decrease the feeling of pain, decrease reaction to pain as well as increase pain tolerance by their action on the nervous system. Some non-opioid pain tablets act on the tissues to reduce the response to the inflammatory substances released at the site of tissue damage. Combination drugs (such as paracetamol and codeine) may have more pronounced effects because of the different mechanism of action of their components. We do not know how some other tablets, such as alpha-2 agonists (clonidine) and gabapentin (usually used for nerve pain that follows shingles and long-term pain) relieve pain. Good pain control may shorten the time spent in hospital after caesarean section, improve satisfaction and reduce healthcare costs.

Shingles is contagious and can be spread from an affected person to babies, children, or adults who have not had chickenpox. But instead of developing shingles, these people develop chickenpox. Once they have had chickenpox, people cannot catch shingles (or contract the virus) from someone else. Once infected, however, people have the potential to develop shingles later in life.

Anti-viral medications can help ease the pain and shorten an attack of shingles. The medication works best if administered within three days, and ideally within 24 hours, of the onset of a rash. If you think you have shingles, seek urgent medical attention. Analgesic medication may also ease post-herpetic neuralgia, but consult your doctor first.

First off, the effectiveness of Shingrix is greater than that of Zostavax. Shingrix is intended to generate a strong and long-lasting immune response that can help overcome the decline in immunity as people age. Also, Zostavax is a live vaccine, only requiring one dose, whereas Shingrix is a non-live vaccine and requires two doses.

Shingles is contagious to people who have not previously had chickenpox when there are new blisters forming and old blisters healing. Like with chickenpox, the time prior to healing or crusting of the blisters is the contagious stage of shingles. After all of the blisters are crusted over, the contagious period is over and the virus can no longer be spread.

Shingles is a skin rash characterised by pain and blistering which usually appears on one side of the face or body. Tender, painful skin, tiredness, headache and photophobia may occur 2 to 3 days before the skin  turns red and breaks out in tiny fluid-filled blisters.

^ Brisson M, Edmunds WJ, Law B, et al. (2001). “Epidemiology of varicella zoster virus infection in Canada and the United Kingdom”. Epidemiol. Infect. 127 (2): 305–14. doi:10.1017/S0950268801005921. PMC 2869750 . PMID 11693508.

^ a b c Gagliardi, AM; Andriolo, BN; Torloni, MR; Soares, BG (3 March 2016). “Vaccines for preventing herpes zoster in older adults”. Cochrane Database of Systematic Reviews. 3: CD008858. doi:10.1002/14651858.CD008858.pub3. PMID 26937872. Archived from the original on 9 March 2016.

Unfortunately, individuals can get shingles more than once, so recurrence is possible. Although more than two shingles outbreaks in a lifetime is rare, they are significant because they usually occur in people with multiple medical problems or increasingly weakened immune responses. This complication of shingles often indicates that the person has increasing medical problems that need to be diagnosed or aggressively treated (or both).

Chickenpox can be dangerous for some people. Until your shingles blisters scab over, you are contagious and should avoid physical contact with anyone who hasn’t yet had chickenpox or the chickenpox vaccine, especially people with weakened immune systems, pregnant women and newborns.

Studies show children who receive the chickenpox vaccine have a lower risk of developing shingles. However, it remains unclear whether people who get the chickenpox vaccine as adults have a lower risk of shingles.

People with shingles are contagious to persons who have not had chickenpox and can catch chickenpox from close contact with a person who has shingles. The Herpes zoster vaccine is effective in preventing or reducing the symptoms of shingles, and it is recommended for people 60 years and older. Treatment includes antiviral medication and pain medication.

Painkillers – for example, paracetamol, or paracetamol combined with codeine (such as co-codamol), or anti-inflammatory painkillers (such as ibuprofen) – may give some relief. Strong painkillers (such as oxycodone and tramadol) may be needed in some cases.

You may be concerned about additives to the shingles vaccine — especially thimerosal. Thimerosal is a preservative that contains mercury. It’s added then removed to some vaccines to prevent bacteria and other germs from growing in them. The worry about thimerosal arose when early research linked it to autism, although this connection has since been found to be untrue. The shingles vaccine does not contain any thimerosal.

