Shingles can be extremely painful. While there is no cure, early treatment can speed recovery, and getting vaccinated can reduce the risk of having shingles or lessen the length and severity of illness if you do get it.
What’s causing the enthusiasm: Shingrix, which the pharmaceutical firm GlaxoSmithKline intends to begin shipping this month. Large international trials have shown that the vaccine prevents more than 90 percent of shingles cases, even at older ages.
The most important complication of shingles is post-herpetic neuralgia (PHN).This is chronic nerve pain over the affected site that persists for at least 3months after the rash resolves. The pain may however last indefinitely and can severely impact on quality of life. PHN is more common if shingles occurs after the age of 50 years.
According to the U.S. Centers for Disease Control and Prevention (CDC), about 20 percent of people with shingles develop a rash that crosses multiple dermatomes. Dermatomes are separate skin areas that are supplied by separate spinal nerves.
“But, with time and as one gets older, there is a decline in natural immunity and the virus can flair up again, presenting as shingles,” Glass said. Consequently, the risk of shingles increases as one gets older and the likelihood of persistent pain increases dramatically after the age of 50.
The shingles vaccine has not been shown to cause any serious side effects or health consequences. Minor side effects of the vaccine include redness, swelling, soreness, or itching at the site of injection, and headache. It is safe for those who have received the shingles vaccine to be around babies or those with weakened immune systems. It has not been shown that a person can develop chickenpox from getting the shingles vaccine, although some people who receive the vaccine may develop a mild chickenpox-like rash near the injection site. This rash should be kept covered and will disappear on its own.
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.
At first, it consists of small red raised spots. The spots then turn into small blisters filled with a cloudy fluid. These blisters dry up after five to seven days and gradually form scabs. The scabs drop off within two to three weeks but it can take longer for the skin to totally heal.
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.
Department of Health and Ageing (DOHA). The Australian Immunisation Handbook. 9th ed. [online] Canberra, ACT: Commonwealth of Australia. 2008 [Last updated Sept 2010, accessed 12 Jul 2011] Available from: http://www.health.gov.au
Common symptoms experienced with shingles include flu-like symptoms such as chills, fever, and fatigue, along with abdominal and back pain when those skin dermatomes are involved. In some cases when the virus has affected the facial area, people can experience loss of eye motion, drooping eyelids, taste problems, facial pain, headache, and hearing loss.
If an antidepressant or anticonvulsant is advised, you should take it regularly as prescribed. It may take up to two or more weeks for it to become fully effective to ease pain. In addition to easing pain during an episode of shingles, they may also help to prevent PHN. See separate leaflet called Postherpetic Neuralgia for more information.
The causative agent for shingles is the varicella zoster virus (VZV) – a double-stranded DNA virus related to the Herpes simplex virus. Most individuals are infected with this virus as children which causes an episode of chickenpox. The immune system eventually eliminates the virus from most locations, but it remains dormant (or latent) in the ganglia adjacent to the spinal cord (called the dorsal root ganglion) or the trigeminal ganglion in the base of the skull.
Localized pain is a typical symptom of shingles, which sometimes even precedes the onset of the rash. Like the tingling and tickling, the rash-prone area may begin to be painful – either a dull throbbing ache or sharp, shooting pains may occur, primarily affecting the surface of the skin. Once the rash begins to appear, this pain only intensifies with patients often complaining that their skin feels like it’s being constantly pricked by needles. This severe and constant pain subsides as the rash heals, but some residual low-intensity aches may be felt for a while.
having a history of a disease that affects the immune system, including neoplastic disorders, cancer, leukemia, lymphoma, an autoimmune disorder, HIV or herpes simplex virus. (6) Having received an organ transplant also increases the risk
Zostavax®, the shingles vaccine, reduced the risk of shingles by 51% and the risk of post-herpetic neuralgia by 67% based on a large study of more than 38,000 adults aged 60 years or older. Protection from shingles vaccine lasts about 5 years.
According for the Centers for Disease Control and Prevention, shingles is not contagious, but the virus that causes shingles can be spread through skin-to-skin contact if a rash is present. An individual may develop chickenpox after physical contact with a person affected by the shingles rash.
