Shingles

WHAT IS SHINGLES

Shingles is caused by the varicella-zoster virus, which also causes chickenpox. If you had chickenpox as a kid (or adult for that matter), you have the virus. The CDC says 99% of Americans 40 and older had chickenpox – even if they don’t remember it.

Once a person has had chickenpox, the virus lies inactive in nerve tissue. Years later, it may reactivate as shingles (herpes zoster). The Center for Disease Control (CDC) estimates that about one million cases are diagnosed in the United States each year.

As a person’s immunity begins to decline with age, the shingles virus is more and more likely to activate. It’s not a once-in-a-lifetime kind of thing: you can have shingles multiple times.

In a typical shingles case, the skin becomes red, blistered and painful. The rash occurs in a band-like area, usually a region involving a particular affected nerve. Clusters of small bumps become fluid-filled blisters, which later drain and form crusted scabs. The blistering rash is usually limited to a small area on one side of the body, often on the face or torso, but it can also produce typical virus symptoms: chills, fever, upset stomach or headache. In severe cases, the weight of clothing or a passing breeze can cause agony.

If you have shingles, you should get to a doctor to receive anti-viral medicine as soon as possible.

WHAT ARE THE COMPLICATIONS OF SHINGLES

Aside from the pain and discomfort of ordinary shingles, the virus is all too often accompanied by postherpetic neuralgia (PHN), a long-lasting, intense set of symptoms. Manifesting as persistent pain after the shingles rash heals; PHN can last for months or even years. In rare cases, PHN can cause disability and suffering for the rest of the patient’s life.

Studies of pain severity have shown that the long-term pain of PHN exceeds pain scores for childbirth, musculoskeletal pain, osteoarthritis, and chronic cancer pain.

Possible complications of shingles include:

• Body systems that can be affected include the eyes, nervous system, lungs, liver, and brain.
• Vision loss. Shingles in or around an eye (ophthalmic shingles) can cause painful eye infections that may result in vision loss.
• Postherpetic neuralgia. For some people, shingles pain continues long after the blisters have cleared.
• Neurological problems.
• Skin infections.

When shingles affects internal organs, it’s a serious complication that requires urgent medical attention. Internal shingles symptoms include:

• persistent pain
• fever
• cough
• abdominal pain
• headache

WHAT TO DO IF YOU HAVE SHINGLES

Antiviral drugs (medications used to combat viral infections) are used against the varicella zoster virus. These medications help shorten the course of the illness, decrease its severity, and hasten healing of the skin lesions. They may also help prevent the potential complications sometimes encountered with shingles.

Antiviral medications are most effective when started within 72 hours of the first appearance of the rash. However, in select cases of shingles (e.g., in an immunocompromised person), it can be started after 72 hours.

There are several antiviral medications that can be used, including:

• acyclovir (Zovirax)
• famciclovir (Famvir)
• valacyclovir (Valtrex)

In certain situations, intravenous (IV) antiviral medication may need to be administered.

PREVENTING SHINGLES

Given the pain and discomfort of shingles symptoms, as well as the potential complications, preventive treatment is the best way to go. For years, “preventive treatment” meant taking Zostavax, which had a very modest success rate (around 50%) and a typical effectiveness of three years, though by the second and third years the effectiveness was even lower than in the first year.

In October of 2017, CDC approved Shingrix. It takes two injection doses, at least two months apart and the success rate is 99%+. Downsides? There is some redness and swelling for a day or two. Some patients report some initial pain at the injection site.

WHO SHOULDN’T TAKE SHINGREX

There is a short list of people who shouldn’t use Shingrix:

• Pregnant women
• Immunocompromised individuals
• Some HIV patients (depends on white blood cell count)

If you think you might fall into one of these groups, you should check with your medical care provider before beginning a Shingrix regimen.

WHAT IF I’VE ALREADY BEEN VACCINATED WITH THE OLDER VACCINE, ZOSTAVAX

The CDC is very clear about this: even if you have recently taken Zostavax, the benefits of Shingrix are so superior that they recommend you take Shingrix.

CONCLUSION

Shingrix is a major advancement in the prevention of shingles. Since it is covered under Preventive Care Services by the Health Plan, this is definitely a vaccination worth checking into.