House Call: Clearing up Myths about Shingles

Chances are you know someone who has suffered from shingles, a viral infection that more often pops up later in life and can sometimes lead to long-term, serious, even devastating nerve pain. Most people know it can be itchy and quite painful and that it is somehow related to chickenpox but beyond that, it’s surprisingly misunderstood for a common illness.

In the U.S., about 1 million people a year get shingles. That’s about 1 out of 3 who will develop shingles in their lifetime. About 10% to 18% of those will have some form of nerve pain that lasts after the rash has gone away. Called postherpetic neuralgia, it can be severe in some people. Most important, the risk of severe complications like postherpetic neuralgia increases with age and is highest in the over 65 age group.

But shingles pain is avoidable. There are anti-viral medications to treat shingles, but even better, there is a vaccine that is 90% effective at preventing it. The Centers for Disease Control and Prevention recommends the two-dose Shingrix vaccine for most people 50 and older. If you have chronic health conditions or are a younger adult (19 or older) with a weakened immune system, the vaccine is also recommended, but consult first with your health care provider.

Anyone who has had chickenpox – about 99% of Americans born before 1980 – is at risk. The safe, effective vaccine can keep you from spending three to five weeks coping with a painful, blistering rash and other symptoms like fever, headache and chills as well as the risk of long-lasting pain and other complications.

Let’s clear up some misunderstandings about shingles and the vaccine.

Shingles is not ‘adult chickenpox’

Shingles is caused by the same virus that causes chickenpox (the varicella zoster virus), but it’s a different disease. After you recover from chickenpox, the virus stays inactive in the spinal column and then can be reactivated later in life. Once triggered, it migrates down the nerves to your skin causing the blisters and rash that are often found at the waist or on the face. We don’t know why the shingles virus is sometimes triggered. It’s possible that a weakened immune system is responsible, but it may also be triggered by a viral infection or stress. Although people of all ages can get shingles, risk for shingles and for lasting nerve pain increases with age, making the vaccine that much more important for seniors.

Unlike chickenpox, shingles is not normally contagious, but the virus that causes it can be spread to adults and children who haven’t had chickenpox. For this reason, it’s important to keep the rash covered and not share towels, sheets or clothes.

Shingles is not just a typical viral infection

Shingles usually isn’t mild. It’s a massive and serious inflammatory response that includes what can be an incredibly painful rash. Most people recover in a few weeks, but there is still a risk of lasting burning and shooting nerve pain in the places you had the rash.

Anti-viral drugs may decrease the intensity of shingles if treatment is started early, but the virus still comes with risks, including resulting hearing problems and secondary infections like pneumonia. In rare cases, shingles can appear on the face and involve the eyes and optic nerves, which can result in severe complications, including blindness. Itching on the tip of the nose can indicate that optic nerves are affected, and the illness should be watched closely.

If you think you have shingles, it’s important to contact your health care provider right away.

You still need the shingles vaccine even if …

• You’ve had chickenpox. Anyone who has had chickenpox is at risk for shingles. Even if you’re one of the 1% of people who hasn’t had chickenpox or doesn’t know if you did, you could still get shingles from acquiring the virus.

• You’ve already had shingles. It’s not common, but people can get shingles more than once. I’ve actually had patients get shingles in their 20s and again in their 30s on a different part of their body!

• You had a past shingles vaccine, Zostavax. Shingrix is a newer, more effective vaccine, and people who had the Zostavax vaccine should still get the two doses of Shingrix. The immunity from Zostavax has been found to wane over time, and it was only about 67% effective to begin with. Two doses of Shingrix provides more lasting protection and is up to 97% effective.

• You’re 50 and you think shingles is for older people. At age 50, the risk for the virus reactivating to cause shingles and the risk for long-lasting nerve pain increase significantly. The risk just rises from there.

You can get the Shingrix vaccine at your health care provider’s office or at a local pharmacy, along with your flu shot if you like. Like many vaccines, you may have mild side effects afterward that go away after a few days, such as a sore arm, headache, fatigue or fever.

The vaccine is a two-dose series. You need to return for a second dose between two and six months after the first to get the full effectiveness. With two shots, Shingrix’s protection stays strong for at least ten years.

Our natural immune function can keep the virus dormant for many years, but as we age or if our immune system is stretched, the virus can reactivate and cause terrible pain. Getting a vaccination curbs risk of the misery and complications that shingles can bring.