Shingles; The Varicella Zoster Virus

Shinglesshingles

Almost 1 out of every 3 people in the United States will develop shingles, also known as zoster or herpes zoster. There are an estimated 1 million cases each year in the United States. Anyone who has had the chickenpox may develop shingles; even children can get shingles. The risk of the disease increases as a person gets older. About half of all cases occur among men and women 60 years old or older.  There are many reports, however, of shingles showing up in children and in the 20 year old to 40 year old range.

People who have medical conditions that keep their immune systems from working properly, such as certain cancers, including leukemia and lymphoma, and human immunodeficiency virus (HIV), and people who receive immunosuppressive drugs, such as steroids and drugs given after organ transplantation, are also at greater risk of getting shingles.

People who develop shingles typically have only one episode in their lifetime. In some cases, however, a person can have a second or even a third episode.

Shingles is caused by the varicella zoster virus, the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays in the body in a dormant (inactive) state. For reasons that are not fully known, the virus can reactivate years later, causing shingles. Herpes zoster is not caused by the same virus that causes genital herpes, a sexually transmitted disease.

Shingles usually starts as a painful rash on one side of the face or body. The rash forms blisters that typically scab over in 7–10 days and clears up within 2–4 weeks.

Before the rash develops, there is often pain, itching, or tingling in the area where the rash will develop. This may happen anywhere from 1 to 5 days before the rash appears.

Most commonly, the rash occurs in a single stripe around either the left or the right side of the body. In other cases, the rash occurs on one side of the face. In rare cases (usually among people with weakened immune systems), the rash may be more widespread and look similar to a chickenpox rash. Shingles can affect the eye and cause loss of vision.

  • Other symptoms of shingles can include:
  • Fever
  • Headache
  • Chills
  • Upset stomach

Shingles cannot be passed from one person to another. However, the virus that causes shingles, the varicella zoster virus, can be spread from a person with active shingles to a person who has never had chickenpox. In such cases, the person exposed to the virus might develop chickenpox, but they would not develop shingles.

The virus is spread through direct contact with fluid from the rash blisters, not through sneezing, coughing or casual contact.

A person with shingles can spread the virus when the rash is in the blister-phase. A person is not infectious before blisters appear. Once the rash has developed crusts, the person is no longer contagious.

Shingles is less contagious than chickenpox and the risk of a person with shingles spreading the virus is low if the rash is covered.

  • If you have shingles:
  • Keep the rash covered.
  • Do not touch or scratch the rash.
  • Wash your hands often to prevent the spread of varicella zoster virus.
  • Until your rash has developed crusts, avoid contact with pregnant women who have never had chickenpox or the varicella vaccine; premature or low birth weight infants; and immunocompromised persons (such as persons receiving immunosuppressive medications or undergoing chemotherapy, organ transplant recipients, and people with HIV infection).

The most common complication of shingles 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 in most patients. PHN can, however, persists for many years in some persons.

As people get older, they are more likely to develop PHN, and the pain is more likely to be severe. PHN occurs rarely among people under 40 years of age but can occur in up to half (and possibly more) of untreated people who are 60 years of age and older.

Shingles may lead to serious complications involving the eye. Very rarely, shingles can also lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis) or death.

Several antiviral medicines—acyclovir, valacyclovir, and famciclovir—are available to treat shingles. These medicines will help shorten the length and severity of the illness. But to be effective, they must be started as soon as possible after the rash appears. Thus, people who have or think they might have shingles should call their healthcare provider as soon as possible to discuss treatment options.

Analgesics (pain medicine) may help relieve the pain caused by shingles. Wet compresses, calamine lotion, and colloidal oatmeal baths may help relieve some of the itching.

The only way to reduce the risk of developing shingles and the long-term pain that can follow shingles is to get vaccinated. A vaccine for shingles is licensed for persons aged 60 years and older.

The shingles vaccine (Zostavax®) was recommended by the Advisory Committee on Immunization Practices (ACIP) in 2006 to reduce the risk of shingles and its associated pain in people age 60 years and older.

Your risk for developing shingles increases as you age. The Shingles Prevention Study involved individuals age 60 years and older and found the shingles vaccine significantly reduced disease in this age group. The vaccine is currently recommended for persons 60 years of age and older. Even people who have had shingles can receive the vaccine to help prevent future occurrences of the disease.

Shingles vaccine is available in pharmacies and doctor’s offices. Talk with your healthcare professional if you have questions about shingles vaccine.

At this time, CDC does not have a recommendation for routine use of shingles vaccine in persons 50 through 59 years old. However, the vaccine is approved by FDA for people in this age group.

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.
  • Women who are or might be pregnant

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

The shingles vaccine does not contain thimerosal (a preservative containing mercury).

What are the risks from shingles vaccine?

A vaccine, like any medicine, could possibly cause serious problems, such as severe allergic reactions. However, the risk of a vaccine causing serious harm, or death, is extremely small.

No serious problems have been identified with shingles vaccine.

Mild Problems:

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

Like all vaccines, shingles vaccine is being closely monitored for unusual or severe problems.

What about taking aspirin during a Shingles episode? We don’t know yet, but we are monitoring this closely and will keep you updated.  Never give a child aspirin during a shingles episode, as shingles is a dormant chickenpox virus!

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