It begins with a burning sensation in the skin, followed by a rash of very painful fluid-filled blisters that can then burst and turn into sores before healing. Often an area on just one side of the body is affected, usually the chest but sometimes the head, face and eye.

First, Shingrix requires two doses, administered at least two months apart. Prodding the older population to get a single shot has proved tough: barely 31 percent of those over age 60 have been vaccinated against shingles. How much harder will it be to persuade people to get two Shingrix injections?

The Centers for Disease Control and Prevention (CDC) recommends the Zostavax vaccine for people aged 60 years and above. This age group has the highest risk of getting shingles and of experiencing a complication.

For this reason, people affected by shingles should stay away from babies, children, pregnant women, people with a weak immune system, people who have not had chickenpox, or people who have not been vaccinated against chickenpox. Once a person develops chickenpox, he/she cannot contract the virus from others. The virus remains dormant in their body. However, people who have not had chickenpox, are at a of getting exposed to the virus, and developing chickenpox. Once infected, these people can develop shingles later in life.

Individuals should also receive care as soon as possible if they have a medical illness that decreases their ability to fight off infection; these people may be able to avoid complications if treated in the early stage of shingles.

The first indications that chickenpox and shingles were caused by the same virus were noticed at the beginning of the 20th century. Physicians began to report that cases of shingles were often followed by chickenpox in the younger people who lived with the person with shingles. The idea of an association between the two diseases gained strength when it was shown that lymph from a person with shingles could induce chickenpox in young volunteers. This was finally proved by the first isolation of the virus in cell cultures, by the Nobel laureate Thomas Huckle Weller, in 1953.[91]

^ Yih WK, Brooks DR, Lett SM, Jumaan AO, Zhang Z, Clements KM, Seward JF (2005). “The incidence of varicella and herpes zoster in Massachusetts as measured by the Behavioral Risk Factor Surveillance System (BRFSS) during a period of increasing varicella vaccine coverage, 1998–2003”. BMC Public Health. 5: 68. doi:10.1186/1471-2458-5-68. PMC 1177968 . PMID 15960856.

And you do not want to get shingles. The disease is characterized by a painful, blister-like rash that forms on one side of your face or body. The blisters typically scab over in seven to 10 days, and can take up to four weeks to clear up. Anywhere from one to five days before the rash shows up, people often have pain, itching, or tingling where the rash will develop. Shingles can also cause a fever, headaches, chills, and an upset stomach. There’s also a chance that shingles patients can develop lingering nerve pain known as postherpetic neuralgia, Dr. Adalja says.

The treatment for shingles is aimed at diminishing the effects of the virus, as well as pain management. There are several medications that can be used, and your doctor will discuss the best treatment options for your particular situation. The vast majority of cases of shingles can be managed at home. In some cases, people with an impaired immune system or individuals with severe symptoms and/or complications may require hospital admission.

Increasing age: Though shingles can rarely occur in children, it is much more common in older adults, with the incidence increasing with age. This is thought to be in large part due to waning immunity as people age. Approximately 50% of all cases of shingles occur in adults 60 years of age or older.

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Shingles is a painful skin rash, often with blisters. It is also called Herpes Zoster or just Zoster. A shingles rash usually appears on one side of the face or body and lasts from 2 to 4 weeks. Its main symptom is pain, which can be quite severe. Other symptoms of shingles can include fever, headache, chills, and upset stomach. Very rarely, a shingles infection can lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis), or death.

In clinical trials ZVL recipients had a 51% overall reduction in shingles and less severe illness when shingles did occur compared with placebo recipients. ZVL efficacy was inversely related to age; efficacy was 70% among persons 50-59 years of age, 64% among persons 60-69 years of age and 38% among persons 70 years and older. Protection against shingles declined over time after vaccination. By 6 years after vaccination protection declined to less than 35%.

Varicella zoster virus (VZV) has a high level of infectivity and has a worldwide prevalence.[66] Shingles is a re-activation of latent VZV infection: zoster can only occur in someone who has previously had chickenpox (varicella).

Zostavax is approved by the Food and Drug Administration for people aged 50 years and older. However, CDC does not have a recommendation for routine use of Zostavax in people 50 through 59 years old. Protection from this shingles vaccine lasts about 5 years, so adults vaccinated before they are 60 years old might not be protected later in life when the risk for shingles and its complications are greatest. Adults 50 through 59 years who have questions about shingles vaccine should discuss the risks and benefits with a healthcare provider.

