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.
Anyone who has recovered from chickenpox may develop shingles, including children. But the risk increases as people age. It is most common in those 50 and older. The risk of getting shingles increases as a person gets older. People who have medical conditions that keep the immune system from working properly, like cancer, leukemia, lymphoma, and human immunodeficiency virus (HIV), or people who receive drugs that suppress the immune system, such as steroids and drugs given after organ transplantation, are also at greater risk.
Shingles is caused by the same varicella-zoster virus that causes chickenpox. The virus can re-emerge decades after a recovery from chickenpox, often causing a painful rash that may burn or itch for weeks before it subsides.
Shingles is caused by the re-activation of the varicella zoster herpes virus, which is also the virus that causes chickenpox. Once you have had chickenpox the virus remains dormant in your body within a single sensory nerve. It can become active again at any time but particularly when your immunity is low. Your immunity or ability to fight infection may be lowered by several things including old age, stress, illness, injury, chemotherapy, HIV/AIDS or after organ transplantation.
Shingles, or herpes zoster, is a viral infection caused by the chickenpox virus. Symptoms include pain and a rash on one side of the body. Shingles most commonly affects older adults and people with weak immune systems.
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.
Very rarely, shingles can lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis), or death. For about one person in five, severe pain can continue even after the rash clears up. As people get older, they are more likely to develop this pain, and it is more likely to be severe.
For our “Mother’s Day Out” program, one of the teachers has shingles. The program serves moms of 2-month-olds to 4-year-olds. All children are up to date with their vaccinations, but some are too young to have received varicella vaccine. Is it safe for the teacher to work?
Unless the immune system is compromised, it suppresses reactivation of the virus and prevents shingles outbreaks. Why this suppression sometimes fails is poorly understood, but shingles is more likely to occur in people whose immune systems are impaired due to aging, immunosuppressive therapy, psychological stress, or other factors. Upon reactivation, the virus replicates in neuronal cell bodies, and virions are shed from the cells and carried down the axons to the area of skin innervated by that ganglion. In the skin, the virus causes local inflammation and blistering. The short- and long-term pain caused by shingles outbreaks originates from inflammation of affected nerves due to the widespread growth of the virus in those areas.
The condition generally clears up within a few weeks. But some people who have had shingles go on to develop what’s known as post-herpetic neuralgia, in which nerve pain persists for months and sometimes years. The risk of developing post-herpetic neuralgia rises with age.
The varicella vaccine (Varivax) has become a routine childhood immunization to prevent chickenpox. The vaccine is also recommended for adults who’ve never had chickenpox. Though the vaccine doesn’t guarantee you won’t get chickenpox or shingles, it can reduce your chances of complications and reduce the severity of the disease.
There are several effective treatments for shingles. Drugs that fight viruses (antivirals), such as acyclovir (Zovirax), valacyclovir (Valtrex), or famciclovir (Famvir), can reduce the severity and duration of the rash if started early (within 72 hours of the appearance of the rash). In addition to antiviral medications, pain medications may be needed for symptom control. Both nonsteroidal anti-inflammatory medications and narcotic pain-control medications may be used for pain management in 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.
Where slates are particularly heavy, the roof may begin to split apart along the roof line. This usually follows rot developing and weakening the internal timbers, often as a result of poor ventilation within the roofspace. An important aspect to slate roofs is the use of a metal flashing which will last as long as the slates. Slate shingles may be cut in a variety of decorative patterns and are available in several colors.
What is shingles? Is shingles contagious? What does shingles look like? Take the Shingles (Herpes Zoster) Quiz featuring pictures, quick facts, symptoms, treatments, and causes of this itchy, painful rash.
Postherpetic neuralgia (PHN) may require additional medications such as opioids (for example, oxycodone, morphine) to control pain. PHN is the pain that remains in some people even after the rash goes away. Some patients do not respond to common pain-management therapies and may need to be referred to a pain-management specialist. Drugs usually prescribed for seizures and other nerve-related problems, gabapentin and pregabalin, have been effective in reducing pain in some patients with shingles, including those with PHN.
