The Shingles Story

Shingles is like Act II of the play “Chicken Pox.” You can’t get shingles unless you have had chicken pox. Both diseases are caused by the same virus, varicella zoster.  The first time around it causes chicken pox. When it reemerges, it causes shingles. After chicken pox occurs, the virus doesn’t disappear, but rather hides in nerve cells, perhaps forever or until it is reactivated. The mechanism by which this occurs is not totally clear. Stressors thought to contribute to the emergence of shingles include injury, infection, immune system deficiency (which naturally occurs as people age) and/or emotional distress.  Whatever the cause, when it does resurface, it results in shingles.

 Shingles is a very painful disease.  It can be so painful that the slightest touch can be excruciating. Shingles generally causes a rash that may last for several weeks. The classic rash appears as a red band on one side of the torso. The first sign of shingles may be excessive skin sensitivity in an area on one side of the body usually under the ribs, face (especially the eyes and nose), head, neck or waist with or without a rash.  This sensitivity then becomes painful and may burn, itch, or ache.  After a few days, this rash will develop small white blisters, usually linear in shape.  The blisters may have small red circles around them.  Over time (about 2-3 weeks, similar to chicken pox) the blisters scab over. 

Unfortunately for some, the pain that accompanies this rash can drag on for months or even years. This lasting pain is called postherpetic neuralgia, which occurs in 10-20% of cases.  There are some treatments that can be tried, such as small doses of antidepressants, antiseizure medications and some topical creams. However about 40-50% of persons do not respond to any treatment.

 There are three important things to understand about the relationship between chicken pox and shingles:

• You can’t get shingles unless you have had chicken pox. Essentially, you get shingles from your own chicken pox virus awakened by some stressor on your body.  
• It is highly unlikely that you can get shingles from other persons with shingles. (Although it may be possible, though extremely rare, if you are exposed to the fluid of the blisters of a person with shingles.)
• You do not get shingles from persons with chicken pox, but you can get chicken pox from person with shingles, if you have never had natural chicken pox or the chicken pox vaccine.

 If you suspect that you have shingles, you should see your healthcare provider right away, as there are some medications (antivirals) that can be effective if taken within the first 48 to 72 hours.  Over the counter pain relievers may help.  Sometimes people need prescription pain relievers to obtain comfort.

The Shingles Vaccine There is a vaccine available that can reduce the risk of shingles. It is for use in persons 60 and older. In a large study, this vaccine was shown to prevent shingles in about half of the participants. Those who still got shingles even though they were vaccinated had a less severe case. The immunization was also shown to cut by two-thirds the risk of developing postherpetic neuralgia if you do get shingles. Research has shown that it is most effective when given between age 60 and 69. Immunity lasts for at least 6 years and perhaps longer. Some people should NOT get shingles vaccine: A person who has ever had a life-threatening or severe allergic reaction to gelatin, the antibiotic neomycin, or any other component of 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 treatment such as radiation or chemotherapy, cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma; or women who are or might be pregnant

Not all health care providers will have this vaccine available at their office as it requires being kept frozen. However, many pharmacies carry this vaccine. Because you can get shingles more than once, the Advisory Committee on Immunization Practices (ACIP) recommends that you should get this immunization even if you have had shingles in the past. You can call your insurance company to see if they will cover the shot. It is covered under Medicare Part D, but it is listed as a pharmacy benefit. (There are legislative efforts to get it covered under Medicare part B but they have not been successful yet.)Your provider may be willing to write a prescription for you to get it from a pharmacy and bring it to the office for administration, but that will require that it be transported correctly. Even if you can’t get insurance coverage, it may be worth spending the money to prevent contracting shingles.   

For a packet of written information on shingles and some suggestions on where within the District you can get the shingles shot if your doctor does not have it, call QVHD, 248-4528 or request online at www.qvhd.org