HCA Virginia Physicians November 13, 2017

by Richard Peebles, MD

Shingles, also known as herpes zoster, is an infection caused by the same virus that causes chickenpox—the varicella-zoster virus. Even decades after you recover from chickenpox, inactive copies of the varicella-zoster virus live within your nerves. If these viruses become reactivated, then you develop shingles. About 20% of people who had chickenpox will develop shingles.  Most people only have a single episode of shingles, but if you have a weakened immune system you can have more than one episode. Contact with a person who has shingles could lead to chickenpox in someone who has never had chickenpox and has not received the varicella vaccine.

The Shingles Prevention Study conducted by The Centers for Disease Control (CDC) found receiving the shingles vaccine significantly reduced the incidence of the disease in those aged 60 and older. 1In October 2017, the U.S. Food and Drug Administration (FDA) licensed a new shingles vaccine called Shingrix®.

Herpes Zoster Blisters

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Symptoms

Shingles usually begins with an unpleasant itching, burning, tingling, or painful sensation in a band-like area. A skin rash of fluid-filled bumps begins to appear 3-4 days after you notice these skin sensations.

Early symptoms may include:

  • Fever
  • Muscle aches
  • Fatigue
  • Anxiety, nervousness
  • Discomfort in the skin, usually on one side of the face, torso, trunk, back, or buttocks. The discomfort may feel like:
    • Numbness
    • Itching
    • Burning
    • Stinging
    • Tingling
    • Shooting pain
    • Electric shock
    • Sharp pain
    • Extremely sensitive to even light touch

The period of active shingles begins when you first notice a rash in the same location where you felt the skin sensations:

  • The rash begins as a reddish band or individual bumps in a line.
  • The bumps develop fluid-filled centers.
  • Over the course of 7-10 days, the bumps begin to dry and crust over.
  • You may continue to have pain and/or itching in the area of the rash; the pain may be severe.
  • If the rash develops on the side of your nose or elsewhere on your face, you should contact your doctor right away. This can signal that your eye is affected.

It takes about five weeks to recover from shingles, although about 20% of people continue to have pain and discomfort after the rash has healed. This syndrome of pain in the area of the previously infected nerve is called postherpetic neuralgia. In some cases, it is severe and debilitating.

Treatment

While there are no treatments to cure shingles, there are treatment goals, like:

  • Shortening the length of the illness.
  • Preventing complications, such as postherpetic neuralgia.
  • Relieving pain and discomfort.
  • Preventing the rash from becoming infected.

The best course of action is to proactively receive a vaccination that will help prevent you from getting the shingles virus at all.

Shingles Vaccination

In October 2017, the FDA approved a new shingles vaccine called Shingrix® for adults aged 50 years and older. Because the risk of contracting shingles increases as you get older, the Centers for Disease Control and Prevention (CDC) recommend that people 60 years old and older get a shingles vaccine. The vaccine is given in one dose as a shot, and can be given in a doctor’s office or pharmacy. It is effective for up to five years.

Who Should Get Shingles Vaccine?

Older adults should get the vaccine whether or not they recall having had chickenpox, which is caused by the same virus as shingles. The CDC reports that “more than 99% of Americans aged 40 and older have had chickenpox, even if they do not remember getting the disease. There is no maximum age for getting shingles vaccine.”

While the CDC does not have a recommendation for regular use of the shingles vaccine in people 50 to 59 years old, adults in that age range should discuss the risks and benefits of receiving the vaccine with their doctor. Those who have had shingles in the past also can get the vaccine to help prevent it from reoccurring.

Who Should Not Get Shingles Vaccine?

There are some people should not get shingles vaccine, including:

  • A person who has had a life-threatening or severe allergic reaction to gelatin, the antibiotic neomycin, or any other component of the shingles vaccine. Tell your doctor if you have any severe allergies.
  • A person who has a weakened immune system because of:
    • HIV/AIDS or another disease that affects the immune system.
    • Treatment with drugs that affect the immune system, such as steroids.
    • Cancer treatments like radiation or chemotherapy.
    • Cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma.
  • Women who are or might be pregnant. Women should not become pregnant until at least 4 weeks after getting the shingles vaccine.

Someone with a minor illness, such as a cold, may be vaccinated, but those with a moderate or severe acute illness should wait until they recover. This includes anyone with a temperature of 101.3°F or higher.

Side Effects

While any vaccine could trigger an allergic reaction, the risk of serious side effects from the shingles vaccine is extremely small. Some mild side effects may be:

  • Redness, soreness, swelling, or itching at the site of the injection (about 1 person in 3).
  • Headache (about 1 person in 70).

Some who receive the vaccine may develop a chickenpox-like rash near the place where they were vaccinated. As a precaution, this rash should be covered until it disappears.

Signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and weakness. These would start a few minutes to a few hours after the vaccination. If you have a severe allergic reaction, call 9-1-1 for emergency assistance.

After getting the shingles vaccination, it is safe to be around infants and young children, pregnant women, or people with weakened immune systems. The CDC states that, “There is no documentation of a person getting chickenpox from someone who has received the shingles vaccine (which contains varicella zoster virus).” In addition, the shingles vaccine does not contain thimerosal, a preservative containing mercury.

As those at the CDC say, “Don’t wait, vaccinate!”

Source:
1Centers for Disease Control and Prevention: www.cdc.gov/vaccines

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