Although shingles (also sometimes called herpes zoster) is caused by carrying a virus, certain risk factors make people more susceptible to its effects. Having the virus alone doesn’t guarantee that shingles will develop, and even if it does, certain preventative measures can help keep it from returning once it’s cleared up.
Herpes zoster virus causes shingles. No one knows for sure what causes the chickenpox virus to become reactivated to cause shingles. Some investigators suggest that the following conditions may participate in virus reactivation, since they have been associated with a higher incidence of shingles. This is a list of only some of the major conditions that may trigger reactivation but have as yet not been proven to do so:
The virus very seldom becomes reactivated in more than one nerve at a time. Only in severe cases of weakened immune systems will the rash spread to other areas of the skin, sometimes across the midline like a real girdle or even to internal organs like the liver and lungs.
Pregnant women can get shingles, but it is rare. While chickenpox can pose a very serious risk to a fetus, there is almost no risk to the fetus if the mother gets shingles. symptoms of shingles are the same in pregnant and non-pregnant women. Any area of skin that has pain, tingling, itching or burning — even without a rash or blister — should be brought to the attention of a doctor, as this could be the early stages of shingles.
One in three people will develop shingles in their lives. Shingles occurs in people who have previously had chickenpox –the virus that causes chickenpox (varicella zoster virus) remains in the body after recovery and may be reactivated years later. The risk of shingles increases with age. The illness usually presents with a painful, blistered rash along one side of the body. Commonly affected areas are the trunk, the face, and the neck. Many people with shingles experience post-herpetic neuralgia, a painful nerve condition, after the blisters disappear.
Varicella is much more likely to affect external skin than moist mucous membranes inside the mouth or vagina. Ulcers or sores on the vagina are more often due to HSV-1 or HSV-2 (herpes infections). Taking a viral culture from the site of a fresh ulcer is the only way to know for sure, though.
The nerve pain of shingles can linger, lasting for weeks or even months in some cases. Generally, shingles pain is more persistent and longer-lasting in older adults. Younger people usually show no signs of the disease once the blisters have cleared up.
^ Hicks LD, Cook-Norris RH, Mendoza N, Madkan V, Arora A, Tyring SK (May 2008). “Family history as a risk factor for herpes zoster: a case-control study”. Arch. Dermatol. 144 (5): 603–08. doi:10.1001/archderm.144.5.603. PMID 18490586.
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.
Classic textbook descriptions state that VZV reactivation in the CNS is restricted to immunocompromised individuals and the elderly, however, recent studies have found that most patients are immunocompetent, and less than 60 years old. Old references cite vesicular rash as a characteristic finding, however, recent studies have found that rash is only present in 45% of cases. In addition, systemic inflammation is not as reliable an indicator as previously thought: the mean level of C-reactive protein and mean white blood cell count are within the normal range in patients with VZV meningitis. MRI and CT scans are usually normal in cases of VZV reactivation in the CNS. CSF pleocytosis, previously thought to be a strong indicator of VZV encephalitis, was absent in half of a group of patients diagnosed with VZV encephalitis by PCR.
It’s not possible to transmit shingles to someone. However, if you’ve never had chickenpox or the chickenpox vaccine, it’s possible to get chickenpox from someone with shingles through direct contact with active blisters. The same virus causes both shingles and chickenpox.
Shingles occurs when the virus that causes chickenpox starts up again in the body after it’s been dormant and undetectable. After a child or adult has chickenpox, that person immediately become a carrier. This means that person won’t experience chickenpox again but will carry a dormant version of the virus that hides out on nerve roots within the body or on the non-neuronal satellite cells located in the cranial nerve, dorsal nerve and autonomic ganglia. (5)
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.
EvaluatePharma, which derives its forecasts by averaging the estimates of a number of stock market analysts, predicts U.S. sales of Shingrix could reach $583 million by 2022, and should outstrip Zostavax’s U.S. sales in 2020. It projects that domestic sales of Zostavax will drop by nearly 31 percent by 2022, falling to $337 million from $491 million this year.
The reactivation of the dormant varicella zoster virus depends a lot on how strong someone’s immune system is. The more impaired immunity becomes (which often happens as someone becomes older), the likelier people are to develop shingles if they carry the virus.