• James Tippett MD

Are you concern about Shingles?

Shingles is a neurological viral infection that results from the reactivation of the chickenpox virus known as herpes zoster. After having had chickenpox, the virus lies dormant in the central nervous system and for unknown reasons “wakes up” and multiplies in a single nerve resulting in a painful rash in the distribution of the involved nerve. The rash has the appearance of multiple cold sores and

disseminates in a linear fashion most commonly on the chest or abdominal wall but can occur anywhere. There can be pain and sensitivity in the infected nerve 7-10 days before skin changes are noted. An individual can have more than one bout of the infection and during the acute phase can cause chickenpox in someone who has not previously had the illness. However, shingles cannot be transmitted from one individual to another.

It is estimated that 1 in 3 people will experience a bout of shingles in their life time and the risk increases with age with prevalence being greatest in those over 65.

The pain of shingles is one of the worse pains we see in patients and is equivalent to the pain of child birth! After the acute phase resolves, which can last from days to weeks, there is a 10-15% risk of developing post herpetic neuralgia. This results from persistent inflammation in the involved nerve resulting in pain and hypersensitivity for years. I have an 80 y/o patient who had the infection over 20 years ago and continues to have pain and sensitivity on her chest wall to the point that she cannot take a shower or wear certain clothing! I also recall a patient who had facial shingles with eye involvement which caused scarring of the cornea and loss of vision.

In 2006 the first shingles vaccine (Zostavax) was released and was shown to be about 60% effective in prevention. However, it was observed that the immunity began to wane after about 5 years and some studies show waning immunity after 3 years in older populations.

In November of last year another vaccine was released called Shringrix. This vaccine’s effectiveness is over 90% and after over 4 years it has been observed that the immunity has declined very little.

Immunization experts have made the following observations and recommendations:

  • The immune system responds more strongly to Shingrix and it is preferred over Zostavax.

  • The vaccine can be given starting at age 50 and is highly recommended at age 65 and older.

  • It is a two-dose vaccine with the second dose administered 2-4 months after the initial injection.

  • Shingrix is recommended even if you have previously had shingles or received Zostavax. It is not endorsed for older adults who have compromised immunity or are taking medication that suppresses the immune system. The vaccine is constituted from nonliving viral particles and not live viruses, as is Zostavax, so it is possible that people who are immunocompromised may be candidates for the vaccine when appropriate studies are completed.

  • Even if you don’t recall having had chicken pox the vaccine is advised. Studies have shown that more than 99% of Americans age 40 and older have had chicken pox.

  • Egg allergy is not a contraindication to receiving the vaccine.

  • Side effects are uncommon and if they occur are self- limiting in 48-72 hours.

In summary, shingles is a serious and disabling neurologic disorder that is almost entirely preventable with appropriate vaccination. So, come on folks, ask your physician for a Shingrix prescription right away. Most local pharmacies have stocked the vaccine.



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