Federal officials have recommended a vaccine against shingles that is more effective than an earlier version at protecting older adults from the painful rash. But persuading many adults to get this and other recommended shots continues to be an uphill battle, health providers say.
Another important risk factor is immunosuppression. Other risk factors include psychological stress. According to a study in North Carolina, “black subjects were significantly less likely to develop zoster than were white subjects.” It is unclear whether the risk is different by gender. Other potential risk factors include mechanical trauma and exposure to immunotoxins.
Shingles cannot be passed from one person to another. However, the virus that causes shingles, the varicella zoster virus, can spread from a person with active shingles to cause chickenpox in someone who had never had chickenpox or received chickenpox vaccine.
Tests showed that the vaccine significantly reduced the incidence of shingles in older adults. The single-dose vaccine was shown to be more than 60% effective in reducing shingles symptoms, and it also reduced the incidence of post-herpetic neuralgia (PHN) by at least two-thirds. Even if you have had shingles, you can still have the vaccine to help prevent future outbreaks.
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.
^ 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.
Shingles may lead to stroke and heart attack The herpes zoster virus causes chickenpox and shingles; following shingles, there appears to be a higher risk of acute cardiovascular events such as stroke or myocardial infarction Read now
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.
Most people do not get side-effects from the vaccine but you may get a red, sore or itchy area around the injection site. Some people may feel some other side-effects, such as a temperature, aches and pains, a rash or headache. Other side-effects are rare.
^ Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS (2007). “A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction”. Mayo Clin. Proc. 82 (11): 1341–49. doi:10.4065/82.11.1341. PMID 17976353.
In most cases after one to two days, but sometimes as long as three weeks, the initial phase is followed by the appearance of the characteristic skin rash. The pain and rash most commonly occurs on the torso, but can appear on the face, eyes or other parts of the body. At first the rash appears similar to the first appearance of hives; however, unlike hives, shingles causes skin changes limited to a dermatome, normally resulting in a stripe or belt-like pattern that is limited to one side of the body and does not cross the midline. Zoster sine herpete (“zoster without herpes”) describes a person who has all of the symptoms of shingles except this characteristic rash.
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.
WASHINGTON — In an unusually close vote, an advisory panel to the Centers for Disease Control and Prevention on Wednesday recommended the use of a new vaccine to prevent shingles over an older one that was considered less effective.
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha’s educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
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.
Shingles can affect the skin around your eyes (ophthalmic zoster). This can give you red and streaming eyes (conjunctivitis) and may damage your eyes or affect your vision. If you have shingles around your eyes you may need to see an ophthalmologist (a who specialises in eye conditions).
Once a person has had chickenpox, the virus lies inactive in nerve tissue. Years later, it may reactivate as shingles. The C.D.C. estimates that about one million cases are diagnosed in the United States each year.
The family name of all the herpesviridae derives from the Greek word herpein (“to creep”), referring to the latent, recurring infections typical of this group of viruses. Zoster comes from Greek zōstēr, meaning “belt” or “girdle”, after the characteristic belt-like dermatomal rash. The common name for the disease, shingles, derives from the Latin cingulus, a variant of Latin cingulum meaning “girdle”.
Because herpes zoster can only occur in people who have already had chickenpox, neither of the shingles vaccines is intended to prevent the initial viral infection. They are, instead, intended to stimulate the immune system to resist the reactivation of existing virus. This reactivation triggers the symptoms of the disease, which include local burning, itching and rash. In addition, they help to prevent the most concerning sequela of shingles which is persistent, often severe, pain in the site of the reactivation. Neither vaccine provides herd immunity since adults with shingles almost never pass this virus along to others.
Wearing loose clothing can help avoid extra pain from clothing rubbing against the rash. Avoid close skin-to-skin contact with others who have not had chickenpox, are ill, or who have a weakened immune system to avoid spread of the virus.
Shingles, which is also referred to as herpes zoster, is characterized by a blistering skin rash that occurs on one side of the body. People above the age of 50, or those with a weak immune system are more likely to get affected by this condition. For this reason, people who are taking immunosuppressant drugs for the treatment of a chronic illness are vulnerable.
CDC still recommends Zostavax® for healthy adults 60 years and older to prevent shingles. This shingles vaccine may be used in certain cases, such as when a person prefers Zostavax or is allergic to Shingrix. You can learn more about Zostavax.
^ a b c d e f g h i j k l m n o p q r s t u v w Hamborsky J (2015). Epidemiology and Prevention of Vaccine-Preventable Diseases (PDF) (13 ed.). Washington D.C. Public Health Foundation. pp. 353–74. Archived (PDF) from the original on 2017-01-20.
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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.
^ 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.
During their lifetime about 30% of Americans will develop herpes zoster, which translates into an estimated 1 million cases each year in this country. The risk of zoster increases with increasing age; about half of all cases occur among people age 60 years or older. People who are immunosuppressed, as occurs with leukemia, lymphoma, and human immunodeficiency virus (HIV) infection, and people who receive immunosuppressive drugs, such as steroids and cancer chemotherapy are also at greater risk of zoster. People who develop zoster typically have only one episode in their lifetime. In rare cases a person can have a second or third episode.
^ Weller TH (1953). “Serial propagation in vitro of agents producing inclusion bodies derived from varicella and herpes zoster”. Proc. Soc. Exp. Biol. Med. 83 (2): 340–46. doi:10.3181/00379727-83-20354. PMID 13064265.
The vaccine is recommended for most adults 60 years and older, even those who have already had shingles because it can ward off a repeat occurrence. It is not recommended for people with allergies to certain vaccine ingredients, those with weakened immune systems and women who are pregnant or planning to get pregnant. And it is not a treatment for people with active shingles.
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.