What Older Adults Should Know About Shingles

How to Avoid This Difficult Disease

Shingles is a potentially very painful disease that occurs when the chicken pox virus (varicella zoster) reactivates in your body. This can happen decades after you were first infected with chicken pox, even if you don't remember having had chicken pox in the first place. Here's an overview of who gets shingles, whether it's contagious, and how to prevent it, along with a look at whether the shingles vaccine is right for you.

1
Who Gets Shingles?

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Adults over the age of 50 are at greatest risk. Shelby Ross / The Image Bank / Getty Images

After a bout with chicken pox, the varicella zoster virus — a member of the herpes family — is not eradicated from your body. Rather, it lies dormant in the nerve roots and the spine, until declining immunity allows the virus to reawaken and cause shingles.

While anyone with a compromised immune system, such as those with HIV, patients undergoing treatment for cancer and even children can get shingles, the vast majority of people who develop this disease are older adults, in whom disease or age (in those about 50 years and older) causes a reduced immunity. About half of all adults will have had shingles by the time they reach 85 years of age.

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2
How Do I Know if I Have Shingles?

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The hallmark symptom of shingles is a blistering rash that develops in a finite band on the torso, neck or face (the region of skin supplied by that particular nerve), though other typical flu symptoms, such as fever and headache, may also occur.

In addition to the localized rash, pain severity is another clue that you might have shingles. Patients have described the acute pain as "excruciating." It is wise to seek out a health-care provider as quickly as possible, as medications prescribed to treat shingles need to be administered promptly for greatest relief.

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3
How is Shingles Treated?

Shingles is usually treated with anti-viral drugs such as acyclovir or famciclovir, although such medication must be administered within three days (72 hours) of the start of shingles for it to be most effective. Corticosteroids, a family of anti-inflammatory drugs, can help calm the rash and reduce severe inflammation. Opioids such as morphine are often prescribed for the pain that develops in an acute case of shingles.

Unfortunately, antiviral medications cannot prevent one of the most severe complications of shingles: long-term nerve pain called postherpetic neuralgia, or PHN. The older a person is, the more likely he is to develop PHN. This chronic pain is typically resistant to treatment, though certain antidepressants and long-acting pain medication may provide relief.

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4
Can I Catch Shingles From Someone Else?

Though shingles only occurs as a secondary infection — after a primary infection with the chicken pox virus has already happened — fluid in the shingles rash does contain the varicella zoster virus, which can be passed on to another person. In other words, you can catch chicken pox from someone with an active case of shingles, but you cannot catch shingles directly from another person.

Because of this risk of transmitting the chicken pox virus, health authorities recommend wearing bandages or clothing to cover the shingles rash, and avoiding contact with people who may be vulnerable to chicken pox, such as the elderly, those who have compromised immune systems, and women who are pregnant.

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5
How Can I Avoid Getting Shingles?

Shingles can be prevented in three different ways. First, you can avoid getting exposed to the chicken pox virus initially, though the US Centers for Disease Control and Prevention (CDC) reports that more than 95% of adults have been exposed in their lifetimes. Second, younger people who've been vaccinated against chicken pox in the broad immunization program launched in 1995 have a lesser chance of developing a chicken pox infection, and therefore a lower probability of getting shingles. Third, you can get the shingles vaccine, which will prevent about half of shingles cases in people over 60, as well as much of the severe chronic pain that may accompany the disease.

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6
Should I Get the Shingles Vaccine?

Fortunately, the incidence of shingles and its complications can be reduced with the shingles vaccine, Zostavax. As of 2011, the vaccine was approved in both the United States and Canada for people over the age of 50. For people over 60, health authorities in both countries go further, specifically recommending that people in this age group get the shingles vaccine.

Their advice is based on large-scale studies showing that the vaccine can prevent about half of shingles cases in people over the age of 60, as well as reduce the severity and duration of short-term complications. Even better, people who got the vaccine were found to be 67% less likely to develop devastating long-term postherpetic neuralgia. Currently, the vaccine is administered as a one-time dose, but future research will determine if a booster shot is required to maintain immunity against shingles.

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Sources:

CDC Seeks to Protect Older Adults With Shingles Vaccine Message. US Centers for Disease Control and Prevention Public Information Sheet. Accessed April 12, 2013.
http://www.cdc.gov/vaccines/vpd-vac/shingles/downloads/shingles-vac-msg-2008.pdf

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 Vaccination: What You Need to Know. US Centers for Disease Control and Prevention Public Information Sheet. Accessed March 20, 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 20, 2013.
http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/10vol36/acs-1/index-eng.php

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