If you have ever cared for a patient with shingles, you probably hope you never have the shingles experience- intense itching and pain. Unfortunately, according to the Center for Disease Control (CDC), 1 in 3 people in the United States will be diagnosed with shingles. This is a surprising 1 million cases diagnosed each year. Shingles, also known as herpes zoster, is caused by the varicella zoster virus- the same virus that causes chickenpox. Those at greater risk for shingles include the following individuals:
With medical conditions that weaken the immune system
Receiving immunosuppressive medications
Over the age of 50
Recent illness or trauma
Despite the high rate of occurrence, there are still common myths and misconceptions associated with shingles. Do you still believe any of these myths?
It is all about the rash.
Fact: The shingles rash is usually a group of small blisters that eventually dry and scab over in about a month. This itchy rash is one of the tell-tale characteristics of shingles but pain often causes the most discomfort. The pain can be severe and may occur as early as 2 to 4 days before the rash. Unfortunately, the nerve pain caused by shingles can also continue long after the rash disappears.
Shingles only occur on one side of the back.
Fact: It is true shingles often occur on one side of the body, is linear and follows a nerve pathway (dermatome). However, shingles can occur anywhere on the body, including eyes and ears. Approximately 2% of cases are disseminated (shingles on both sides of the body) and occur along multiple dermatomes.
Only older adults get shingles.
Fact: It is true that as you age, your risk of shingles increases and about 50% of shingle cases are in the over 60 age group. However, shingles can occur in anyone at any age. Individuals with compromised immune systems, due to illness, medications, trauma or stress, are at greater risk.
Shingles and Chickenpox are the same disease.
Fact: Shingles is caused by varicella zoster- the same virus that causes chickenpox. However, shingles and chickenpox are not the same illness. Here are key differences:
Chickenpox is milder and usually affects children under 10 years of age
Once you have chickenpox, the varicella zoster virus lies dormant in the body. People get shingles when varicella zoster is reactivated in the body.
Shingles is not spread from person to person. However, if someone has not had chickenpox (or the chickenpox vaccine) they can contract chickenpox from direct contact with fluid from shingle blisters.
There is no treatment for shingles, you just have to suffer through it.
Fact: It is possible to reduce the severity of shingles by starting antivirals (acyclovir, famciclovir and valacyclovir) within the first three days of an outbreak. The nerve pain associated with shingles can be treated at early onset and with persistent nerve pain after the outbreak has resolved. Treatment to treat pain may include:
Topical capsaicin and numbing agents (i.e. lidocaine)
Oral analgesic and narcotics
There is nothing you can do to avoid the shingles.
Fact: Two vaccinations against shingles are currently available- Shingrix and Zostavax. Zostavax has been used since 2006 and is a live vaccine. The newer Shingrix (a recombinant zoster vaccine) is recommended over Zostavax by the Center for Disease Control. The CDC recommends healthy adults, 50 years or older, receive Shingrix in two doses, separated by 2 to 6 months. Shingrix has proven to be up to 90% effective in preventing shingles compared to Zostavax 65% effectiveness rate. Shingrix is available to individuals who have had shingles or have received Zostavax in the past. Studies have shown 99% of individuals over the age of 50 have had chickenpox and Shingrix is recommended even if you don’t remember having chickenpox.
**Note: Zostavax may still be given to individuals that prefer Zostavax, are allergic to Shingrix or prefer vaccination with only one injection.
Prevention of Complications
The shingles vaccine is the only way to prevent shingles and the complications of shingles. The most common complication is a condition called postherpetic neuralgia (PHN). People with PHN have severe pain in the areas where they had the shingles rash, even after the rash clears up. The pain from PHN may be severe and debilitating, but it usually resolves in a few weeks or months. Some people can have pain from PHN for years and it can interfere with daily life. About 10 to 13% of people who get shingles will experience PHN, although it is rare among people under 40 years of age. Shingles may also lead to serious complications involving the eye such as vision loss. Although rare, shingles can also lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis), or death.
What are your thoughts on the shingles vaccine? Has your geographical area experienced shortages of the vaccination?
For additional Information:
Center for Disease Control, Shingles Vaccine: What You Should Know