It’s perfectly safe for you to be around friends and family members — even children — after getting the vaccine. Rarely, people develop a chickenpox-like rash on their skin after they’ve been vaccinated. If you get this rash, you’ll want to cover it. Make sure any babies, young children, or people who are immunocompromised and haven’t been vaccinated against chickenpox don’t touch the rash.
Though the clinical studies included a large number of participants, she noted that participation rates among ethnic minorities were “quite low.” Different population groups, then, might have bad reactions to the vaccine not yet seen by the scientists, she said.
While there is no cure for shingles, antiviral medications can put the brakes on an attack. Prompt treatment can make a case of shingles shorter and milder, while cutting in half the risk of developing postherpetic neuralgia. Doctors recommend starting prescription antiviral drugs at the first sign of a shingles rash. Options include acyclovir, valacyclovir, or famcyclovir.
The doctor may decide to do tests to confirm that a patient has shingles. However, these tests listed below are not always necessary, as a presumptive diagnosis based on clinical findings is often definitive enough for diagnosing shingles.
Can you get shingles more than once? The vast majority of people only get shingles one time in their lives and never again, since the immune system develops resistance against the virus as it heals. That being said, a small percentage (less than 10 percent) experience shingles two to three times.
Transmission only occurs through direct contact with blisters, and it can cause chickenpox in someone who has never been infected with the virus. During the time before blisters appear and after crusting, there is no risk of viral transmission.
To prevent shingles, adults who are 60 years old and older should receive the shingles vaccine. To relieve pain, you can apply a cool washcloth to the blisters. Keep the rash covered as much as possible to avoiding spreading the varicella virus to others. Ask your doctor if you’re a candidate for anti-viral medications, which can reduce the length and intensity of the virus. You doctor can also prescribe pain medications if necessary.
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.
ACIP recommends routine vaccination of people 50 years and older with recombinant zoster vaccine (RZV). For vaccination providers who choose to use ZVL for persons 50 through 59 years of age despite the absence of an ACIP recommendation, factors that might be considered include particularly poor anticipated tolerance of herpes zoster or postherpetic neuralgia symptoms (for example, attributable to preexisting chronic pain, severe depression, or other comorbid conditions; or inability to tolerate treatment medications because of hypersensitivity or interactions with other chronic medications). More information on this issue is available at www.cdc.gov/mmwr/pdf/wk/mm6044.pdf, page 1528.
The CDC also recommend that children, teens, and adults receive the chickenpox shot in two doses. Although there is a very small chance the being infected with Varicella zoster virus despite vaccination, the CDC report that the vaccination may allow for milder chickenpox symptoms if this happens.
Registered nurse Shannon Haskell administers H1N1 vaccination to an elderly woman in Lakefield, Ont., in 2009. Advocates for seniors are calling for a new vaccine to protect against shingles that will be available across Canada in mid-January to be provided for free. (Fred Thornhill/Reuters)
We weren’t familiar with the recommendations and tested a 50-year-old for varicella antibody because she said she never had chickenpox. Her result was negative. Should this patient receive zoster vaccine or varicella vaccine?
Shingles is an extraordinarily painful condition that involves inflammation of sensory nerves. It causes numbness, itching or pain followed by the appearance of clusters of little blisters in a strip pattern on one side of the body. The pain can persist for weeks, months or years after the rash heals and is then known as post-herpetic neuralgia.
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.
Influenza (the flu) is caused by a virus. The flu is more than just a bad cold and can occasionally lead to serious complications, including death. Specific antiviral medication is available. It is…
To avoid chicken pox, the Centers for Disease Control and Prevention (CDC) recommends two doses of the chicken-pox vaccine — which is 98% effective — for kids, adolescents and adults who have not had chicken pox. Adults who have not had the disease and may be in close contact with young children who are likely to be infected should consider getting vaccinated. Children should receive the first dose when they are between 12 months old and 15 months old, and a second dose when they are 4 years old to 6 years old. The U.S. started chicken-pox immunizations in 1995, so Walters would not have been vaccinated as a child.
“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.”