A Painful Viral Infection

by Dr. Gregory Johnson
Methodist Geriatric Assessment Clinic

If you've had chickenpox, you're at risk for this potentially serious disease.

Sharp, burning pain crackles like static along a nerve route in your body. Angry red blisters rise from the pain site several days later. When the bumps blister and turn cloudy, you realize this is no ordinary rash.

You've got shingles, a viral infection of a nerve.

The same virus that causes chickenpox causes shingles. Once a person has had chickenpox, the virus can live, yet remain inactive in your body. If it becomes active again, usually later in life, it can cause shingles. If you've had chickenpox, there is no way to predict if you'll get shingles. What's more, the inactive virus usually has no signs or symptoms, so shingles can appear at any time without warning.

Now there’s a new vaccine available that can help reduce the number of people afflicted each year. The herpes zoster vaccine was licensed in late 2006 and has been recommended by the CDC’s vaccine advisory panel. Without vaccination, about 20 percent of people who have had chickenpox will eventually get shingles. A person who lives to be 85 has a 50-50 chance of getting shingles.

Results from a recent international survey reveal that most people are aware of shingles but do not truly understand the complexity of the condition or the potential impact it has on their overall health. Ninety-one percent of all survey respondents were aware of shingles, but most admitted to knowing little or nothing about the condition. So here’s an overview.

The virus that causes chickenpox never leaves the body and can be reactivated as shingles, especially in people whose immune system is weakened by advancing age, extreme stress, a disease like cancer or AIDS, chemotherapy, steroids or medications.

Zostavax, the only zoster vaccine on the market, was studied in over 38,000 people throughout the U.S. who were 60 or above. Half received the vaccine, and half received a placebo. Participants were studied for a period of three years to see if they contracted the virus. The vaccine reduced the occurrences of shingles by about half and reduced the pain that followed an episode of shingles by 67 percent.

A person cannot catch shingles from someone who has an outbreak—unless they have never had chicken pox or come into contact with the rash. A shingles rash usually appears on one side of the face or body and lasts from two to four weeks. The main symptom is severe pain, but other symptoms include fever, headaches, chills and an upset stomach. The rash usually begins as clusters of small bumps that develop into fluid-filled blisters.

Shingles is a bad disease, and a good enough reason to get vaccinated. But in about one third of cases, shingles turns into an excruciatingly painful disease called postherpetic neuralgia, or PHN. A smaller percentage will get a painful, blinding disease called ophthalmic zoster. PHN pain can last for years. Sudden, lancing pain can quite literally bring patients to their knees. Each year, there are more suicides due to PHN pain than due to cancer pain.

Based on the initial study, researchers estimated that the vaccine could prevent 250,000 cases of shingles a year and significantly reduce its severity and complications in another 250,000 people. iBi