Shingles ,or herpes zoster, is a painful localized skin eruption caused by reactivation of the chicken pox virus. In most cases, the virus has been dormant or inactive since the affected individual recovered from chicken pox many years ago when they were children. Almost everyone over 40 had chicken pox as a child and all of these individuals are at risk for this reactivation.
Shingles is very common, afflicting about one million Americans annually. According to the U.S. Centers for Disease Control, one in three people will develop shingles during their lifetimes. Its incidence increases as one ages and becomes especially common over the age of 50.
In addition to the discomfort caused by the skin eruptions, shingles can have three serious complications. One is postherpetic neuralgia, in which the pain from the eruption persists for months or years. According to the CDC, this occurs in between 10 and 18 percent of patients.
The second complication is eye involvement, which not only can result in ongoing pain but also in loss of vision. Eye involvement occurs in 10-25 percent of patients. The final complication is that hospitalization is required for up to three percent of patients, usually individuals who have a compromised immune system.
All of the complications are more common in patients older than 60 years.
Th good news is that recent advances in medicine have brought better treatment and prevention of shingles. The treatment is with antiviral drugs that can significantly decrease the pain and duration of the skin eruptions.
But better yet, shingles eruptions can be prevented by the administration of a new, single-dose vaccine with the trade name Zostavax. Studies have shown the vaccine cuts the risk of developing shingles in half. Zostavax is recommended for people over 60 years old but its effectiveness declines for those in their 70s and 80s.
According to the CDC, in addition to being partially effective in preventing the development of shingles, the vaccine has also been shown to reduce the incidence of postherpetic neuralgia in 70 percent of the patients who do develop the disease.
Some authorities do not recommend this vaccine for those who have already had shingles because second attacks of shingles are rare and the vaccine has not been shown to be effective in this group of patients.
Other experts recommend Zostavax vaccine for all individuals over 60 whether or not they have had shingles in the past. Their reasoning is that there is no laboratory evaluation to test for the previous occurrence of shingles and patients may have had the diagnosis made in error. If the diagnosis was not correct, then the patients would not have the increased immunity that a true episode of shingles would have induced.
There are other studies indicating that the rate of recurrence of shingles is high enough to warrant vaccination. Therefore, the Advisory Committee on Immunization Practices at the CDC recommends the vaccine for essentially everyone 60 and older, including those who have had a previous episode of shingles.
The vaccine has been found to be safe. The most common side effects are headache and pain and swelling at the site of injection. Zostavax should not been given to individuals with allergies to the antibiotic neomycin or to pregnant women. As it is a live vaccine, it should not be given to people with compromised or weakened immune systems.
To determine if you or someone in your family would be a candidate for the vaccine, call your primary care provider’s office or discuss it at the next office visit.
Dr. Robert Allen is the executive medical director of Penobscot Community Health Care in Bangor.