Avoiding Shingles

Most viruses attack and then go away. Not so, the varicella (herpes) viruses, one of which is varicella zoster, the bug that causes chickenpox. Before 1995, when the varicella vaccine came out, chickenpox was a way of life, and almost everyone got it. Most of us suffered through it and got on with our lives. But the sneaky varicella burrows into nerve cells and becomes dormant. Years later, usually after age 60, some change in the body can allow it to re-emerge, this time in the form of shingles.

    While shingles is not contagious, it can be a real pain. Dr. Sarah George, assistant professor of infectious diseases at Saint Louis University School of Medicine, explains how it works: “As we get older, our immune system becomes weaker, and a dormant virus in a nerve reactivates and spreads out along that nerve,” she says. “It can be anywhere in the body. It might be a nerve that wraps across the chest, the abdomen, face, eye, arm or leg. We think some of the triggers include high stress, a major illness, surgery, steroids or other drugs that depress immunity.”

    According to the CDC, shingles develops in stages. A prodromal stage that may last several days or weeks before the rash appears can include numbness and tingling in the area around the affected nerves, sharp pains or burning, even flu-like symptoms and lymph node swelling. The time to treat is when the rash appears, advises George. “During rash eruption, the virus expresses an enzyme. The antiviral medications target that enzyme and can shorten the outbreak, decreasing the number of blisters, and decreasing pain down the road,” she says. “To be effective, the antiviral medication should be started within 24 hours of rash appearance.”

    If you’ve already had shingles and are in generally good health, she says, you probably won’t get shingles again. If you haven’t and are at least 60 years old, you should get the vaccine. It’s safe and effective, and as far as we know, one dose is enough. “We know it protects for seven to 10 years because of tests and patients being followed from clinical trials,” George notes. “Shingles vaccine reduces the risk of shingles by an average of 50 percent, but even in those who still get shingles, the case is much milder; and much less likely to result in a long-term side effect called post herpetic neuralgia (PHN), lingering pain in the area long after the rash is gone.”

    Dr. Lawrence Gelb, professor of medicine in the Division of Infectious Diseases at Washington University, has worked on both chickenpox and Zostavax (shingles) vaccines available to the general public in 2006.  “What we have found is that the earlier you get the vaccine, in your early sixties, the more effective it is,” he says. “People 60 to 65 who received it had a 64 percent reduction in shingles. By the time you get to your early eighties, it’s only 20 percent effective in preventing the outbreak, but again, its big value is in causing a milder case, and its ability to decrease significantly the incidence of PHN.”

    Gelb says Zostavax represents a totally new concept in vaccines. Most vaccines prevent a new disease. The shingles vaccine prevents a recurrence of something you already have. The only downside, he says, is cost. It’s covered under the Part D drug coverage with Medicare, but its $175 purchase price can jump to $300 when cost of administration is considered. All in all, he thinks it’s a good investment. If you know anyone who has had shingles, you will probably agree.