More than one committee member suggested that familiarity with shingles — and the serious pain it can — accounts for this unusually high rate of acceptance. There are an estimated 1 million cases of shingles in the nation each year, according to the CDC.

For both RZV and ZVL rates of serious adverse events (an undesirable experience associated with the vaccine that results in death, hospitalization, disability or requires medical or surgical intervention to prevent a serious outcome) were similar in vaccine and placebo groups.

The news raised questions about how likely adults are to get chicken pox and how chicken pox is related to a condition that’s more common among adults, shingles. So here are some quick facts about the infections.

Everything you need to know about shingles Shingles is a painful condition related to chicken pox. Find out how it is transmitted, who is at risk of catching it, and how to prevent it spreading. Read now

The rash of shingles can be very painful. So even if the doctor doesn’t think you need an anti-shingles medicine, they may be able to give you stronger painkillers than those you can buy over the counter from the chemist.

Shingles is caused by the varicella zoster virus (VZV), the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays dormant (inactive) in the body. For reasons that are not fully known, the virus can reactivate years later, causing shingles.

The U.S. Centers for Disease Control and Prevention advises people with active shingles to stay away from people who have never had chickenpox or the chickenpox vaccine, especially pregnant women, and individuals with weak immune systems, including people undergoing chemotherapy or taking immune-suppressing drugs, people with HIV/AIDS, and organ transplant recipients.

A Tzanck smear, which is less commonly performed now since newer diagnostic techniques are available (see below), involves opening a blister and putting fluid and skin cells from it on a glass slide. After using a special stain, the slide is examined under the microscope for characteristic viral changes in the cells. This method is unable to distinguish between VZV and herpes simplex virus (HSV), however. VZV causes shingles and chickenpox. HSV types may cause cold sores or genital herpes.

ZOSTAVAX® II does not protect everyone, so some people who get the vaccine may still get shingles. However, if you develop shingles despite being vaccinated, ZOSTAVAX® II can help reduce the intensity and duration of pain. ZOSTAVAX® II is indicated for the prevention of herpes zoster (shingles) and for immunization of individuals 50 years of age or older. ZOSTAVAX® II cannot be used to treat existing shingles or the pain associated with existing shingles. ZOSTAVAX® II has not been studied in individuals who have previously experienced an episode of herpes zoster. Side effects and allergic reactions can occur. The most common side effects were at the injection site and included redness, pain, swelling, hard lump, itching, warmth, and bruising. Headache and pain in the arm or leg were also reported. ZOSTAVAX® II should not be used if you have a blood disorder or any type of cancer that weakens your immune system, a weakened immune system as a result of a disease, medication, or other treatment, active untreated tuberculosis or if you are pregnant.

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

^ Tsai, Shin-Yi; Chen, Hsuan-Ju; Lio, Chon-Fu; Ho, Hui-Ping; Kuo, Chien-Feng; Jia, Xiaofeng; Chen, Chi; Chen, Yu-Tien; Chou, Yi-Ting (2017-08-22). “Increased risk of herpes zoster in patients with psoriasis: A population-based retrospective cohort study”. PLoS ONE. 12 (8): e0179447. Bibcode:2017PLoSO..1279447T. doi:10.1371/journal.pone.0179447. ISSN 1932-6203. PMC 5567491 . PMID 28829784. Archived from the original on 2017-09-01.

It’s important to visit a doctor right away if you think you’re developing shingles, since it can sometimes be mistaken for rashes like poison ivy, impetigo, scabies or herpes simplex virus. When pain persists, it might be mistaken for heart complications, migraines or menopausal symptoms.

Developing shingles while you’re pregnant won’t harm your baby. However, if you have symptoms of shingles and especially chickenpox, or if you come into contact with someone who has chickenpox while you’re pregnant, contact your GP or midwife.

^ Marin M, Güris D, Chaves SS, Schmid S, Seward JF (June 22, 2007). “Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP)”. MMWR Recomm. Rep. 56 (RR–4): 1–40. PMID 17585291. Archived from the original on September 4, 2011.

