Shingles in Older People

Chicken Pox's Encore

In the world of infectious disease, chicken pox is the kind of virus that keeps on giving. It’s responsible for not just one, but two potentially serious illnesses. And in fact shingles — the painful secondary disease — can hit you decades after you were first infected with chicken pox. Here's a look at what shingles is, and what to do if you're stricken with it.

Shingles and older age: What's unusual about shingles is that it's not actually a new disease; it's the reactivation of a virus you've already been exposed to.

Chicken pox is caused by the varicella-zoster virus (VZV), a member of the herpes family. When you recover from chicken pox, the virus is not eradicated from your body — it lies dormant in nerve roots in the spine and brain.

As you age — for reasons not completely understood — your immunity to the virus declines, and the virus can reactivate, traveling up the nerves to the skin. This is called a herpes zoster infection, or shingles. Typically, a blistering rash develops on a band or strip of skin supplied by that nerve. The rash is often on only one side of the body, on the neck or chest. Sometimes, however, no rash appears. While increasing age is a major risk factor, children can get shingles, as can anyone with a compromised immune system, such as people with HIV infection, cancer patients, or those undergoing chemotherapy, radiation therapy, or treatment that causes suppression of their immune system.

Who's at risk of shingles? Anyone who's been exposed to the chicken pox virus is at risk of shingles. According to the US Centers for Disease Control and Prevention (CDC), more than 95% of all adults have had chicken pox, whether or not they recall having had the disease.

An estimated 20-30% of adults will develop shingles, with about half of all adults getting it by the age of 85. The chance of getting shingles increases with age.

Symptoms: People with shingles often describe the pain as agonizing, making even the weight of clothing against the skin difficult to bear. Complications of shingles include visual and hearing impairments, scarring, infections of the central nervous system, neuromuscular diseases (including Guillain-Barré syndrome), and subsequent bacterial infections. The most common and serious complication, according to the CDC, is a chronic pain syndrome called postherpetic neuralgia (PHN). A patient's likelihood of developing PHN increases — as does the risk of all shingles complications — with increasing age. More than a third of patients who get shingles will develop serious complications.

Long-term pain: According to the CDC, studies on shingles have rated the severity of postherpetic neuralgia as greater than that of childbirth, osteoarthritis, and chronic cancer pain, with almost half of patients describing it as "excruciating" and "horrible".

The importance of early intervention: If anti-viral medications are started within 72 hours (3 days) of the onset of shingles, the severity and duration of the outbreak can be significantly reduced. Timely drug treatment also diminishes the risk of long-term complications. Such medications include acyclovir, famciclovir, and valacyclovir.

The rash of shingles may persist for 2-4 weeks, and longer-term complications may persist for a year or more.

Incidence of shingles and cost of treating it: In the United States, there are about a million new cases each year, which incur a cost of approximately $600 million for treatment. In Canada, direct medical costs account for about $68 million annually to treat the average 130,000 new cases each year.

Can I get shingles more than once? A repeat case of shingles is uncommon, but possible. Some people do get the disease more than once.

Shingles vaccine: Fortunately, there's a single-dose vaccine to prevent shingles. Zostavax, manufactured by Merck Research Laboratories, was approved by the US Food and Drug Administration in 2006 for people 60 years and older, and updated in 2011 to include people aged 50 to 59. In Canada, Zostavax was available for people over 60 beginning in 2008, with approval for adults between 50 and 59 years of age, announced in 2011.

In a study involving more than 38,000 adults aged 60 and older, the vaccine reduced the incidence of shingles by more than half (51%), and the incidence of postherpetic neuralgia by two-thirds. Therefore, while a person who's been vaccinated might still get shingles, it will likely be a milder case of shorter duration, with the chance of long-term PHN being much reduced.

While governments in the United States and Canada have approved the vaccine for people aged 50 and older, health plans may not cover the cost, which can range from about $150-$175 for the shot. To date, how long the vaccine remains effective has not been established. Eventually, booster shots (a repeat vaccination to "top-up" your immunity against shingles) may be recommended.

Sources:

Age Page: Shingles. US National Institute on Aging Public Information Sheet. Accessed March 4, 2013.
http://www.nia.nih.gov/health/publication/shingles

CDC Seeks to Protect Older Adults With Shingles Vaccine Message. US Centers for Disease Control and Prevention Public Information Sheet. Accessed March 4, 2013.
http://www.cdc.gov/vaccines/vpd-vac/shingles/downloads/shingles-vac-msg-2008.pdf

Herpes Zoster (shingles) Vaccine. Public Health Agency of Canada Public Information Sheet. Accessed March 4, 2013.
http://www.phac-aspc.gc.ca/publicat/cig-gci/p04-herp-zona-eng.php

Marla Shapiro, Brent Kvern, Peter Watson, Lyn Guenther, Janet McElhaney, and Allison McGeer. "Update on Herpes Zoster Vaccination: A Family Practitioner's Guide." Canadian Family Physician October 2011 vol. 57 no. 10 1127-1131.
http://www.cfp.ca/content/57/10/1127.full

Shingles. US National Institutes of Health Senior Health Public Information Sheet. Accessed March 11, 2013. (br) http://nihseniorhealth.gov/shingles/aboutshingles/01.html

Shingles Vaccination: What You Need to Know. US Centers for Disease Control and Prevention Public Information Sheet. Accessed March 4, 2013.
http://www.cdc.gov/vaccines/vpd-vac/shingles/vacc-need-know.htm

Statement on the Recommended Use of Herpes Zoster Vaccine. Public Health Agency of Canada Information Sheet. Accessed March 4, 2013.
http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/10vol36/acs-1/index-eng.php

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