A Question from a Reader: I am 56 years old and with each passing year I find myself identifying more closely with my senior patients in ways I never imagined. I notice an occasional stiff back and noisy knees in the morning, require frequent visits to the restroom on long trips (especially if I am drinking plenty of fluids to stay hydrated), and more recently a reasonable fear of shingles. I have seen a number of patients over the years with shingles outbreaks and some have been very painful and serious. Shingles is a painful rash caused by the chickenpox virus that remains dormant in your body years after having the pox. Often, when older or with an immune system in a weaken state, the virus resurfaces and causes the painful rash. But, sometimes it is more complicated and can cause a host of other problems such as hearing or visual impairment or inflammation of the nerves. In fact, one of my patients suffered from foot drop from a shingles outbreak affecting the nerve root in his lower back which weakened the muscles of the ankle. However, there is good news! You may have read advertisements in magazines or seen commercials on television regarding ZostavaxR, the vaccine for shingles manufactured by Merck & Co. I just got my prescription!
Shingles, also called Herpes Zoster, is a painful skin rash that often blisters. It is caused by the same virus that causes chickenpox, the Varicella Zoster virus. When a person has chickenpox, the virus remains in their body throughout life. As a result, years after the outbreak of the pox, shingles can occur, especially at times when the body is in a weakened state. While rare, this scenario can also occur for those having the chickenpox vaccine.
While shingles signs and symptoms vary, the hallmark sign is a painful rash, which is commonly found on one side of the face/head or shoulder/trunk and lasts between 2 and 4 weeks. In some cases, the pain can be fairly significant and often develops along with a tingling sensation 1 to 5 days before the rash. Other symptoms include, but are not limited to; headache, fever, chills and upset stomach. In very rare cases, a shingles infection can lead to more serious problems such as; infection of the brain (encephalitis), infection of the lung (pneumonia), hearing and visual impairment and death. In 20% of the cases, shingles can lead to a very painful inflammation of nerves called post-herpetic neuralgia that lasts long after the rash has cleared.
How common is Shingles?
More than one million people get shingles each year in the USA.
Who is most vulnerable?
Among those who have had chickenpox, people who are 50 years old and older are the most vulnerable. Among this group, those who have a poor immune system or a weakened physical state due to other health issues such as cancer, chemotherapy, and long term steroid use are most vulnerable.
Is there a way to prevent shingles?
In 2006, a vaccine to reduce the risk of shingles was licensed. Studies found a 50% reduction in shingles among those who were vaccinated. For those who were vaccinated and still had shingles, it was found to reduce the intensity of pain as compared to unvaccinated people.
Additionally, when possible, shingles can be prevented by maintaining a strong immune system through maintaining a well-balanced, healthy lifestyle including a healthy diet and daily exercise.
Who should get the Shingles vaccine?
While it is presently recommended for those 60 years of age and older, those over 50 are also eligible.
Who should not get the Shingles vaccine?
Those under 50 years of age
Those who have ever had a life-threatening allergic reaction to gelatin or the antibiotic neomycin
Those with a weakened immune system due to: AIDS or other immune system diseases, prolonged use of steroids, cancer treatments such as radiation or chemotherapy, cancer involving the bone marrow or lymphatic system such as leukemia or lymphoma
Those who are pregnant or might be pregnant
Those with moderate acute illness with a temperature of 101 degrees Fahrenheit or higher
What are the risk factors for the Shingles vaccine?
As with any medicine, severe allergic reactions can occur, however, no serious problems have been reported with the shingles vaccine to date.
Mild problems such as redness, soreness, swelling, or itching at the injection site can occur in 1 of 3 people.
Headaches can occur in 1 of 70 people
In summary, shingles affects more than a million people per year in the USA. The painful rash and the possibility for more serious complications associated with shingles makes the shingles vaccine a viable option for those over 50. To learn if you would benefit from the vaccination, discuss this matter further with your physician.
Sources: US National Library of Medicine – National Institutes of Health; Centers for Disease Control
Medical Reviewer: Gregory Cali, DO, Pulmonologist, Dunmore, PA
Read “Health & Exercise Forum” – Every Monday in the Scranton Times-Tribune. This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: firstname.lastname@example.org
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is an Associate Professor of Clinical Medicine at The Commonwealth Medical College.