For those who have already had chickenpox, there is also a shingles vaccine. The Food and Drug Administration approved the shingles vaccine for adults over the age of 50. The CDC recommend adults over the age of 60 who have a history of chickenpox get the vaccine. There is no maximum age for getting the vaccine.

As with chickenpox and/or other forms of herpes, direct contact with an active rash can spread VZV to a person who has no immunity to the virus. This newly infected individual may then develop chickenpox, but will not immediately develop shingles.[17]

In the UK, there is an NHS shingles vaccination programme for people in their 70s. The programme began in September 2013. The shingles vaccine is a one-off injection, given in your upper arm, usually by your practice nurse. Currently, you can have the shingles vaccination if you were aged 70, 71, 72, 73, 78 or 79 on 1 September 2016. You cannot have the injection on the NHS after your 80th birthday.

Some patients with shingles can be treated appropriately by their primary-care physicians, including internal medicine or family medicine specialists; initial care may be started by an emergency medicine physician. However, if there is a chance the eye may be involved, an ophthalmologist should be consulted. If a person is pregnant and gets shingles, they should consult with their OB/GYN physician immediately. For long-term or chronic pain involved in postherpetic neuralgia, a neurologist and/or pain specialists may be involved in the care of the patient.

“The new shingles vaccine represents a major step forward,” said Dr. Amesh Adalja, a senior associate with the Johns Hopkins Center for Health Security in Baltimore. “The efficacy of this vaccine is significantly higher than Zostavax, and those vaccinated with Zostavax should benefit from revaccination with Shingrix.”

Once you’ve had chicken pox, you may eventually come down with shingles. Trouble is, there’s plenty of misunderstanding about how this virus (which causes both chicken pox and shingles) is transmitted.

You cannot catch shingles from other people. You can only get shingles if you’ve had chickenpox before. But is shingles contagious? Yes, people with active cases of shingles are contagious: They can give other people chickenpox.

Vaccinations increase our ability to fight diseases that may be contagious or even fatal. Immunity occurs by getting the disease or through the use of a vaccine. There are two types of vaccine: inactivated vaccines and vaccines made from live, weakened viruses.

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If the pain of shingles is very intense it may be mistaken for other problems, and occasionally people get the pain without a rash. Therefore, it is important to get a proper diagnosis in order to treat it as soon as possible.

In addition, Zostavax’s effectiveness appears to last just five years, according to the CDC. And research presented in the fall at IDWeek, an annual meeting for infectious disease professionals, suggests that Zostavax may actually wane after only three years.

The rash could form as a band around your rib cage, abdomen, face or forehead, or down an arm or a leg (although this is less common). Spots will appear and then turn into blisters, which will dry up to form a crust or scab over the top.

Though most people will experience only one episode of shingles during their lifetime, recurrence can occur in certain individuals. In order to help prevent recurrent episodes of shingles, individuals with no contraindications can receive the zoster vaccine (Shingrix), which can prevent recurrent episodes of shingles. Otherwise, people who do experience a recurrent case of shingles should see their doctor as soon as the rash appears to promptly receive antiviral medication.

Early signs of shingles include burning or shooting pain and tingling or itching, generally on one side of the body or face. A rash appears as a band or patch of raised dots on the side of the trunk or face. The rash develops into small, fluid-filled blisters, which begin to dry out and crust over within several days. When the rash is at its peak, symptoms can range from mild itching to intense pain. (Source: excerpt from Skin Care and Aging — Age Page — Health Information: NIA)

Prescription pain medication is often necessary as the pain level is very high in many people. The pain is often so intense that people cannot have any clothing touch the skin area with shingles. Drugs such as oxycodone (Oxycontin, Roxicodone), morphine, amitriptyline (Elavil, Endep), or gabapentin (Neurontin), in addition to topical creams, are often required to help manage the pain. Lidocaine and/or capsaicin (Qutenza, Capzasin) are also occasionally used on the affected area; both are used after the blisters resolve for control of pain in postherpetic neuralgia.

Today, shingles is usually treated with a combination of medications, which are used to lower the severity of pain and help the scabs heal more quickly. However, many people have also successfully turned to alternative therapies to lower their odds of getting shingles in the first place, building up their immunity and managing pain.

