Do you know anyone who has had shingles? If you do, you probably know that it is a very painful illness that can have many serious consequences. But what causes shingles? It is actually caused by the same virus that causes chickenpox. Once you have been infected by the Varicella-zoster virus (VZV) in an initial case of the chickenpox, the virus hides in your nervous system, and can become active again at any time. However, there are vaccines available to prevent this potentially dangerous illness. While there can be side effects from the vaccines, they are usually much milder than thedisease itself, making it safe for most people. So here’s what you should know when you are considering whether or not to get the vaccine.
What is Shingles?
If you have ever had chickenpox, or even if you had such a mild case of chickenpox that you were unaware of being ill, then you are at risk of developing shingles. This disease usually starts with tingling, burning, or itching on your skin, in one area, on one side of your body. For example, it may start on one side of your head or face, on one ankle, or on one side of your chest. The most common places are on the chest and back, but again, it only happens on one side of the body. In addition, you might feel like you are coming down with a flu, and you might have a headache. Within a few days, a rash with blisters will appear where the burning or tingling first occurred. The pain you experience with the rash can be anywhere from mild to severe, is usually a stabbing or burning sensation, and will often interfere with sleep and other activities. The blisters will generally open in about 3 to 4 days, and they will crust over, dry up, and fade within 3 to 4 weeks.
The worse thing about shingles (other than the pain during the acute illness) is that it can lead to serious or debilitating complications, especially as you get older. Once the blisters open, there is a risk of a bacterial infection. However, the most common complication of shingles is lingering pain after the infection is gone. Postherpetic neuralgia (PHN) which often feels like burning in the area that the infection occurred, can linger from months to years after the rash disappears, interfering with sleep, causing depression, and greatly decreasing your quality of life.
If the shingles rash occurs around an eye, you are at a greater risk of getting inflammation of that eye. This will not only cause severe eye pain and sensitivity, but can cause permanent loss of vision. Additionally, inflammation of an ear due to shingles can cause facial weakness on the affected side.
What Increases the Risk of Shingles?
It is estimated that about 20% of all people will experience shingles at some point in their life. Of course, it can only occur if you have had chickenpox. And while anyone who has had chickenpox can get shingles, it usually affects people over the age of 50. Additionally, anyone with a weakened immune system is at greater risk of getting shingles. This can include people with chronic illnesses, like diabetes, but having cancer or cancer treatment poses an even greater risk. Likewise, people who take medications that suppress the immune system, such as steroids like prednisone, antirejection medications following an organ transplant, or those who take medications for rheumatoid arthritis, are at a greater risk. People who are infected with the human immunodeficiency virus (HIV) are more likely to contract any infection, including shingles.
Should You Get Vaccinated?
If you are 50 years of age or older, you should consider receiving a shingles vaccine. There are two types of vaccines available, and which one you should receive depends on your individual circumstances.
The live attenuated vaccine (Zostavax) was the only vaccine available against shingles in the United States until recently. It is approved for people 60 years of age and older. As the name states, this vaccine contains a live virus, which can pose the risk of developing active shingles. The benefit of Zostavax is that it has been found to decrease the incidence of shingles by over 50%, to decrease the average length of painful symptoms during an outbreak, and to decrease the incidence of PHN by over 65%. However, studies have shown that protection against shingles wanes about 8 years after vaccination.
The inactivated recombinant zoster vaccine (Shingrix) was recently approved for use in the United States for people 50 years of age and older. This vaccine contains proteins from the zoster virus, but does not contain the active virus. It is given in 2 injections, about 2 to 6 months apart, and appears to give very good protection against shingles, especially in older patients. Because there is no active virus in the vaccine, it cannot cause any infection, and is safe for people with a weakened immune system.
What are the Risks?
Although rare, because Zostavax contains a live virus, the risk exists for developing shingles even months later. For this reason, the vaccine is not recommended for people with a weak immune system. It is ok to receive this vaccine if you live with someone with a weakened immune system, but if you develop any shingles blisters, you should avoid contact with this person until the blisters are gone. Otherwise, the most common side effect associated with the vaccine is pain, redness, and swelling at the injection site, lasting up to about 3 days. Other complications are extremely rare.
The only side effects that have been reported with Shingrix are pain, redness, and swelling at the injection site.
There are two additional reasons that you should never receive a shingles vaccine. Zostavax should never be given to a pregnant woman, although this would be highly unlikely as it is only recommended for people 60 years of age and older. Additionally, people with known allergies to gelatin or neomycin should not receive either vaccine.
All things considered, receiving the right shingles vaccine, at the right age, greatly reduces your chance of contracting this painful and sometimes debilitating illness. If you have any questions about whether you should receive the vaccine, or which vaccine is right for you, please contact us at Advanced Medical PA, where our mission is providing quality health care in both internal medicine and primary care. Call us at (561) 434-1935 to request an appointment, or request one online.