^ a b Araújo LQ, Macintyre CR, Vujacich C (2007). “Epidemiology and burden of herpes zoster and post-herpetic neuralgia in Australia, Asia and South America” (PDF). Herpes. 14 (Suppl 2): 40A–44A. PMID 17939895.

Antiviral medications, such as acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir), can decrease the duration of skin rash and pain, including the pain of PHN. These medications must be started early (up to about 24-72 hours after rash development) in the disease course to have any benefit. The doctor will decide which medications you may need. In special cases (for example, those with suppressed immune function), the antiviral medication may need to be given intravenously in the hospital. Only acyclovir is approved for use in children who get shingles.

People usually get better in a matter of weeks, with no lasting effects. In rare cases, it can lead to serious complications or even death. Some people experience postherpetic neuralgia, which means they continue to have pain in the area where their rash had been, even weeks, months or years after their skin has healed.

The characteristic rash of shingles typically appears after an initial period of burning, tingling, itching, or stinging in the affected area. After a few days, the rash then appears in a stripe or band-like pattern along a nerve path (called a dermatome), affecting only one side of the body without crossing the midline. The rash erupts as clusters of small red patches that develop into blisters, which may appear similar to chickenpox. The blisters then break open and slowly begin to dry and eventually crust over.

The rashes are irritating and can last for days or weeks. Many can begin treating their shingles pain by taking over the counter medications. Some also report finding relief with creams or antihistamines, but usually require a doctor’s care to fully heal. If you feel you are experiencing shingles rash pain, your regular doctor can prescribe you stronger medications to keep the pain at bay.

Shingles travels along a nerve path, causing pain and strange sensations. Your skin might tingle or feel like it’s burning before the blisters appear. Itching and sensitivity to touch are also symptoms of shingles.

In contrast, Shingrix is 97% effective against shingles for people between the ages of 50 and 69 and 91% effective for people 70 or older. It is 91% effective against postherpetic neuralgia for people 50 and older. These rates are based on evidence presented to the committee from clinical trials with over 38,000 total participants.

This is not the time to watch your symptoms develop and wait for the rash to run its course. Although most cases of shingles resolve in two to six weeks, the risk of longer-term complications rises with age, weakened immunity, and delay or absence of treatment. If you think you have shingles, it’s important to get diagnosed right away. You can see a general practitioner, family medicine physician, internist, dermatologist, or neurologist for an evaluation.

Advocates for older Canadians are calling on provincial governments to cover the cost of a new vaccine against shingles that will soon be available. Shingles is a painful illness to which seniors are more susceptible and advocates say vaccine coverage should be treated as a public health issue.

Steroids help to reduce swelling (inflammation). A short course of steroid tablets (prednisolone) may be considered in addition to antiviral medication. This may help to reduce pain and speed healing of the rash. However, the use of steroids in shingles is controversial. Your doctor will advise you. Steroids do not prevent PHN.

Department of Health and Ageing (DOHA). National Immunisation Program Schedule. [online] Canberra, ACT: Commonwealth of Australia. 2007 [Accessed 11 Jul 2011] Available from: http://www.immunise.health.gov.au

In addition to antiviral medications, pain medications may be given. Both nonsteroidal anti-inflammatory medications and narcotic pain-control medications may be used for pain management in shingles. Postherpetic neuralgia (PHN) may require additional medications to control pain.

Longo DL, et al., eds. Varicella-zoster virus infections. In: Harrison’s Principles of Internal Medicine. 19th ed. New York, N.Y.: McGraw-Hill Education; 2015. http://accessmedicine.mhmedical.com. Accessed May 9, 2017.

An outbreak of shingles can last for 3 to 4 weeks. Sometimes the pain is present but the blisters never appear. This can be a very confusing cause of pain. Some affected people develop postherpetic neuralgia (PHN), in which the localized pain remains even after the rash is gone.

Hi, my story…Started with a severe back ache, and urinary issues. Diagnosed at first with a UTI that didn’t seem to respond to antibiotics. Then ended up in the ER because of fear of the bloating…

After someone has had chicken pox, the virus stays in the nerve cells of the person’s spine (called ‘nerve roots’). It does not damage the nerve or the way the nerve works until, for some reason which is not yet clear, the virus starts to grow again, causing shingles.

People taking high-dose steroids. (This means adults taking 40 mg prednisolone (steroid tablets) per day for more than one week in the previous three months. Or, children who have taken steroids within the previous three months, equivalent to prednisolone 2 mg/kg per day for at least one week, or 1 mg/kg per day for one month.)

Dr Finn Romanes, public health doctor at Victoria, Department of Health and Human Services explains the department’s program to monitor and manage the risks associated with Mosquitoes. Learn about the…

^ Apisarnthanarak A, Kitphati R, Tawatsupha P, Thongphubeth K, Apisarnthanarak P, Mundy LM (2007). “Outbreak of varicella-zoster virus infection among Thai healthcare workers”. Infect. Control Hosp. Epidemiol. 28 (4): 430–34. doi:10.1086/512639. PMID 17385149.

An antiviral medicine is most useful when started in the early stages of shingles (within 72 hours of the rash appearing). However, some cases your doctor may still advise you have an antiviral medicine even if the rash is more than 72 hours old – particularly in elderly people with severe shingles, or if shingles affects an eye.

Shingles is a notifiable disease. This means doctors, hospitals and laboratories must inform the Department of Health of your diagnosis to assist the Department in determining the frequency of this infection in the community. Notification is confidential.

Having experienced injuries or nerve damage also seems to raise the risk for shingles, since within the nerves is where the virus lays dormant. Some research suggests that traumatic stimulation of the nerves in the dorsal root ganglion can trigger the virus to reactive. Some people also seem to be genetically predisposed to the development of herpes zoster to some extent, with research showing that changes in the gene for interleukin-10 (an immune-system mediator) are associated with an increased incidence of herpes zoster, as is a family history of the virus.

^ de Melker H, Berbers G, Hahné S, et al. (2006). “The epidemiology of varicella and herpes zoster in The Netherlands: implications for varicella zoster virus vaccination”. Vaccine. 24 (18): 3946–52. doi:10.1016/j.vaccine.2006.02.017. PMID 16564115.

Medicare Part D plans cover the shingles vaccine, but there may be a cost to you depending on your plan. There may be a copay for the vaccine, or you may need to pay in full then get reimbursed for a certain amount.

^ Enders G, Miller E, Cradock-Watson J, Bolley I, Ridehalgh M (1994). “Consequences of varicella and herpes zoster in pregnancy: prospective study of 1739 cases”. The Lancet. 343 (8912): 1548–51. doi:10.1016/S0140-6736(94)92943-2. PMID 7802767.

The first indications that chickenpox and shingles were caused by the same virus were noticed at the beginning of the 20th century. Physicians began to report that cases of shingles were often followed by chickenpox in the younger people who lived with the person with shingles. The idea of an association between the two diseases gained strength when it was shown that lymph from a person with shingles could induce chickenpox in young volunteers. This was finally proved by the first isolation of the virus in cell cultures, by the Nobel laureate Thomas Huckle Weller, in 1953.[91]

The shingles vaccine is made from the live virus. However, the virus is weakened, so it shouldn’t make anyone with a healthy immune system sick. People whose immune system is weaker than normal do need to be careful. In very rare cases, people with a weakened immune system have gotten sick from the varicella zoster virus in the vaccine. Talk to your doctor if you suspect that you have a weakened immune system.

The National Immunisation Program (NIP) provides a free shingles vaccine at 70 years of age (from November 2016). There is also a free catch-up program for 71 to 79 year olds until the end of 2021. The shingles vaccine is available on prescription for people aged 50 to 69 years and from 80 years  but it must be paid for by the patient. Vaccination is still recommended for people who have had shingles infection in the past. It is recommended to wait at least a year after recovery.

The C.D.C. reasons that if a person gets vaccinated in his 50s, the vaccine may provide peak protection at a time when shingles is less likely to occur, since the risk of shingles increases with age. Therefore, with a booster vaccine not yet approved, it may be better to wait.

There is no known cure for shingles. The virus runs its course and usually disappears after two to three weeks. However, evidence suggests that certain treatments in the first three days after appearance of the virus can significantly reduce the duration and complications involved.

Sometimes, however, the infection can manifest in a way that causes some initial confusion. The pains that go along with shingles can be intense and can even be mistaken for a heart attack or backache.

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